In 1968, reports of the first microelectrode recordings of insulin-secreting cells were published. Thirty years later it is now established that electrical responses of beta-cells play a critical role in stimulus-secretion coupling. It is now also clear that defects in ion channel genes compromise the mechanisms which govern secretion and lead to the onset of disease. Here, the physiology of insulin release is reviewed in the context of ion channels, the ionic control of insulin release and the pathophysiology of hyperinsulinism of infancy.