INS and monoclonal gammopathy: This statement excludes the one case reported in 2012 in which circumstantial evidence suggested that an insulin autoimmune syndrome evolved into myeloma with an anti-insulin monoclonal immunoglobulin (Table 1).10 Presumably, in the great majority of cases, the clone of B lymphocytes resulting in the insulin autoimmune syndrome mediated by a monoclonal anti-insulin immunoglobulin is neither of sufficient size to engender a discernible effect on the serum immunoglobulin levels nor is it subject to clonal evolution, as is the clone underlying essential monoclonal gammopathy.10