INS and obesity due to melanocortin 4 receptor deficiency: Hyperinsulinemia associated with obesity, type 2 diabetes, and sulfonylurea treatment may have blunted further effect of insulin treatment in these subjects.(38) There is accumulating evidence that the suppression of bone turnover in response to a glucose challenge is less robust with increased insulin resistance and the presence of type 2 diabetes.(8, 39, 40)