As the fat cell hypertrophy, then it itself becomes insulin resistant. The cells must be within a few microns of a capillary in order to survive. But as the cells are getting so big, unlike any else in the body can do this, the fat cells begin to become hypoxic. They simply cannot get enough oxygen because they're too far from the blood vessels. And so the hypertrophic fat cell to ensure its own survival begins secreting a full profile of pro-inflammatory proteins,. Some of which can induce the synthesis of new capillaries.