ISCHEMIC CHANGE ON ELECTROCARDIOGRAM INDUCED BY HYPOGLYCEMIA IN A DIABETIC PATIENT

A 34-year-old female patient who presented to our hospital had been tr eated with insulin for diabetes since she was 25 year old. For the pre vious year she had experienced chest pain on exertion and during hypog lycemia. During both chest pain and exercise tests, ST depression and flattening of the T wave were recognized in leads II, III, aV(F), and V-2-V-6 on the electrocardiogram, and thus ischemic heart disease was suspected. Cardiac catheterization was performed, but no organic steno sis or spasms were found. Hypoglycemia (41 mg/dl) was induced by intra venous injection of rapid insulin (total 18 U, 0.4 U/kg). However, no coronary change was seen, although she felt chest pain and the same is chemic electrocardiographic changes occurred. We hypothesized the caus es of the ischemic change to be both the effects of insulin on the car diovascular system and the physiologic stress induced by the existence of microvascular abnormality. Special care should therefore be taken with diabetic patients being treated with insulin or hypoglycemic agen ts.