This fact was confirmed in the literature and by our own studies performed in the Department of Forensic Medicine and Forensic Toxicology in Katowice [ 32 , 33 ]. Fortunately, insulin crosses the blood-retinal barrier and may be identified in the VH, which is generally very valuable alternative material for many different chemical-toxicological analyses [ 34 , 35 ].
The advantage of this material is that it is easy to obtain during typical forensic autopsy. Another advantage is anatomical isolation, useful especially in the case of advanced autolytic and putrefactive changes in corpore. It has also a very low cell count, so there is a small postmortem metabolism of glucose and other substances by surviving cells.
In Thevis et al. This was a significant advance in postmortem biochemistry. In our department, we have analyzed material consisted of 93 samples of vitreous humor taken during forensic autopsies. Analysis revealed that in 86 vitreous humor samples The concentration of insulin in vitreous humor was determined only in seven cases range of results, 1.
We have described above one of these cases, where insulin was used to commit suicide [ 15 ]. The IRMA method is known as sensitive, specific, and relatively cheap in comparison to modern methods, but it requires adequate apparatus for the measurement of radioactivity and some experience in its interpretation.
It is worth knowing that the studies on insulin determination using antibody-radiolabeled antigen reaction in the late s were the beginning of a new medical discipline—radioimmunology [ 36 ].
Until the introduction of radioimmunoassay RIA , death caused by insulin overdose was extremely difficult to prove [ 4 ]. In , Palmiere et al. Regardless of the method used in toxicological investigation, an analytically confirmed higher level of insulin in the vitreous humor plays an important and even a decisive role in structuring the final medicolegal opinion about the cause of death.
An interesting observation, so far unused in the forensic practice, is an increase in the expression of certain genes stimulated by insulin, especially in hyperinsulinemic conditions. This is a potentially promising area for further research. An example might be the changes of neuropeptide Y NPY gene expression and its release during hypoglycemic stress.
Han et al. They have concluded that these results suggest that NPY may play a role in insulin-induced hypertension. Another example can be increased vascular resistance in the equine digit and overexpression of endothelin-1 ET-1 in the laminar tissue due to the short-term hyperinsulinemia [ 39 ]. An overdose of insulin is a potential life-threatening condition and requires urgent medical attention [ 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. The clinical manifestations of hypoglycemia occur when the blood glucose level is less than 2.
Symptomatology includes two groups of symptoms. The first one is caused by stimulation of the autonomic nervous system and includes profuse sweating, anxiety, tremor, and hunger. The second one is caused by progressive dysfunction of the central nervous system CNS due to neuroglycopenia and includes nausea, headache, dizziness, blurred vision, abnormal intellectual processes, behavioral disturbances, and finally loss of consciousness, convulsions, and death.
The most optimal place of the treatment is clinical toxicology ward, but patients who are overdosed with insulin can be also treated in typical intensive care units or in less serious cases—in general internal wards. Physiologically for every molecule of insulin formed, a corresponding molecule of C-peptide is formed. However, it should be remembered that C-peptide is very unstable in postmortem blood [ 4 ].
Treatment of hypoglycemia is initially based on the securing of basic vital functions breathing and circulation. Subsequently, infusions of glucose solution adjusted to the current blood glucose levels are used. Here, learn more about insulin pens. A doctor can help customize a safe and effective insulin therapy regimen for a person with type 1 diabetes. According to the American Academy of Family Physicians, there are several different types of insulin that people can use separately or in combination.
These include :. A doctor will prescribe one of these insulins or a mixture alongside a carefully controlled schedule. Following this closely will reduce the risk of side effects and complications. Learn about different types of insulin here. Alternative treatment options include lifestyle and dietary changes and non-insulin medications, such as metformin. However, if a person is unable to control their blood sugar levels using these treatments, a doctor may recommend insulin therapy.
Women with gestational diabetes typically receive insulin, but they can also manage their diabetes with metformin. A doctor will explain the safest way to take these medications during pregnancy.
According to the American Diabetes Association ADA , several common myths surround the use of insulin therapy for people with type 2 diabetes. People who take insulin may sometimes hear others make the following statements, but they have no basis in research or fact:.
People with type 2 or gestational diabetes should discuss with their doctor whether insulin therapy is the best choice for them. They may be able to use other treatment options to control their blood sugar levels, such as non-insulin medications and lifestyle and dietary changes. It is essential that people who need to take insulin monitor their blood sugar levels regularly.
Taking too much or too little insulin can lead to side effects or complications. Following the prescribed treatment schedule is also vital. It is essential not to miss a dose and take every dose at the right time. Anyone who experiences side effects while taking insulin therapy should speak to a doctor. It is possible that another treatment plan or a different type of insulin may be more suitable for their needs and lifestyle.
People with type 1 diabetes need to take insulin daily to control their blood sugar levels and remain healthy. However, this treatment can cause weight gain at the start of the course, and taking too much insulin can lead to hypoglycemia. Many individuals with type 2 diabetes and gestational diabetes can use non-insulin medications and lifestyle changes to manage their condition without needing insulin.
Ingole said the note was written and signed by the deceased in Marathi said that they had committed suicide because they had suffered a severe financial loss in the commodity business. It further read that no one should be held responsible for their death. Investigations have revealed that Pujari had died between The bodies were handed over to the family members of the victims after a post-mortem was conducted at a government hospital in Chiplun.
We are in the process of recording statements of their family members. A complaint of accidental death has been registered as of now. Investigations in the suicide pact will continue," Ingole added. Both Kulkarni and Pujari were bachelors. They had studied up to HSC. On Friday night, a year-old unmarried doctor, Govind Prakash, allegedly killed his mother Mukambika 76 and sister Shyamala 40 by injecting them with insulin at their house in Rajarajeshwarinagar.
He attempted suicide using the same method, but survived and is now out of danger. His father, Subbaraya Bhat, has filed a case of murder against him. Prakash was a diabetologist and had opened a clinic in Vijayanagar, named after his sister Shyamala. However, he had recently shut down the clinic as he was said to be undergoing depression. The use of insulin as a murder weapon has shocked doctors and patients alike. Metrolife spoke to doctors to understand the dangers of insulin overdose.
Those who cannot produce it on their own inject it into their body, a method of treating diabetes. But when it is given to the wrong person in wrong dosage, it can be a dangerous drug.
The drug can then drastically lower the blood sugar level which can lead to irreversible brain death.
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