Insulin and hypoglycemia . Forensic considerations

Diabetes mellitus is one of the most frequent chronic diseases worldwide. Of special clinical and forensic interest is the development of hypoglycemia, which can occur either spontaneously or after administration of insulin and oral antidiabetics. Not only hypoglycemia is of special forensic interest but also the so-called hypoglycemia unawareness disorder which is observed in 25 % of people with type 1 diabetes. The diagnostics and assessment of hypoglycemia in road users is based on the anamnesis, evaluation of the therapy in a defined case and laboratory analyses which, however, are often carried out too late. In cases of deliberate induction of hypoglycemia with a suicidal or homicidal intent, interpretation of the analyses is faced with several challenges. The postmortem diagnosis of hypoglycemia should be carried out by analyzing the vitreous humor. For the determination of insulin administered by a third party, mass spectrometric analyses of insulin and C-peptide in serum, vitreous humor and tissue from the injection side are absolutely necessary.