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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for insulin induced tachycardia

Answered by
Dr.
Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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Posted on Thu, 1 Dec 2016 in Diabetes
Question: Hi Doctor, I am located in XXXXXXX My mother (aged 61 years) has been a diabetic for last 18 years. She was managing it using pills and recently (around 10 months back) her doctor switched her to insulin. Currently she is taking Human Actrapid & Human Insulatard. During a routine check-up the doctor found out that her pulse rate is very high (125). We looked at all the earlier reports and her pulse rate was consistently between 85 to 100 for many years. There is no other significant change in her lifestyle/other medication. Note that she is being treated for high BP as well. I need your advice to identify the root cause for the change in her pulse rate. Can the high pulse rate be caused by insulin allergy? Note that when the she started the insulin medication she had itching/dry skin throughout the body and the doctor altered the insulin type. She is also getting tired once in every few days and it takes few hours for her to recover though she follows the medication andCan you please help?

Also I want to know the risks associated with this high pulse rate.

Look forward to your response,

Regards,
XXXX
doctor
Answered by Dr. Shuba Hariprasad 4 hours later
Brief Answer:
Link is present between insulin & high pulse rate but not a direct causative effect

Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.

There have been studies that show a link between increased heart rate and insulin but not a direct causative effect.

Would you clarify a few things for me, please?
-does she have any other medical issues?any other medications? Including any ayurveda or alternative medicine therapy? -
-Any cough syrups or additional caffeine intake?
-any other symptoms like giddiness, palpitations, headache, sweating?
-Have you checked her blood pressure, heart rate and sugar during her weakness episodes? If not, please do.
-any calf/leg pain with swelling or change in colour of skin? Any itching?
-is she mostly sedentary or is she active? Is she able to do her routine activities?
-is she on any blood thinners?

As she is a diabetic she needs to be evaluated for her cardiac status.
I recommend :
- a physician and cardiologist consult
- electrocardiogram and echocardiogram
- blood tests (complete blood count, TSH, free t3 and t4, electrolytes, kidney and liver function tests, clotting parameters )
- a stress test if possible. (as decided by her cardiologist)


High rate puts a strain on the heart. In the presence of diabetes this can compromise this heart muscle.
If the heart rhythm is irregular, this can result in clot formation which can break off and travel into the circulation of the lungs and brain or other areas leading to cutting off of the blood supply (stroke, pulmonary embolism) both of which are life threatening.

Please give her the medications as advised be her cardiologist and see if it helps.
Hope this helps. Please let me know if there is anything else I can help you with.
Wish you both good health.

Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Shuba Hariprasad 2 days later
Dr. Shuba,

Thanks a lot for your response. I am provided answers to your questions as much as I can. Kindly check.

     -does she have any other medical issues?any other medications? Including any ayurveda or alternative medicine therapy? -

No. No Ayurveda or alternative therapy

     -Any cough syrups or additional caffeine intake?

She doesn’t take coffee. But drinks good amount of tea (may be 3 to 4 times a day but without sugar)

     -any other symptoms like giddiness, palpitations, headache, sweating?

When she gets tired, she gets sweating

     -Have you checked her blood pressure, heart rate and sugar during her weakness episodes? If not, please do.

Yes, we did once. The sugar level was at 200. The heart rate was around 90 and the blood pressure was 135/85

     -any calf/leg pain with swelling or change in colour of skin? Any itching?

No

      -is she mostly sedentary or is she active? Is she able to do her routine activities?

She is a housewife. It is sedentary lifestyle but she goes for walking everyday in the morning.

     -is she on any blood thinners?

I am not sure. Can you kindly check the prescription attached

The doctors has done multiple tests – (1) ECG, (2) Heart Echo, (3) Holster & (4) Blood test. I have attached those reports.

Can you please check these reports and let me know if you are able to arrive at any new conclusion. She is taking the medicines as prescribed by the diabetologist and cardiologist. Her current heart rate has come down (80 to 90). However she suddenly feels tried (though she might have taken food a short while ago) and takes few hours to recover. It was not seen earlier. Can it be side effect of any of the medicines?

Overall the doctors we are consulting are not able to find the root cause for the increase in heart rate and the random tiredness.

Please provide your advice/suggestions.

Thanks,
XXXX
doctor
Answered by Dr. Shuba Hariprasad 4 hours later
Brief Answer:
Reduce caffeine /tea intake

Detailed Answer:
Hello sir,

Thank you for the follow up and detailed clarifications.

Based on the reports,prescription and the clarifications provided, I believe that she has an irritable heart (easy to excite or stimulate).

Let me address the issues one at a time.

1)diabetes- medications for controlling glucose can sometime cause tiredness. Please try to see if the tiredness occurs after this medication time.
*Her glucose levels need to be well controlled I order to prevent related complications.
*If you have a glucometer, please check once a week (fasting and 1.5 hrs after meals).
*Go for regular follow ups to get this under control.
If high fasting glucose value, take a test at 3am in the morning (to detect the exact method of treatment)
*she also needs to eat on time. Smaller but frequent meals help. Reducing intake is not the answer (occurs frequently as lots of unhealthy food habits are curbed) but eating the right foods in adequate quantity is important while on medications.

2)hypertension - her blood pressure is reasonably controlled. Please continue medications
*Salt intake must be restricted as advised.
*stress busters (praying, meditation, yoga (taught by a specialist)) along with exercise will help.
*sound sleep is important. So disciplined sleep and wake time is crucial for her health.
*if she gets too stressed or emotional with certain events, avoid those circumstances.

3)heart disease/increased heart rate:
*you sent 2 ecgs. ECG 2 was not conclusive (I believe there was error while taking the ecg).
ECG 1 is clear and shows:
- high pulse rate (tachycardia)
-1st degree atrioventricular block (AVB). This is benign and doesn't need treatment.
*the Holter test indicates multiple extra and untimely beats which to me means and irritable heart. Whether this is due to an underlying heart disease or due to external factors needs to found.

For this I recommend :
-thyroid panel (thyroid stimulating hormone, free t3 and t4,)
- reduction of caffeine (tea intake) to 1 cup a day. Make it two cups for a week and then to 1cup. Do not stop all of a sudden. Can cause withdrawal and maybe stressful for her. She can supplement with other warm liquids like decaffeinated green tea or soup, warm water with lemon.
Caffeine is an irritant and can increase heart rate.
*please note if the heart rate increases after any particular meal or event.
*monitor her heart rate, sugar and blood pressure everyone she feels tired. This may help to find the root cause. Maintain a diary with these details.

-She is on blood thinners (ecosprin) and cholesterol meds.
-She needs to improve her HDL (healthy oils like canola, gingelly and coconut oil instead of refined oil/have nuts and seeds like walnuts, almonds, flax seeds- unsalted. 6-8 nuts make a Good snack.
-fresh whole fruits and vegetables,sprouts can help Control sugar and prevent tiredness.

If after 3 - 4weeks of the above measures, she does not show improvement and she has new symptoms, she may a stress test (treadmill test) and possibly an angiogram(if stress test is positive) to check for blocks in the blood supply to her heart.

-if at any point, her heart rate goes below 60 or she passes out, call her doctor immediately. Medications will need to be adjusted.
For now she is being treated appropriately. I believe the reduction in caffeine will help Control the heart rate. It will take a couple of weeks to notice though.

Hope this helps.
Please let me know if there is anything else I can help you with.
Wish you all good health.
Regards,
Dr. Shuba Hariprasad

Above answer was peer-reviewed by : Dr. Prasad
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