A retrospective study of 29 fatal cases of insulin overdose

• Published in: Forensic science international Vol. 361; p. 112126
• Main Authors: Yuan, Yuhao, Yu, Zhonghao, Tong, Fang, Zhao, Shuquan, Li, Yiling, Shi, Qing, Zhou, Yiwu
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.08.2024; Elsevier Limited
• Subjects: Autopsies; Autopsy; Case review; Death; Diabetes; Diabetes mellitus; Forensic science; Forensic toxicology; Glucose; Injection; Insulin; Insulin overdose; Laboratory tests; Mass spectrometry; Mass spectroscopy; Medical records; Mortality; Murders & murder attempts; Overdose; Peptides; Poisoning; Protamine sulfate; Statistical analysis; Suicides & suicide attempts; Insulin overdose; Case review; Forensic toxicology; Insulin
• ISSN: 0379-0738; 1872-6283; 1872-6283
• DOI: 10.1016/j.forsciint.2024.112126

To summarize recent cases of fatal insulin poisoning both domestically and internationally, thereby offering valuable insights for the forensic identification of insulin overdose cases. Literature published since 2000 on fatal insulin overdose were systematically searched and screened. Data encompassing variables such as year, age, sex, cause of death, scene conditions, occupations, medical histories of victims and perpetrators, autopsy timing, dosage and administration methods, forensic pathology, and toxicological analysis, were compiled for rigorous statistical analysis. Among the 29 fatal cases of insulin poisoning, suicides and homicides accounted for 55.2 % and 41.4 %, respectively. Precisely 34.5 % of victims or perpetrators were associated with the medical industry, 27.6 % had diabetes, and 24.1 % had mental illnesses such as depression. Intravenous injection resulted in quicker death than did subcutaneous injection. In some cases, immunohistochemical staining of insulin and protamine at injection sites yielded positive results. The average molar ratio of insulin to C-peptide in post-mortem blood was 13.76 ± 5.167, indicating a significant diagnostic value for insulin poisoning. Assessment of cases of fatal insulin overdose should be thorough, incorporating case investigation, scene examination, medical records review, autopsy findings, pathological examinations, and laboratory tests, alongside considering the condition of the body and timing of death autopsy. Using mass spectrometry to detect insulin proves valuable, particularly in cases of poor body preservation. •Studies reveal a notable incidence of fatal insulin poisoning.•Victims and perpetrators are connected to the medical field and have diabetes or mental health issues.•Findings highlight the importance of immunohistochemical staining and assessing the insulin to C-peptide ratio in post-mortem blood.•Variations in injection methods (intravenous vs. subcutaneous) influence the onset and speed of fatal outcomes.•Advanced techniques such as mass spectrometry prove indispensable in cases.