Destruction

of pancreatic islet tissue caused directly by circulating ghrelin spikes.

Cessation

of hepatic gluconeogenesis, elevated leptin activity, and reduced nocturnal

epinephrine release.

Decreased

brain glucose utilization, elevated nocturnal cortisol and growth hormone (GH),

and suppressed insulin secretion secondary to sympathetic activation.

Increased central glucose clearance, suppressed

cortisol rhythms, and beta-cell hyper-responsiveness.