In particular in the type 2 scenario, this ER stress can induce a process lasting many years or even decades, comprising both an initial phase of compensatory hyperinsulinemia due to insulin resistance and a subsequent phase of a slowly developing hypoinsulinemia due to deterioration of the insulin biosynthetic capacity in the beta cell ER and the gradual decease of the beta cell volume (Lenzen 2017). The gene discussed is INS; the disease is hyperinsulinism.