Chapter 2 - Fatal insulin overdose: a case and a short overview

Abstract

A case of suicide by insulin overdose is apparently simple to handle and file, but it triggers more than a few questions and reflections, both because it is rare and because the postmortem assessment can be quite complex. In this example the deceased person was not immediately identified, and the body was found in the open and close to a water source (creek). Critical information, such as clinical and psychiatric history, and/or a farewell letter, were missing, the body had been hastily moved from the death scene by rescue staff. An entomology expert was also needed for the estimation of the postmortem interval (PMI). The external examination and the autopsy ruled out external violence, but the decomposition stage prevented any reliable identification of injection marks. Postmortem biochemistry on blood was consistent with the hypothesis of hypoglycemic encephalopathy by insulin overdose with suicidal intent as cause, mode and manner of death. A short review of up to date literature on insulin overdoses is also outlined, with the aim of providing solid scientific references for similar cases.