Death by poisoning through ministration of insulin: a review

Abstract

Hypoglycemia as a cause of criminal death is rare and of difficult diagnosis. The purpose of

this review is to alert those involved in criminal investigations to identify the possibility of hypoglycemia being caused in a criminal manner as well as to discuss the forensic procedures related thereto. This review found 69 cases of global literature, the majority of the criminals being close relatives, with some knowledge of the use of insulin, and the majority of the victims survived when they were discovered and responded to the treatment. Most of the victims were children, elderlies and patients. Hypoglycemia is a first sign of homicidal use of insulin on live persons and requires the demonstration of a concentration of plasmatic insulin over 1000pmol/L and undetectable levels of plasmatic peptide C to establish the diagnosis. Measurements of plasmatic glucose are trifling when the victim is found dead. Immunoassays available for clinical use to detect and measure insulin and peptide C may have analytical errors and should not be considered reliable, unless special precautions, including the separation by gel filtration or high-pressure liquid chromatography, are taken before the analysis. If injection marks are identified, the coroner should remove an area of adjacent tissue and forward it for immunohistological analysis. The coroner should also request a dosage of sulfonylurea by mass spectrometry on blood and urine samples to eliminate any possibility of usage of such agent, which could disguise the laboratorial condition.