Hypoglycaemia as a cause of dynamic ECG changes: recognition and management.
BMJ Case Reports · 2025-05-15 · Case report
Abstract
An elderly man with type 2 diabetes on two times per day biphasic insulin presented after a fall in the toilet, preceded by reduced intake and transient loss of consciousness. Paramedics found profound hypoglycaemia (capillary blood glucose (BG) - 0.9 mmol/L) and administered intravenous glucose, raising BG to 7.2 mmol/L. In the emergency department, he experienced recurrent hypoglycaemia (BG 1.8 and 2.6 mmol/L). ECG revealed T-wave abnormalities and QT prolongation, raising concerns for myocardial ischaemia or arrhythmia. Troponin was mildly elevated (14 ng/L), but he remained haemodynamically stable (pulse 52, BP 120/56, RR 16, SpO₂ 99%). Glycated haemoglobin (HbA1c) was 73 mmol/mol, potassium 3.2 mmol/L with normal renal function. CT of the head was unremarkable. Following glucose correction, ECG abnormalities resolved and there were no further indications of acute coronary syndrome (ACS) or arrhythmia. His insulin regimen was changed to insulin glargine 10 units daily, with continued metformin. This case underscores the critical need to recognise hypoglycaemia-induced ECG changes, preventing misdiagnosis and unnecessary cardiac interventions.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Fluids & blood · Glucose · Older adults
Related articles
- Hypoglycemic Events Focusing on Situational Factors, Bystander Identification, and Prehospital Management. (J Clin Med, 2026)
- Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial. (Lancet Glob Health, 2020)
- Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team. (Emerg Med J, 2006)
- Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia. (Front Endocrinol (Lausanne), 2024)
- Emergency treatment of hypoglycaemia: a guideline and evidence review. (Diabet Med, 2017)
- A Review of the Efficacy of 10% Dextrose as an Alternative to High Concentration Glucose in the Treatment of Out-of-Hospital Hypoglycaemia (Paramedicine, 2009)