Hypokalaemia during insulin‐induced hypoglycaemia in hypopituitary adults with and without growth hormone deficiency

Davies, J. S.; Hinds, Nicholas; Millward, E.; McDowell, I.F.W.; Scanlon, M. F.

doi:10.1046/j.1365-2265.1998.00508.x

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…In our study, insulin use alone or in combination with oral medications was associated with a >2.5-fold–increased risk of cardiovascular events. These findings are consistent with Currie et al (15), which identified a lower survival rate in insulin users compared with oral medication users. The mechanism for the excess risk associated with insulin and sulfonylurea use is not clearly understood; however, it is possible that hypoglycemia plays a role.…”

Section: Discussionsupporting

confidence: 92%

“…The mechanism for the excess risk associated with insulin and sulfonylurea use is not clearly understood; however, it is possible that hypoglycemia plays a role. It has been proposed that hypoglycemia may precipitate cardiac arrhythmias through hypokalemia and sympatho-adrenal activation (15,16). In addition, glucose variability has been implicated as a factor in oxidative stress and vascular inflammation (17).…”

Section: Discussionmentioning

confidence: 99%

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A1C and Cardiovascular Outcomes in Type 2 Diabetes

et al. 2010

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OBJECTIVEType 2 diabetes is associated with increased cardiovascular risk. The role of aggressive glycemic control in preventing cardiovascular events is unclear. A nested case-control study design was used to evaluate the association between average A1C and cardiovascular outcomes.RESEARCH DESIGN AND METHODSAdults with type 2 diabetes were identified among members of Kaiser Permanente Southern California. Type 2 diabetes was identified based on ICD-9 diagnosis codes and either A1C >7.5% or prescriptions for hypoglycemic agents. Case subjects were defined based on nonfatal myocardial infarction, nonfatal stroke, or death attributed to cardiovascular events during a 3-year window. Four type 2 diabetes control subjects were matched to each case subject based on age, sex, and index date for the corresponding case. A conditional logistic regression model was used to estimate the odds ratio of cardiovascular events and compare three patient groups based on average A1C measured in the preindex period (≤6, >6–8, >8%).RESULTSA total of 44,628 control subjects were matched to 11,157 case subjects. Patients with an average A1C ≤6% were 20% more likely to experience a cardiovascular event than the group with an average A1C of >6–8% (P < 0.0001). Patients with an average A1C >8% experienced a 16% increase in the likelihood of a cardiovascular event (P < 0.0001). We found evidence of statistical interaction with A1C category and LDL level (P = 0.0002), use of cardiovascular medications (P = 0.02), and use of antipsychotics (P = 0.001).CONCLUSIONSHigh-risk patients with type 2 diabetes who achieved mean A1C levels of ≤6% or failed to decrease their A1C to <8% are at increased risk for cardiovascular events.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

A1C and Cardiovascular Outcomes in Type 2 Diabetes

et al. 2010

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“…All but one developed acute hypokalaemia within 30 min, which lasted for almost 2 h. Ratzmann and Zoellner [11] reported a mean decrease of serum potassium by 0.8 mmol/l during ITT in short healthy children. Comparable results were observed in adults by Davies et al [12]and by Strakosch et al [13]. In all these studies glucose administration, which may exaggerate hypokalaemia, was not performed.…”

Section: Discussionsupporting

confidence: 56%

Insulin Tolerance Test Causes Hypokalaemia and Can Provoke Cardiac Arrhythmias

Binder¹,

Bosk²,

Gass³

et al. 2004

Horm Res Paediatr

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We report the observation and analysis of a new adverse event during the insulin tolerance test (ITT) and propose additional safety procedures. An 8-year-old girl with growth hormone insufficiency had a cardiac arrest due to ventricular flutter when she was tested for growth hormone deficiency by the ITT. Severe hypokalaemia (K⁺ 2.6 mmol/l) was observed after resuscitation. Ergometry ECG revealed catecholaminergic polymorphic ventricular tachycardia, a hereditary arrhythmogenic disease. Consecutive measurements of serum potassium during ITT in 29 short children (21 boys) with growth failure revealed a mean decrease of serum potassium by 1.1 ± 0.4 mmol/l with the nadir at 30 min after the insulin bolus. Hypokalaemia (serum potassium <3.5 mmol/l) occurred in all but one child; severe hypokalaemia (serum potassium <2.9 mmol/l) was measured in every third child. This observation indicates that acute hypokalaemia which is induced by insulin and catecholamine excess occurs frequently in ITT. The case shows that the combination of acute hypokalaemia and the adrenergic counterregulation in ITT is a strong trigger of cardiac arrhythmias, which can become life-threatening if the child has an arrhythmogenic disease. Therefore, we recommend ECG monitoring during ITT to enhance the detection of cardiac arrhythmias. In addition, in the case of a comatose child during ITT the determination of the glucose and potassium level as well as adequate treatment are necessary.

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“…The need for an underlying predisposing genetic or epigenetic condition, resulting in an ionic transmembrane electrolyte imbalance (7,20), has been shown for HypoPP associated with thyreotoxicosis and may partly explain why HypoPP does not occur in all patients with GH deficiency. The need for a predisposing genetic factor is also suggested by a previous study showing that insulin-induced hypoglycemia is not associated with an increased risk of hypokalemia among hypopituitary adults with GH deficiency compared to individuals with normal anterior pituitary function (21).…”

Section: R Lanzi Sc Previtali V Sansone Et Almentioning

confidence: 91%