INS and monoclonal gammopathy: The low affinity of insulin for the binding antibodies in some cases of the insulin autoimmune syndrome and all cases studied of monoclonal gammopathy sets the stage for a dissociation of the insulin–antibody complex, contributing to an elevated free insulin level and the late postprandial hypoglycemic attacks.30 There is a continuous on–off binding process in which the rate of association of antibodies with insulin is very fast and a higher association constant favors the bound fraction.