Nighttime heart palpitations: a warning sign of hypoglycemia; case analysis of diabetes patients who are easily misdiagnosed.
Case Study: Frequent Heart Palpitations, Root Cause Lies in Blood Sugar: Ms. Zhang has suffered from coronary heart disease and diabetes for many years, consistently undergoing medication treatment, and her condition has been stable. However, for the past month, she has experienced frequent heart palpitations, especially at night when she is sleeping soundly, her heart frequently waking her up. Ms. Zhang suspected heart failure and went to a nearby hospital for examination. The results showed frequent premature ventricular contractions (PVCs), so the doctor prescribed medication to control the PVCs and improve blood flow to the heart. However, after a month, the heart palpitations became more frequent. Ms. Zhang was very worried, believing her condition was serious and incurable, and sought medical help from various sources.
Dr. Zhou examined Ms. Zhang and found no abnormalities. During a detailed medical history inquiry, he discovered that the patient was taking metformin daily and self-administering insulin to treat her diabetes. Each time she woke up in a panic at night, she would sweat, and she felt that eating something would calm her down.
Based on the patient's characteristics, Dr. Zhou ordered a Holter monitor test and asked her to monitor her blood sugar during any subsequent episodes. The next day, the patient returned for a follow-up visit. The situation was clear: the patient experienced palpitations again that evening, and a self-tested blood glucose level was 3.1 mmol/L.
It was obvious that the patient had experienced nocturnal hypoglycemia. Dr. Zhou consulted with an endocrinologist, adjusted the treatment plan, and the patient's premature contractions quickly disappeared. While the diagnosis and treatment of the disease are not difficult, some issues are worth considering. Regarding this case, Dr. Zhou would like to provide some information about hypoglycemia, especially for diabetic patients:
Hypoglycemia is defined as a blood glucose level <2.8 mmol/L in non-diabetic patients and <3.9 mmol/L in patients receiving diabetes medication. The causes of hypoglycemia are complex, and many patients do not present with typical symptoms. Symptoms may include palpitations, irritability, weakness, and dizziness. Elderly diabetic patients are particularly prone to hypoglycemic reactions, and their symptoms are often atypical. In severe cases, it can lead to coma and even death.
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