INS and hyperinsulinism: Moreover, FFA-induced hyperinsulinemia stimulates the mitogen-activated protein kinase (MAPK) pathway and increases reactive oxygen species (ROS) levels and proinflammatory and prothrombotic mediator production via nicotinamide adenine dinucleotide phosphate (NADPH) oxidase stimulation, linking insulin resistance, oxidative stress and inflammation (Satish et al., 2019).