Severe Hypoglycemia-Induced Fatal Cardiac Arrhythmias Are Augmented by Diabetes and Attenuated by Recurrent Hypoglycemia
| Autor: | Justin Bayles, Simon J. Fisher, Andrew Jordan, Dorit Daphna-Iken, Allie Skinner, Candace M. Reno, Marina Litvin, Jennifer VanderWeele |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Complications endocrine system diseases Heart block Endocrinology Diabetes and Metabolism medicine.medical_treatment Recurrent hypoglycemia 030209 endocrinology & metabolism Hypoglycemia Streptozocin Diabetes Mellitus Experimental Rats Sprague-Dawley 03 medical and health sciences Electrocardiography 0302 clinical medicine Heart Rate Recurrence Internal medicine Diabetes mellitus Heart rate Internal Medicine medicine Animals medicine.diagnostic_test business.industry Insulin nutritional and metabolic diseases Arrhythmias Cardiac medicine.disease 3. Good health Rats 030104 developmental biology Endocrinology Epinephrine Potassium business medicine.drug |
| Zdroj: | Diabetes |
| ISSN: | 1939-327X |
| Popis: | We previously demonstrated that insulin-mediated severe hypoglycemia induces lethal cardiac arrhythmias. However, whether chronic diabetes and insulin deficiency exacerbates, and whether recurrent antecedent hypoglycemia ameliorates, susceptibility to arrhythmias remains unknown. Thus, adult Sprague-Dawley rats were randomized into four groups: 1) nondiabetic (NONDIAB), 2) streptozotocin-induced insulin deficiency (STZ), 3) STZ with antecedent recurrent (3 days) hypoglycemia (∼40–45 mg/dL, 90 min) (STZ+RH), and 4) insulin-treated STZ (STZ+Ins). Following treatment protocols, all rats underwent hyperinsulinemic (0.2 units ⋅ kg−1 ⋅ min−1), severe hypoglycemic (10–15 mg/dL) clamps for 3 h with continuous electrocardiographic recordings. During matched nadirs of severe hypoglycemia, rats in the STZ+RH group required a 1.7-fold higher glucose infusion rate than those in the STZ group, consistent with the blunted epinephrine response. Second-degree heart block was increased 12- and 6.8-fold in the STZ and STZ+Ins groups, respectively, compared with the NONDIAB group, yet this decreased 5.4-fold in the STZ+RH group compared with the STZ group. Incidence of third-degree heart block in the STZ+RH group was 5.6%, 7.8-fold less than the incidence in the STZ group (44%). Mortality due to severe hypoglycemia was 5% in the STZ+RH group, 6.2-fold less than that in the STZ group (31%). In summary, severe hypoglycemia–induced cardiac arrhythmias were increased by insulin deficiency and diabetes and reduced by antecedent recurrent hypoglycemia. In this model, recurrent moderate hypoglycemia reduced fatal severe hypoglycemia–induced cardiac arrhythmias. |
| Databáze: | OpenAIRE |
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