INS and hyperinsulinism: In the presence of hyperinsulinemia, metformin further enhanced the expression of BCL2L11 in a concentration-dependent manner at 5.5 mmol/L glucose (FCNG, 0.1+ins = 1.50, p = 0.009; FCNG, 1.0+ins = 1.66, p = 0.012), but reversed the upregulation that was observed after treatment with metformin and particularly insulin alone at 17.0 mmol/L glucose (FCHG, 0.1+ins = 1.08, p = 0.077 vs FCNG, 0.1 and p = 0.059 vs FCHG, ins; FCHG, 1.0+ins = 0.96, p = 0.014 vs FCNG, 1.0), indicating an unfavorable influence of glucose during the combined treatment.