Natural protamine Hagedorn insulin may require twice-daily dosing and is associated with more hypoglycaemia than the basal analogues due to a ‘peak’ effect ~4 h – 6 h after injection.31 This peak is also utilised to limit the number of insulin injections by ‘standing in’ for a mealtime short-acting insulin injection. The gene discussed is INS; the disease is Hypoglycemia.