Brief Answer:
Link is present between insulin & high pulse rate but not a direct causative effect

Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.

There have been studies that show a link between increased heart rate and insulin but not a direct causative effect.

Would you clarify a few things for me, please?
-does she have any other medical issues?any other medications? Including any ayurveda or alternative medicine therapy? -
-Any cough syrups or additional caffeine intake?
-any other symptoms like giddiness, palpitations, headache, sweating?
-Have you checked her blood pressure, heart rate and sugar during her weakness episodes? If not, please do.
-any calf/leg pain with swelling or change in colour of skin? Any itching?
-is she mostly sedentary or is she active? Is she able to do her routine activities?
-is she on any blood thinners?

As she is a diabetic she needs to be evaluated for her cardiac status.
I recommend :
- a physician and cardiologist consult
- electrocardiogram and echocardiogram
- blood tests (complete blood count, TSH, free t3 and t4, electrolytes, kidney and liver function tests, clotting parameters )
- a stress test if possible. (as decided by her cardiologist)


High rate puts a strain on the heart. In the presence of diabetes this can compromise this heart muscle.
If the heart rhythm is irregular, this can result in clot formation which can break off and travel into the circulation of the lungs and brain or other areas leading to cutting off of the blood supply (stroke, pulmonary embolism) both of which are life threatening.

Please give her the medications as advised be her cardiologist and see if it helps.
Hope this helps. Please let me know if there is anything else I can help you with.
Wish you both good health.

Regards,
Dr. Shuba Hariprasad

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Brief Answer:
Reduce caffeine /tea intake

Detailed Answer:
Hello sir,

Thank you for the follow up and detailed clarifications.

Based on the reports,prescription and the clarifications provided, I believe that she has an irritable heart (easy to excite or stimulate).

Let me address the issues one at a time.

1)diabetes- medications for controlling glucose can sometime cause tiredness. Please try to see if the tiredness occurs after this medication time.
*Her glucose levels need to be well controlled I order to prevent related complications.
*If you have a glucometer, please check once a week (fasting and 1.5 hrs after meals).
*Go for regular follow ups to get this under control.
If high fasting glucose value, take a test at 3am in the morning (to detect the exact method of treatment)
*she also needs to eat on time. Smaller but frequent meals help. Reducing intake is not the answer (occurs frequently as lots of unhealthy food habits are curbed) but eating the right foods in adequate quantity is important while on medications.

2)hypertension - her blood pressure is reasonably controlled. Please continue medications
*Salt intake must be restricted as advised.
*stress busters (praying, meditation, yoga (taught by a specialist)) along with exercise will help.
*sound sleep is important. So disciplined sleep and wake time is crucial for her health.
*if she gets too stressed or emotional with certain events, avoid those circumstances.

3)heart disease/increased heart rate:
*you sent 2 ecgs. ECG 2 was not conclusive (I believe there was error while taking the ecg).
ECG 1 is clear and shows:
- high pulse rate (tachycardia)
-1st degree atrioventricular block (AVB). This is benign and doesn't need treatment.
*the Holter test indicates multiple extra and untimely beats which to me means and irritable heart. Whether this is due to an underlying heart disease or due to external factors needs to found.

For this I recommend :
-thyroid panel (thyroid stimulating hormone, free t3 and t4,)
- reduction of caffeine (tea intake) to 1 cup a day. Make it two cups for a week and then to 1cup. Do not stop all of a sudden. Can cause withdrawal and maybe stressful for her. She can supplement with other warm liquids like decaffeinated green tea or soup, warm water with lemon.
Caffeine is an irritant and can increase heart rate.
*please note if the heart rate increases after any particular meal or event.
*monitor her heart rate, sugar and blood pressure everyone she feels tired. This may help to find the root cause. Maintain a diary with these details.

-She is on blood thinners (ecosprin) and cholesterol meds.
-She needs to improve her HDL (healthy oils like canola, gingelly and coconut oil instead of refined oil/have nuts and seeds like walnuts, almonds, flax seeds- unsalted. 6-8 nuts make a Good snack.
-fresh whole fruits and vegetables,sprouts can help Control sugar and prevent tiredness.

If after 3 - 4weeks of the above measures, she does not show improvement and she has new symptoms, she may a stress test (treadmill test) and possibly an angiogram(if stress test is positive) to check for blocks in the blood supply to her heart.

-if at any point, her heart rate goes below 60 or she passes out, call her doctor immediately. Medications will need to be adjusted.
For now she is being treated appropriately. I believe the reduction in caffeine will help Control the heart rate. It will take a couple of weeks to notice though.

Hope this helps.
Please let me know if there is anything else I can help you with.
Wish you all good health.
Regards,
Dr. Shuba Hariprasad

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