Possible mechanisms explaining the association of NAFLD with severe hypoglycemia include altered glucose metabolism in NAFLD.44,45 Glucagon level is found to be increased in the presence of NAFLD,46 and hyperglucagonemia might induce downregulation of hepatic glucagon receptor or blunt the counter-regulatory response to hypoglycemic events in hepatic glucose production.47 Also, NAFLD may be associated with glycemic variability through increased oxidative stress,48,49 which is an important determinant of hypoglycemia.50 This evidence concerns the gene GCGR and Hypoglycemia.