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Central to these abilities is the intestinal epithelium, a single monolayer composed of numerous cell types adhered together by tight junction (TJ) protein complexes, which provides selective paracellular permeability to ions, solutes, and water, while also restricting the systemic access of harmful organisms and substances (Knig et al

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Other mechanisms include increased insulin resistance induced by high-dose glucocorticoids that increases intra-portal insulin, decreases IGFBP-1 that increases free IGF-I, and direct glucocorticoid effects in increasing hepatic IGF-I synthesis and decreasing hepatic insulin clearance (105)

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