Sur1 knockout mouse -cells lack K ATP channels and show spontaneous Ca 2؉ action potentials equivalent to those seen in patients with persistent hyperinsulinemic hypoglycemia of infancy, but the mice are normoglycemic unless stressed. Sur1 -/-islets lack first phase insulin secretion and exhibit an attenuated glucose-stimulated second phase secretion. Loss of the first phase leads to mild glucose intolerance, whereas reduced insulin output is consistent with observed neonatal hyperglycemia. Loss of K ATP channels impairs the rate of return to a basal secretory level after a fall in glucose concentration. This leads to increased hypoglycemia upon fasting and contributes to a very early, transient neonatal hypoglycemia. Whereas persistent hyperinsulinemic hypoglycemia of infancy underscores the importance of the K ATP -dependent ionic pathway in control of insulin release, the Sur1 -/-animals provide a novel model for study of K ATP -independent pathways that regulate insulin secretion.ATP-sensitive potassium channels (K ATP channels) 1 are a unique combination of a K ϩ inward rectifier (either K IR 6.1 or K IR 6.2) and a sulfonylurea receptor (SUR1 or SUR2) transport ATPase superfamily members (1-3). These channels respond to changes in ATP/ADP and can couple metabolism to membrane electrical activity. SUR1 and K IR 6.2 comprise the K ATP channels in pancreatic -cells that regulate the ionic pathway mediating glucose-stimulated insulin secretion by setting the resting membrane potential below the activation threshold for voltage-gated Ca 2ϩ channels (4). Mutations in human Sur1 or K IR 6.2 cause a recessive form of persistent hyperinsulinemic hypoglycemia of infancy (PHHI) characterized by oversecretion of insulin despite severe hypoglycemia (1, 5). Surprisingly, two recent studies involving disruption of K ATP channels in mice produced a quite different picture. Targeted overexpression of a dominant-negative K IR 6.2 subunit, K IR 6.2 G132S , in -cells reduced channel activity producing animals that were hypoglycemic at birth but became increasingly hyperglycemic secondary to -cell death (6).K IR 6.2 null mice, K IR 6.2 -/-, on the other hand, completely lack -cell K ATP channels but exhibit a less severe phenotype (7). The K IR 6.2 -/-animals have nearly normal blood glucose levels, showing mild glucose intolerance when challenged with glucose. These animals are reported to release a small amount of insulin in response to glucose, whereas isolated, perifused islets show a small first phase of glucose-stimulated insulin secretion and no second phase. The normal blood glucose levels have been attributed to insulin hypersensitivity secondary to the loss of SUR2A/K IR 6.2 K ATP channels in skeletal muscle.SUR1 null mice, Sur1 -/-, unlike their K IR 6.2 -/-counterparts, are not insulin-hypersensitive. Isolated Sur1 -/-islets exhibit a pattern of glucose-stimulated insulin release consistent with regulation by an underlying K ATP -independent pathway (or pathways), the nature of which is unknown (8 -12). The Sur...