Insulin in Acute Coronary Syndrome: a Narrative Review with Contemporary Perspectives
Intensive glucose control is widely practiced in patients with diabetes mellitus and patients acutely admitted to hospitals with concomitant stress-induced hyperglycaemia. Such a strategy increases the risk of hypoglycaemia by several-fold. Hypoglycaemia leads to a surge in catecholamine levels with a profound haemodynamic response. In patients with a decreased cardiac reserve, such significant changes can culminate in serious or even fatal cardiovascular outcomes. This review is aimed at discussing in depth the evidence to date that links hypoglycaemia with cardiovascular mortality, reviewing the likely mechanisms underlying this association, as well as summarising these from a cardiologist's perspective.