As a result of an auto accident, she was evaluated and found to have episodes of severe hypoglycemia and extraordinarily high total and free insulin and a high-titer anti-insulin autoantibody.10 Her serum protein analysis showed a monoclonal IgG-kappa with no Bence Jones protein in urine, a marrow plasma cell frequency of 3%, and no other evidence of myeloma, consistent with essential monoclonal gammopathy. Here, INS is linked to monoclonal gammopathy.