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March 31, 2002

Hypoglycemia

Question from Evansville, Indiana, USA:

About two months ago, my 42 year old brother passed away, and his formal inquest was scheduled for this week, but was postponed at the family's request because of an inconclusive result on an insulin test, and a sample of his blood is now being tested for insulin at a major medical center. The lawyer we have representing the family at the inquest told us that it looks as if suicide or criminal action are the choices which may be given to the six person inquest panel. I have several questions: What happens to a person who does not have diabetes who may be given an injection of insulin? How long would it take for this injection to take effect? Could person who does not have diabetes self-administer an insulin injection, discard the syringe, drive to a camping area, climb out of his pick-up truck, drop his pick-up's tailgate, take off his pants, and climb into his sleeping bag and zip it up? Would a person who did the above be too incoherent, or immobile, to do what I suggested above? I would appreciate an answer to my questions, because we aren't sure when another inquest will be convened.

Answer:

The main effect of giving insulin to a person who does not have diabetes would be to produce hypoglycemia. The length of time before this took effect and the severity when it did take effect would depend on the kind of insulin, the route of administration, whether any food had been recently ingested, and of course on the effectiveness of the normal counterregulatory hormonal response to the low blood sugar.

A postmortem blood sugar may not be a helpful index of insulin overdose because it is so rapidly destroyed in the bloodstream, and tissue assays from the injection site have been of more forensic value.

Your brother could certainly have carried out all the activities that you listed, except perhaps the drive to the campsite depending on how long that would have taken, but of course the insulin might have been given at the campsite. To give you a rough idea of timing, the most commonly used Regular insulin injected subcutaneously would take between 30 to 60 minutes to begin to act and between two to four hours to achieve its maximum impact.

DOB