Impairment of renal clearance due to CKD results in a longer half-life of circulating insulin, a decrease in the need for insulin therapy in those with DM, and better glycemic control, contributing to a condition called “burnt-out DM.” It is seen in one-third of patients with T2DM and is characterized by low or low-normal hemoglobin A1C (HbA1C <6%) despite discontinuing DM medications. The gene discussed is INS; the disease is type 2 diabetes mellitus.