Lindström T, Jorfeldt L, Tegler L, Arnqvist H J
Department of Internal Medicine, Faculty of Health Sciences, Linköping University, Sweden.
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.
2型（非胰岛素依赖型）糖尿病患者通过胰岛素治疗改善血糖控制会增加低血糖发作的风险。我们的目的是研究低血糖是否会导致2型糖尿病患者出现心电图改变和心律失常。6名接受胰岛素治疗的2型糖尿病患者且无已知心脏病史参与了该研究。通过输注胰岛素诱导低血糖，目标是使血浆葡萄糖浓度小于或等于2.0 mmol/L或出现低血糖症状。所有患者均出现了低血糖症状。动脉血浆葡萄糖最低值的中位数为2.0 mmol/L。动脉血浆肾上腺素浓度从0.4±0.1（均值±标准误）升高至6.9±0.3 nmol/L（p<0.001），而血清钾从4.1±0.3 mmol/L降至3.5±0.2 mmol/L（p<0.001）。除1名患者在血浆葡萄糖浓度为4.4 mmol/L时出现低血糖症状和严重心动过缓性心律失常外，低血糖期间心率显著增加。1名患者在低血糖期间出现频发室性早搏，而4名患者未出现心律失常。5名患者在低血糖期间观察到心电图V2和V6导联ST段压低（p<0.05），4名患者出现T波低平。总之，该研究支持以下假设：2型糖尿病患者的低血糖可能通过引起心律失常而具有危险性。
