THE MECHANISM AND PREVENTION OF CARDIOVASCULAR CHANGES DUE TO INSULIN

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Abstract
The effects of insulin on the heart rate, venous pressure, circulation time and electrocardiogram were investigated in 18 patients (8 normals, 10 with moderate or severe diminution of cardiac reserve) and found to be essentially identical with those of adrenalin. The admn. of insulin with the maintenance of an unlowered blood sugar and the absence of sympathetic stimulation produced no E.C.G. changes. It follows that the changes observed with insulin alone are due to sympathetic stimulation secondary to the insulin-induced hypoglycemia. Attention is called to the dangers of insulin therapy in diabetics with heart disease, as borne out by three personally observed and autopsied cases of acute myocardial infarction immediately following an episode of insulin hypoglycemia. The cardiovascular effects of insulin injn. may be counteracted by the simultaneous admn. of prostigmine. The possible advantages of combined prostig-mine-insulin therapy in diabetics with diminished cardiac reserve are suggested.