INS and Hyperglycemia: Whilst hyperinsulinaemia determined by fasting insulin levels of > 28 uIU/mL may proceed hyperglycaemia for up to 24 years [2,7,8,9,31], early sub-clinical (occult) hyperinsulinaemia may be considered when there is chronic hypoketonaemia measured between 4–6 p.m. for at least three consecutive days (a longer duration would increase confidence).