The regulation of insulin secretion from beta-cells of the pancreatic islets of Langerhans is a highly integrated process involving several plasma membrane ion channels. The key to our understanding of the normal process is the hypothesis that glucose-induced closure of K+ channels leads to a depolarization of the cell membrane potential and the opening of voltage-gated Ca2+ channels. Support for this is provided by direct electrophysiological recordings of ion channel activity, and by recent data that have revealed how gene defects in ion channel subunits leads to the loss of regulated insulin secretion. Here, we review the general features of stimulus-response coupling in beta-cells, and how novel initiatives are providing key insights into beta-cell pathogenesis.