INS and Menkes disease: After the diagnosis of MD was confirmed and at the last follow-up visit, 11 patients used insulin, including one case combined with glucagon-like receptor agonist (GLP-1RA) and three cases combined with sodium-glucose co-transport protein 2 inhibitor (SGLT-2i), without adverse effects such as malaise, ketosis or ketoacidosis, or severe gastrointestinal reactions.