In the setting of insulin-induced recurrent hypoglycemia resulting in HAAF, we hypothesize that the failed autonomic response, which presumably includes blunted exposure of ghrelin cells to norepinephrine released from stomach-projecting sympathetic neurons, might result in even lower ghrelin levels than usual following an occasional episode of insulin-induced hypoglycemia. The gene discussed is GHRL; the disease is Hypoglycemia.