Where in the liver insulin resistance happens determines whether it causes high blood sugar, high fat, or neither.

The liver isn’t the same all the way through—different parts react differently when insulin stops working, leading to very different outcomes for fat and sugar.

When the front part of the liver doesn’t respond to insulin, the body makes more insulin to try to compensate.

When the front part of the liver can't respond to insulin, blood sugar goes up—even if the liver makes less fat.

Hepatic lipid accumulation impairs insulin signaling and glucose metabolism, acting as a primary driver of systemic insulin resistance.

Where fat is stored in the body — especially around the organs — is linked to how the liver processes energy and how sensitive it is to insulin.