Insulin. A Forensic Primer

Fletcher, S.M.

doi:10.1016/s0015-7368(83)71537-9

Cited by 25 publications

(15 citation statements)

References 93 publications

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“…The use of insulin analogs in diabetes therapy reduced the rate of hypoglycemia to nearly 25% (insulin lispro vs. human insulin [14]); other studies only showed that there is a tendency to reduce the frequency of hypoglycemia [15]. The knowledge of possible fatal complications of insulin overdosages occasionally leads to incidents when insulin is used as a weapon either against oneself (suicide or factitious hypoglycemia), against a dependent (Munchausen by proxy), or against another person (homicide) [16]. Arem [17] found 81 cases of factitious hypoinsulinemia in the world literature written until 1985, and more suicides committed by insulin application are documented [18][19][20][21][22][23][24][25][26][27].…”

Section: Hypoglycemiamentioning

confidence: 99%

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

2010

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In developed countries, diabetes is one of the ten most common causes of death. Post mortem diagnosis of glucose metabolism disorders can be difficult and vague because of the lack of characteristic morphological findings. Reviews of the literature are presented concerning biochemical problems in cases of unclear hyper- or hypoglycemia. After repetition of causes, frequency, and mortality of diabetic metabolism disorders, we give hints for the detection of diabetic ketoacidosis, hyperosmolar coma, insulinoma, and insulin- or oral diabetic-induced hypoglycemia. The first part discusses the analytes glucose and lactate, glycated proteins and oral antidiabetics, with special regard to their matrices post mortem, to reference concentrations, stability data and to analytic procedures that should be used in clinical or toxicological laboratories to detect diabetic metabolism disorders after death.

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Section: Hypoglycemiamentioning

confidence: 99%

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

2010

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“…Nethylmaleimide (1 mmol/l) has been reported as an effective inhibitor [122], but it lacked stability in aqueous solution [121]. Appropriate preservatives for blood specimens of insulin and C-peptide are sodium fluoride serum separator tubes [123], heparinized samples are acceptable and the use of EDTA has been discussed controversially [103,[124][125][126]. All plastic and glassware contacting with C-peptide should be washed with a 1% bovine serum albumin solution for example [127] because of an enormous loss of peptide due to adsorption to glass surfaces.…”

Section: Analytical Interferences and Sample Storage For The Peptidesmentioning

confidence: 99%

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

2010

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In continuation to part I, a literature review is presented concerning biochemical problems of forensic post mortem cases of unclear hyperglycaemia or hypoglycaemia. Clinical parameters for this purpose were recently reviewed. Particular attention was paid to the detection of diabetic ketoacidosis, of hyperosmolar coma, insulinoma, insulin-induced or oral diabetic-induced hypoglycaemia. The second part of the review discusses the analytes ketone bodies, synthetic insulins, human insulin, C-peptide, proinsulin and insulin antibodies. Special interest is given to post mortem matrices for those analytes to reference concentrations, stability data, analytic interferences and analytical procedures which should be used in toxicological laboratories willing to detect diabetic metabolism disorders after death.

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“…Prominent cases in the United Kingdom have involved multiple deaths of elderly hospital patients [15], and of children [17], [18]. Similar cases have occurred in the United States [20]–[22], at a Vienna medical centre [23], and at old-age homes in Belgium and the Netherlands [19], [20]. While confirmation of insulin poisoning requires serum insulin and C-peptide concentrations, the first suspicion may be raised by the occurrence of unexplained hypoglycemia [14].…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia in Non-Diabetic In-Patients: Clinical or Criminal?

et al. 2012

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Background and AimWe wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.MethodsWe analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.ResultsAmong the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33–93), at 3.0 mmol/l, 36(CI 24–64), at 2.7 mmol/l, 13(CI 11–19), at 2.5 mmol/l, 11(CI 9–15) and at 2.2 mmol/l, 8(CI 7–11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.ConclusionSignificant non-diabetic hypoglycemia in hospital in–patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.

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Insulin. A Forensic Primer

Cited by 25 publications

References 93 publications

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

Disorders of glucose metabolism–post mortem analyses in forensic cases: part I

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

Hypoglycemia in Non-Diabetic In-Patients: Clinical or Criminal?

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