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Hypoglycaemia is associated with various changes in electrocardiography (ECG). We report recurrent atrial fibrillation (AF) and prolonged QTc interval (QT interval corrected for heart rate) precipitated by insulin-induced hypoglycaemia in a 59-year-old patient with type 1 diabetes. The patient was admitted twice (eight years apart) with severe hypoglycaemia. ECG showed AF and prolonged QTc interval on both occasions. Each time, normal QTc interval and sinus rhythm were established when normoglycaemia was achieved. Simultaneous AF and prolonged QTc interval during a clinical episode of hypoglycaemia could explain the true clinical significance of the effects of hypoglycaemia upon cardiac repolarisation. Copyright © 2010 John Wiley & Sons.