While clinicians have largely focused attention on the association between hypoglycemia and progression of retinopathy thus far, the effect of hypoglycemia on onset could have been masked by less strict glycemic management in previous studies.8 Given the neovascularizing effect of insulin,37 inadequately high insulin level observed in hypoglycemia might affect vascular endothelium and potentially trigger onset of retinopathy. Here, INS is linked to Hypoglycemia.