INS and Hyperglycemia: Mechanism 1: Autoantibodies bind to insulin receptors and competitively inhibit insulin binding, preventing its action ( 11 ); Mechanism 2: They accelerate the receptor degradation rate ( 11 ); Mechanism 3: Paradoxically, these antibodies can act both as insulin agonists and antagonists, causing a biphasic response of hypo- and hyperglycemia in the same patient ( 11 ).