Nuclear magnetic resonance spectroscopy provides non-invasive and real-time assessment of the metabolic fluxes in skeletal muscle during exercise, recovery from exercise and stimulation by insulin. Carbon-13 nuclear magnetic resonance spectroscopy has proved that reduced glycogen synthesis is a consistent feature of insulin-resistant type 2 diabetic patients, their offspring, and obesity. Low intracellular glucose and glucose-6-phosphate concentrations indicate that decreased glucose transport is mainly responsible for common insulin resistance. An elevation of plasma free fatty acids causes similar alterations of muscle glucose metabolism, and could play a central role in the development of impaired muscle glucose transport associated with insulin resistance.