Hypoglycaemia and cardiac arrhythmias in patients with type 2 diabetes mellitus

Diabet Med. 1992 Jul;9(6):536-41. doi: 10.1111/j.1464-5491.1992.tb01834.x.


Improved blood glucose control by insulin treatment in patients with Type 2 (non-insulin dependent) diabetes mellitus increases the risk for hypoglycaemic episodes. Our objective was to investigate if hypoglycaemia causes electrocardiographic changes and cardiac arrhythmias in patients with Type 2 diabetes. Six insulin-treated patients with Type 2 diabetes and no known cardiac disease took part in the study. Hypoglycaemia was induced by insulin infusion aiming at a plasma glucose less than or equal to 2.0 mmol l-1 or hypoglycaemic symptoms. All patients experienced hypoglycaemic symptoms. The median lowest arterial plasma glucose was 2.0 mmol l-1. Arterial plasma adrenaline concentration increased from 0.4 +/- 0.1 (mean +/- SE) to 6.9 +/- 0.3 nmol l-1 (p less than 0.001) while serum potassium was lowered from 4.1 +/- 0.3 mmol l-1 to 3.5 +/- 0.2 mmol l-1 (p less than 0.001). The heart rate increased significantly during hypoglycaemia except in one patient who developed hypoglycaemic symptoms and a severe bradyarrhythmia at a plasma glucose of 4.4 mmol l-1. One patient developed frequent ventricular ectopic beats during hypoglycaemia while four patients showed no arrhythmia. ST-depression in ECG leads V2 and V6 was observed during hypoglycaemia in five patients (p less than 0.05) and four patients developed flattening of the T-wave. In conclusion, the study supports the hypothesis that hypoglycaemia in patients with Type 2 diabetes may be hazardous by causing cardiac arrhythmias.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arrhythmias, Cardiac / etiology*
  • Arrhythmias, Cardiac / physiopathology
  • Blood Glucose / metabolism
  • Blood Pressure
  • C-Peptide / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Electrocardiography
  • Epinephrine / blood
  • Fatty Acids, Nonesterified / blood
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / physiopathology*
  • Insulin / adverse effects*
  • Insulin / therapeutic use
  • Middle Aged
  • Norepinephrine / blood
  • Potassium / blood


  • Blood Glucose
  • C-Peptide
  • Fatty Acids, Nonesterified
  • Insulin
  • Potassium
  • Norepinephrine
  • Epinephrine