From the Guidelines
Yes, insulin can cause tachycardia as a symptom of hypoglycemia, which is a common side effect of insulin therapy. When blood glucose levels drop too low, typically below 70 mg/dL, the body releases stress hormones like adrenaline and norepinephrine to counteract the low blood sugar, as outlined in the 2017 American Diabetes Association standards of medical care in diabetes 1. These hormones increase heart rate as part of the body's fight-or-flight response to what it perceives as a dangerous situation. Tachycardia during hypoglycemia is often accompanied by other symptoms such as:
- Sweating
- Shakiness
- Anxiety
- Hunger
- Confusion This reaction is more common with rapid-acting insulins, but can occur with any insulin formulation if dosing exceeds needs or if meals are delayed or skipped after insulin administration. Patients using insulin should monitor their blood glucose regularly, recognize the symptoms of hypoglycemia, and have fast-acting carbohydrates readily available to treat low blood sugar episodes promptly, as recommended by the American Diabetes Association 1.
From the Research
Insulin and Tachycardia
- Insulin can cause an increase in heart rate, as shown in a study published in the European Journal of Clinical Pharmacology 2.
- This increase in heart rate is thought to be due to the stimulation of cardiac sympathetic activity by insulin.
- However, another study published in Expert Opinion on Drug Safety found that insulin resistance, rather than hyperinsulinemia, increases cardiovascular risk 3.
- Additionally, a study published in Current Diabetes Reviews found that hypoglycemia, which can be caused by insulin, has been implicated in nocturnal sudden death in type 1 diabetes, and the mechanism underlying this is postulated to be cardiac arrhythmia 4.
- A study published in Current Diabetes Reports also found that insulin has complex effects on the cardiovascular system, and that while it can have positive effects on glucose control, it can also have negative effects such as favoring obesity and atherogenesis under certain conditions 5.
- It's worth noting that the relationship between insulin and cardiovascular disease is complex, and more research is needed to fully understand the effects of insulin on the cardiovascular system.
Mechanisms and Evidence
- The mechanisms by which insulin affects heart rate and cardiovascular disease are not fully understood, but are thought to involve the stimulation of cardiac sympathetic activity and the effects of insulin on glucose and lipid metabolism.
- The evidence for the effects of insulin on heart rate and cardiovascular disease comes from a variety of sources, including animal studies, clinical trials, and observational studies.
- A study published in JAMA found that the use of real-time continuous glucose monitoring was associated with significant improvements in hemoglobin A1c and reductions in emergency department visits and hospitalizations for hypoglycemia, but no significant change in emergency department visits or hospitalizations for hyperglycemia or for any reason 6.
- Overall, the evidence suggests that insulin can have both positive and negative effects on the cardiovascular system, and that the relationship between insulin and cardiovascular disease is complex and multifactorial.