INS and hyperinsulinism: Therefore, we propose that the following details be included in the diagnosis of EIAS: (1) History of exogenous insulin use, accompanied by unexplained glycemic fluctuations (hypoglycemia defined as <3.9 mmol/L in diabetic patients, <2.8 mmol/L in non-diabetic patients, combined with hyperglycemia); (2) Persistent hypoglycemia in diabetic patients despite reduction or discontinuation of insulin therapy; (3) Hyperinsulinemia (insulin >100 μIU/ml); (4) An insulin-to-C-peptide molar ratio (ICPR) >1.