Diabetes mellitus (DM) is one of the strongest and independent risk factor for cardiovascular morbidity and mortality. DM is almost a synonym for atherosclerosis and coronary artery disease (CAD). High incidence and extent of atherosclerotic heart disease in diabetics is associated with high incidence of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Ventricular tachycardia (VT) is common in patients with HF. It is a significant cause of mortality as sustained VT can degenerate into ventricular fibrillation (VF) and cause SCD. This chapter covers the pathophysiology of ventricular arrhythmia in diabetes and management.