Netherlands Heart Journal

, Volume 18, Issue 4, pp 197–201 | Cite as

The effect of insulin on the heart

Part 1: Effects on metabolism and function
Review article
Insulin Heart Metabolism Heart Failure Ventribular Function 


Positive inotropic effects of insulin were described early after the isolation of insulin from the pancreas but data on the effect of insulin on the heart are conflicting. Systemic insulin administration results in a reduction in circulating free fatty acids and an improvement in myocardial glucose uptake, which causes an efficiency improvement in the myocardial cell. There is strong evidence that insulin administration results in functional improvement in dysfunctional myocardium. (Neth Heart J 2010;18:197-201.)


  1. 1.
    Visscher MB, Müller EA. The influence of insulin upon the mammalian heart. J Physiol. 1926;62:34-8.Google Scholar
  2. 2.
    Rogers WJ, Stanley AW Jr, Breinig JB, Prather JW, McDaniel HG, Moraski RE, et al. Reduction of hospital mortality rate of acute myocardial infarction with glucose-insulin-potassium infusion. Am Heart J. 1976;92:44-54.Google Scholar
  3. 3.
    DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979;237:E214-23.Google Scholar
  4. 4.
    Haneda T, Ganz W, Burnam MH, Katz J. Metabolic effects of glucose-insulin-potassium in the ischemic myocardium. Jpn Heart J. 1978;19:376-82.Google Scholar
  5. 5.
    Zhu P, Lu L, Xu Y, Greyson C, Schwartz GG. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol. 2000;278:H595-603.Google Scholar
  6. 6.
    Heng MK, Norris RM, Peter T, Nisbet HD, Singh BN. The effect of glucose-insulin-potassium on experimental myocardial infarction in the dog. Cardiovasc Res. 1978;12:429-35.Google Scholar
  7. 7.
    Cave AC, Ingwall JS, Friedrich J, Liao R, Saupe KW, Apstein CS, et al. ATP synthesis during low-flow ischemia: influence of increased glycolytic substrate. Circulation. 2000;2;101:2090-6.Google Scholar
  8. 8.
    Hjermann I. A controlled study of peroral glucose, insulin and potassium treatment in myocardial infarction. Acta Med Scand. 1971;190:213-8.Google Scholar
  9. 9.
    Stanley AW, Jr., Moraski RE, Russell RO, Rogers WJ, Mantle JA, Kreisberg RA, et al. Effects of glucose-insulin-potassium on myocardial substrate availability and utilization in stable coronary artery disease. Studies on myocardial carbohydrate, lipid and oxygen arterial-coronary sinus differences in patients with coronary artery disease. Am J Cardiol. 1975;36:929-37.Google Scholar
  10. 10.
    Russell RO Jr, Rogers WJ, Mantle JA, McDaniel HG, Rackley CE. Glucose-insulin-potassium, free fatty acids and acute myocardial infarction in man. Circulation. 1976;53:I207-9.Google Scholar
  11. 11.
    Rogers WJ, Russell RO, Jr., McDaniel HG, Rackley CE. Acute effects of glucose-insulin-potassium infusion on myocardial substrates, coronary blood flow and oxygen consumption in man. Am J Cardiol. 1977;40:42-8.Google Scholar
  12. 12.
    McDaniel HG, Papapietro SE, Rogers WJ, Mantle JA, Smith LR, Russell RO Jr, et al. Glucose-insulin-potassium induced alterations in individual plasma free fatty acids in patients with acute myocardial infarction. Am Heart J. 1981;102:10-5.Google Scholar
  13. 13.
    Ferrannini E, Santoro D, Bonadonna R, Natali A, Parodi O, Camici PG. Metabolic and hemodynamic effects of insulin on human hearts. Am J Physiol. 1993;264:E308-15.Google Scholar
  14. 14.
    Szabo Z, Arnqvist H, Hakanson E, Jorfeldt L, Svedjeholm R. Effects of high-dose glucose-insulin-potassium on myocardial metabolism after coronary surgery in patients with Type II diabetes. Clin Sci (Lond). 2001;101:37-43.Google Scholar
  15. 15.
    Korvald C, Elvenes OP, Myrmel T. Myocardial substrate metabolism influences left ventricular energetics in vivo. Am J Physiol Heart Circ Physiol. 2000;278:H1345-51.Google Scholar
  16. 16.
    Klein LJ, Visser FC, Knaapen P, Peters JH, Teule GJJ, Visser CA, et al. 11C-acetate as a tracer of myocardial oxygen consumption. Eur J Nucl Med. 2001;28:65-68.Google Scholar
  17. 17.
    Lucchesi BR, Medina M, Kniffen FJ. The positive inotropic action of insulin in the canine heart. Eur J Pharmacol. 1972;18:107-15.Google Scholar
  18. 18.
    Ahmed SS, Lee CH, Oldewurtel HA, Regan TJ. Sustained effect of glucose-insulin-potassium on myocardial performance during regional ischemia. Role of free fatty acid and osmolality. J Clin Invest. 1978;61:1123-35.Google Scholar
  19. 19.
    Liang C, Doherty JU, Faillace R, Maekawa K, Arnold S, Gavras H et al. Insulin infusion in conscious dogs. Effects on systemic and coronary hemodynamics, regional blood flows, and plasma catecholamines. J Clin Invest. 1982;69:132-36.Google Scholar
  20. 20.
    Lee JC, Downing SE. Effects of insulin on cardiac muscle contraction and responsiveness to norepinephrine. Am J Physiol. 1976;230:1360-5.Google Scholar
  21. 21.
    Downing SE, Lee JC. Myocardial and coronary vascular responses to insulin in the diabetic lamb. Am J Physiol. 1979;237:H514-9.Google Scholar
  22. 22.
    Schmidt HD, Koch M. Influence of perfusate calcium concentration on the inotropic insulin effect in isolated guinea pig and rat hearts. Basic Res Cardiol. 2002;97:305-11.Google Scholar
  23. 23.
    Ramanathan T, Shirota K, Morita S, Nishimura T, Huang Y, Hunyor SN. Glucose-insulin-potassium solution improves left ventricular mechanics in diabetes. Ann Thorac Surg. 2002;73:582-7.Google Scholar
  24. 24.
    Meijler FL, Offerijns FG, Willebrands AG, Groen J. Contractiemechanisme en elektrolythuishouding van het geisoleerde, overlevende rattehart, mede in verband met de werking van insuline [Contraction mechanism and electrolyte balance of isolated surviving rat's heart, with reference to an insulin effect]. Ned Tijdschr Geneeskd. 1959;103:1479-86.Google Scholar
  25. 25.
    Markovitz LJ, Hasin Y, Freund HR. The effect of insulin and glucagon on systolic properties of the normal and septic isolated rat Heart. Basic Res Cardiol. 1985;80:377-83.Google Scholar
  26. 26.
    Airaksinen J, Lahtela JT, Ikaheimo MJ, Sotaniemi EA, Takkunen JT. Intravenous insulin has no effect on myocardial contractility or heart rate in healthy subjects. Diabetologia. 1985;28:649-52.Google Scholar
  27. 27.
    Regan TJ, Frank MJ, Lehan PH, Hellems HK. Relationship of insulin and strophanthidin to myocardial metabolism and function. Am J Physiol. 1963;205:790-4.Google Scholar
  28. 28.
    Khoury VK, Haluska B, Prins J, Marwick TH. Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction. Heart. 2003;89:6-5.Google Scholar
  29. 29.
    Klein LJ, van Campen LC, Sieswerda GT, Kamp O, Visser CA, Visser FC. Glucose-insulin-potassium echocardiography detects improved segmental myocardial function and viable tissue shortly after acute myocardial infarction. J Am Soc Echocardiogr. 2006;19:763-71.Google Scholar
  30. 30.
    Yetkin E, Senen K, Ileri M, Atak R, Tandogan I, Yetkin O, et al. Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction. Coron Artery Dis. 2002;13:145-9.Google Scholar
  31. 31.
    Yetkin E, Senen K, Ileri M, Atak R, Battaoglu B, Yetkin O, et al. Identification of viable myocardium in patients with chronic coronary artery disease and myocardial dysfunction: comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion. Angiology. 2002;53:67-6.Google Scholar
  32. 32.
    Cottin Y, Lhuillier I, Gilson L, Zeller M, Bonnet C, Toulouse C, et al. Glucose insulin potassium infusion improves systolic function in patients with chronic ischemic cardiomyopathy. Eur J Heart Fail. 2002;4:18-4.Google Scholar
  33. 33.
    Marano L, Bestetti A, Lomuscio A, Tagliabue L, Castini D, Tarricone D, et al. Effects of infusion of glucose-insulin-potassium on myocardial function after a recent myocardial infarction. Acta Cardiol. 2000;55:9-15.Google Scholar
  34. 34.
    Sasso FC, Carbonara O, Cozzolino D, Rambaldi P, Mansi L, Torella D, et al. Effects of insulin-glucose infusion on left ventricular function at rest and during dynamic exercise in healthy subjects and noninsulin dependent diabetic patients: a radionuclide ventriculographic study. J Am Coll Cardiol. 2000;36:219-26.Google Scholar
  35. 35.
    Alan S, Ulgen M, Dedeoglu I, Kaya H, Toprak N. Long-term glucose insulin potassium infusion improves systolic and diastolic function in patients with chronic ischemic cardiomyopathy. Swiss Med Wkly. 2003 26;133:419-22.Google Scholar
  36. 36.
    Hiesmayr M, Haider WJ, Grubhofer G, Heilinger D, Keznickl FP, Mares P, et al. Effects of dobutamine versus insulin on cardiac performance, myocardial oxygen demand, and total body metabolism after coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 1995;9:653-8.Google Scholar
  37. 37.
    Coleman GM, Gradinac S, Taegtmeyer H, Sweeney M, Frazier OH. Efficacy of metabolic support with glucose-insulin-potassium for left ventricular pump failure after aortocoronary bypass surgery. Circulation. 1989;80:I9-6.Google Scholar
  38. 38.
    Lazar HL, Philippides G, Fitzgerald C, Lancaster D, Shemin RJ, Apstein C. Glucose-insulin-potassium solutions enhance recovery after urgent coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1997;113:354-60.Google Scholar
  39. 39.
    Taegtmeyer H, Goodwin GW, Doenst T, Frazier OH. Substrate metabolism as a determinant for postischemic functional recovery of the Heart. Am J Cardiol. 1997;80:3A-10A.Google Scholar
  40. 40.
    Lazar HL, Chipkin S, Philippides G, Bao Y, Apstein C. Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations. Ann Thorac Surg. 2000;70:145-50.Google Scholar
  41. 41.
    Bruemmer-Smith S, Avidan MS, Harris B, Sudan S, Sherwood R, Desai JB, et al. Glucose, insulin and potassium for heart protection during cardiac surgery. Br J Anaesth. 2002;88:489-95.Google Scholar
  42. 42.
    Lell WA, Nielsen VG, McGiffin DC, Schmidt FE Jr, Kirklin JK, Stanley AW Jr. Glucose-insulin-potassium infusion for myocardial protection during off- pump coronary artery surgery. Ann Thorac Surg. 2002;73:1246-51.Google Scholar
  43. 43.
    McNulty PH, Pfau S, Deckelbaum LI. Effect of plasma insulin level on myocardial blood flow and its mechanism of action. Am J Cardiol. 2000;85:16-5.Google Scholar
  44. 44.
    McDaniel HG, Rogers WJ, Russell RO Jr, Rackley CE. Improved myocardial contractility with glucose-insulin-potassium infusion during pacing in coronary artery disease. Am J Cardiol. 1985;55:932-6.Google Scholar
  45. 45.
    Iozzo P, Chareonthaitawee P, Di TM, Betteridge DJ, Ferrannini E, Camici PG. Regional myocardial blood flow and glucose utilization during fasting and physiological hyperinsulinemia in humans. Am J Physiol Endocrinol Metab. 2002;282:E1163-71.Google Scholar
  46. 46.
    Sundell J, Nuutila P, Laine H, Luotolahti M, Kalliokoski K, Raitakari O, et al. Dose-dependent vasodilating effects of insulin on adenosine-stimulated myocardial blood flow. Diabetes. 2002;51:1125-30.Google Scholar

Copyright information

© Bohn Stafleu van Loghum 2010

Authors and Affiliations

  1. 1.Department of CardiologyVU Medical CentreAmsterdamthe Netherlands
  2. 2.

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