Her medical history included uncontrolled T2DM (HbA1c 8.5% on short-acting sliding scale insulin and insulin glargine 20 U at bedtime), resistant hypertension (blood pressure 141/88 mm Hg) despite administration of six antihypertensive agents, obesity [body mass index (BMI) 43 kg/m2], dyslipidemia, congestive heart failure, chronic obstructive pulmonary disease, sleep apnea, chronic renal insufficiency, and hyperthyroidism. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.