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. 2008 Apr;13(2):97-105.
doi: 10.1111/j.1542-474X.2008.00208.x.

Electrocardiographic alterations during hyperinsulinemic hypoglycemia in healthy subjects

Tomi Laitinen  1 , Tiina Lyyra-Laitinen, Hanna Huopio, Ilkka Vauhkonen, Toivo Halonen, Juha Hartikainen, Leo Niskanen, Markku Laakso
Affiliations

Electrocardiographic alterations during hyperinsulinemic hypoglycemia in healthy subjects

Tomi Laitinen et al. Ann Noninvasive Electrocardiol. 2008 Apr.

Abstract

Background: We evaluated the arrhythmogenic potential of hypoglycemia by studying electrocardiographic (ECG) changes in response to hyperinsulinemic hypoglycemia and associated sympathoadrenal counterregulatory responses in healthy subjects.

Methods: The study population consisted of 18 subjects, aged 30-40 years. Five-minute ECG recordings and blood samplings were performed at baseline and during the euglycemic and hypoglycemic hyperinsulinemic clamp studies. PR, QT, and QTc intervals of electrocardiogram and ECG morphology were assessed from signal-averaged ECG.

Results: Although cardiac beat interval remained unchanged, PR interval decreased (P < 0.01) and QTc interval (P < 0.001) increased in response to hyperinsulinemic hypoglycemia. Concomitant morphological alterations consisted of slight increases in R-wave amplitude and area (P < 0.01 for both), significant decreases in T-wave amplitude and area (P < 0.001 for both), and moderate ST depression (P < 0.001). Counterregulatory norepinephrine response correlated with amplification of the R wave (r =-0.620, P < 0.05) and epinephrine response correlated with flattening of the T wave (r =-0.508, P < 0.05).

Conclusions: Hyperinsulinemic hypoglycemia with consequent sympathetic humoral activation is associated with several ECG alterations in atrioventricular conduction, ventricular depolarization, and ventricular repolarization. Such alterations in cardiac electrical function may be of importance in provoking severe arrhythmias and "dead-in-bed" syndrome in diabetic patients with unrecognized hypoglycemic episodes.

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Figures

Figure 1
Figure 1
A representative case showing a slight amplification of the R wave, a decrease in the ST segment, a remarkable flattening of the T wave, and a slight prolongation of the QT interval as characteristic electrocardiographic changes in response to euglycemic and hypoglycemic hyperinsulinemia.
Figure 2
Figure 2
Relationships between (A) counterregulatory norepinephrine response and a change in the amplitude of the R wave and (B) counterregulatory epinephrine response and a change in the amplitude of the T wave during hyperinsulinemic hypoglycemia. Values represent changes between hypoglycemia and baseline.
See this image and copyright information in PMC

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