Figure 4.

Some factors involved in hyperinsulinemia. Certain genes, hepatic insulin clearance, excess food intake, quality of nutrition, fetal/metabolic programming and exposure to endocrine disrupting chemicals have all been suggested as possible etiological factors in the development of hyperinsulinemia. Loss of pulsatile insulin secretion may contribute to changes in hepatic insulin clearance, hyperinsulinemia and insulin resistance. Note: genes, excess food intake and loss of pulsatile insulin secretion may modify hepatic insulin clearance (see also text for more details).