INS and obesity due to melanocortin 4 receptor deficiency: Severely insulin-resistant patients (daily insulin requirement >200 units or >2 units/kg [1, 2]) with type 2 diabetes treated with high-dose insulin regimens are particularly burdened by longstanding inadequate glycemic control, multiple daily insulin injections, frequent glucose monitoring, obesity, highly prevalent comorbidities, and high healthcare costs, and often have compromised adherence [1–3].