When we explain to a patient how insulin release occurs, we often oversimplify it. We tell them that the release is caused by signals sent to the beta cells when food enters our body. We often add in the “simplicity” of, if you eat the right foods your pancreas will be able to cover the glucose. Patients then go home and try to follow our advice. One day the system works and the next day it does not. This frustrates the patients and they just stop trying. Part of the problem that causes these failures are all the cell affinity binding processes that occur. This week in our Clinical Series we have part 2 of insulin transduction signaling, and how binding, activity and mutations affect our patients.