Animal models of overt statin myopathy reveal clear negative effects on muscle protein and carbohydrate metabolism, which appear to be linked to changes in Akt/FOXO signalling. Forcibly increasing muscle carbohydrate flux under these conditions by pharmacological means blocks statin myopathy. Human volunteer research has delivered less definitive mechanistic insight of the aetiology of statin-related metabolic dysregulation, with little evidence of profound changes in muscle protein and carbohydrate metabolism to date in statin myalgia. However, this may be at least partly explained by statin myalgic patients stopping or changing statin medication before overt muscle pathology has developed to anything like that resembling overt muscle myopathy. Several lines of evidence have associated statin therapy with increased risk of new-onset diabetes and dysregulation of glucose control, but the mechanisms underpinning these observations are currently unresolved.