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K_ATP channels and glucose-induced insulin release: lessons from persistent hyperinsulinemic hypoglycemia of infancy

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a disorder characterized by severe, recurrent hypoglycemia with inappropriately elevated circulating insulin levels. It usually becomes manifest rapidly after birth and, if unrecognized, may lead to severe brain damage. Although the symptoms can be transiently alleviated by fractionated carbohydrate intake, diazoxide or somatostatin, treatment may require total or subtotal pancreatectomy. The disease occurs either in a familial or in a sporadic form. PHHI, a dramatic but rare condition, has recently attracted considerable attention as a model disease of defective glucose-induced insulin secretion.

The role of ion channels in the control of insulin release is increasingly recognized. In pancreatic β-cells, the normal resting membrane potential is maintained by potassium (K⁺) efflux, via ATP-sensitive K⁺ channels (K_ATP channels). The main stimulus for insulin secretion is a rise in blood glucose concentration. Glucose enters the β-cell where it is metabolized, resulting in elevated intracellular ATP