POSTMORTEM INSULIN OVERDOSEJosh deGuzman

Blood Glucose• Blood glucose – sugar within the bloodstream that

provides energy for the cells of the body• Postmortem blood glucose levels fluctuate; variable

decrease in glucose after death• Can be synthesized in vitreous humor in

decomposed/embalmed bodies

Insulin• Hormone produced by pancreas• Secreted by beta cells• Lowers blood sugar (glucose) levels • Induces muscle and liver cells to take up glucose and

store it as glycogen for later use• Stimulates anabolic processes (fat and protein synthesis)

Types of InsulinEndogenous:

• Originating within the body• Insulin made by the pancreas

Exogenous:• Originating outside of the body• Insulin injected or infused by insulin pump

Half-life of Insulin• Insulin aspart: 81 minutes• Insulin aspart mix: 8 – 9 hours• Insulin determir: 5 – 7 hours• Insulin glulisine: 13 minutes (after IV administration),

42 minutes (after subcutaneous administration)• Insulin lispro: 1 hour

Connecting Peptide (C-Peptide)• C-peptide – byproduct of insulin production by the

pancreas• Levels gauge amount of insulin being produced• Endogenous insulin production corresponds with an

increase in c-peptide levels• Exogenous insulin administration is not associated with an

increase in c-peptide levels• C-peptide levels fall after approximately 24 hours post

mortem

Postmortem Analysis• All dead bodies have low blood glucose levels; cannot

accurately diagnose hypoglycemia from postmortem analysis of vitreous humor glucose

• Must test soon after death due to fast half-life of insulin• Cannot calculate the dose of insulin administered

exogenously from postmortem blood analysis• Testing c-peptide not useful since it’s levels are not

associated with exogenous insulin

Sources• http://www.diabetesselfmanagement.com/diabetes-resour

ces/definitions/endogenousexogenous/

• http://www.drugs.com/ppa/insulin-analogs.html• http://www.forensicmed.co.uk/science/toxicology/post-mor

tem-biochemistry/

• http://www.medicalnewstoday.com/articles/249413.php• http://www.medicinenet.com/script/main/art.asp?articlekey

=12467