Insulin resistance was characterized by acanthosis nigricans in the neck, axilla, and back (Figure 1E), as well as by the very high insulin requirements (15 IU/kg/day) and by the low levels of total serum adiponectin (0.5 mg/L – normal range: 3.6–9.6 mg/L). The gene discussed is INS; the disease is acanthosis nigricans.