The ratio of insulin to C-peptide can be used to make a forensic diagnosis of exogenous insulin overdosage

Iwase, Hirotaro; Kobayashi, Masahiko; Nakajima, Makoto; Takatori, Takehiko

doi:10.1016/s0379-0738(00)00298-x

Cited by 68 publications

(54 citation statements)

References 10 publications

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“…An elevated postmortem serum insulin level, along with a suppressed C peptide level, is virtually diagnostic of an exogenous insulin administration. If an injection site is detected on the body, the excision of the surrounding dermal area should be taken into consideration: toxicological analysis and immunohistochemical demonstration of insulin in the tissues at the injection site should always be performed [73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91].…”

Section: Insulin and C Peptidementioning

confidence: 99%

Postmortem chemistry update part I

2011

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Postmortem chemistry is becoming increasingly essential in the forensic pathology routine and considerable progress has been made over the past years. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine may provide significant information in determining the cause of death or in elucidating forensic cases. Postmortem chemistry may essentially contribute in the determination of the cause of death when the pathophysiological changes involved in the death process cannot be detected by morphological methods (e.g. diabetes mellitus, alcoholic ketoacidosis and electrolytic disorders). It can also provide significant information and useful support in other forensic situations, including anaphylaxis, hypothermia, sepsis and hormonal disturbances. In this article, we present a review of the literature that covers this vast topic and we report the results of our observations. We have focused our attention on glucose metabolism, renal function and electrolytic disorders.

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Section: Insulin and C Peptidementioning

confidence: 99%

Postmortem chemistry update part I

2011

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“…Forensic scientists reported that serum insulin concentration in corpses varies significantly amongst individuals [25]. Iwase et al [26] said that insulin level may decrease after death. Powner and Thicoipe [27,28] reported that serum insulin levels either stay at the same level as antemortem levels or are higher.…”

Section: Human Insulin Synthetic Insulin Analogues C-peptide and Prmentioning

confidence: 99%

“…In case of an insulinoma, the ratio of insulin to C-peptide in patients is equivalent to the one in healthy individuals (0.2 [41,42] To interpret correctly the ratio of insulin to C-peptide their absolute concentration, blood glucose concentration, sampling conditions and sampling time must be brought into relation [52, 53]. Iwase et al [26] demonstrated that the ratio of insulin to C-peptide in corpses that were examined less than 24 h after death was significantly lower than in those who were examined later.…”

Section: Relevancementioning

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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“…The physiological levels of insulin in the healthy adult are 24-38 units per day or average of 8-11 nlU/mL. 11 In this murine study, the dosage of insulin encapsulated in MS is lower than the doses above. (Table 1).…”

Section: Dex and Insulin Dosagementioning

confidence: 75%

Adipogenic Factor-Loaded Microspheres Increase Retention of Transplanted Adipose Tissue

Kelmendi‐Doko

Marra

Vidic

et al. 2014

Tissue Engineering Part A

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The aim of this study was to develop and test a controlled delivery system of two adipogenic factors (insulin and dexamethasone [Dex]), to generate stable adipose tissue when mixed with disaggregated human fat. Both drugs were encapsulated in poly(lactic-co-glycolic acid), (PLGA) microspheres (MS) and mixed with human lipoaspirate to induce adipogenesis in vivo. It was hypothesized that the slow release of insulin and Dex would enhance both adipogenesis and angiogenesis, thus retaining the fat graft volume in a nude mouse model. Insulin/Dexloaded PLGA MS (Insulin/Dex MS) were prepared using both single and double emulsion/solvent extraction techniques. The bioactivity of the drugs was assessed by mixing the MS with human lipoaspirate and injecting subcutaneously into the dorsal aspect of an athymic mouse. Five doses of the drugs were examined and samples were analyzed grossly and histologically after 5 weeks in vivo. Mass and volume of the grafts were measured with the microsphere-containing samples, demonstrating increased mass and volume with increasing drug doses. Histological analysis, including H&E and CD31, indicated increased vascularization within the insulin/Dex MScontaining samples compared with the lipoaspirate-only samples. This study demonstrates that the controlled delivery of adipogenic factors such as insulin and Dex through polymer MS can significantly enhance tissue formation and vascularization, therefore presenting a potentially clinically relevant model of adipose retention.

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The ratio of insulin to C-peptide can be used to make a forensic diagnosis of exogenous insulin overdosage

Cited by 68 publications

References 10 publications

Postmortem chemistry update part I

Postmortem chemistry update part I

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

Adipogenic Factor-Loaded Microspheres Increase Retention of Transplanted Adipose Tissue

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