Hypokalemia is also frequently observed in NICTH patients which again points to a high insulin‐like activity in the body.61 As expected, the insulin requirement in patients with type II diabetes may decrease substantially or even disappear after the onset of NICTH.64, 70 Although relatively rare, in addition to hypoglycemic symptoms, patients with acromegaloid soft tissue facial swelling and skin changes, such as skin tags and excessive oiliness, have been described.3, 18, 71 At least in these cases, these observations may point to excessive stimulation of the IGF‐IR (R). This evidence concerns the gene INS and type 2 diabetes mellitus.