INS and cancer: Insulin may increase the risk of cancer through direct and indirect (via increased free insulin-like growth factor-1) mitogenic and anti-apoptotic properties.36 Hyperglycaemia might also increase cancer risk as glucose provides fuel to cancer cells and increases oxidative stress and inflammatory cytokines.39 The colorectal carcinogenesis is complex, heterogenous and associated with multiple factors including genetic, epigenetic and environmental factors.