INS and hyperinsulinism: Hyperinsulinemia is due to both a higher insulin secretion by the pancreas and reduced hepatic clearance [90]: physiologically, the liver degrades 60% of the insulin secreted by the pancreas during the first passage, but in advanced chronic liver diseases, this process is compromised by porto-systemic shunts and liver failure, resulting in a reduced insulin clearance of up to 40% [91].