Spontaneous hypoinsulinaemic hypoglycaemia may occur in patients with known severe comorbidity, such as advanced liver disease (glycogen depletion and reduced gluconeogenesis), renal failure (reduced gluconeogenesis and reduced insulin clearance), malnutrition and anorexia nervosa (glycogen depletion and reduced gluconeogenesis due to substrate deficiency) [29]. Here, INS is linked to nutritional deficiency disease.