C-peptide to insulin molar ratio is helpful in detecting exogenous insulin use, impaired hepatic insulin clearance and impaired C-peptide clearance by the kidneys.
Pancreatic β-cells secrete insulin and C-peptide into the portal vein in a 1 : 1 molar ratio.
More than half of the insulin is cleared on first pass by the liver, whereas C-peptide bypasses the liver and is removed more slowly by the kidneys (half-lives: insulin ≈ 5 min, C-peptide ≈ 30 min).
Decreased c-peptide to insulin ratio is seen in states of reduced hepatic insulin extraction, (e.g., Liver fibrosis).
Low ratio is seen in exogenous insulin intake and in rare insulin-receptor/mutant-insulin syndromes.
High c-peptide to insulin ratio is most often seen when renal clearance of C-peptide is reduced (e.g., chronic kidney disease).
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