Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 6 2026 06 08 704 705 Alla Reddy Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Sandip Baheti Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Siddharth Baheti Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. Jyothi Nair Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India. 2025 11 29 2025 12 08   Hypoglycemia is an under-recognized cause of intraoperative tachyarrhythmias because autonomic warning signs are obscured under general anesthesia. We report a 52-year-old male with type 2 diabetes mellitus who developed ventricular tachycardia and persistent tachycardia immediately after induction for endoscopic combined intrarenal surgery. Despite adequate anesthetic depth and stable hemodynamics, the arrhythmia did not respond to lignocaine. Point-of-care glucose testing revealed severe hypoglycemia (44 mg/dL), and dextrose administration rapidly normalized the heart rate. Opioid-induced alterations in glucose metabolism and diabetic autonomic neuropathy likely contributed. This case underscores the need to consider hypoglycemia in the differential diagnosis of unexplained intraoperative tachycardia in diabetic patients and to perform early glucose assessment. https://aacc.tums.ac.ir/index.php/aacc/article/view/1504