Endocrine Abstracts

Hypoglycaemia – especially in elderly hospital in-patients – is far less uncommon in non-diabetic patients than was previously thought but is only very rarely due to accidental or malicious ‘insulin’ (including insulin analogues and sulphonylurea) administration. The question of when to suspect that this might be the case and how to confirm or refute it is one that crops up from time to time in every community. Sometimes it is relatively simple and easy to confirm as, for example, when the patient is alive when first seen, relevant blood samples have been collected and the appropriate analyses ie for plasma glucose, insulin, C-peptide, proinsulin, β-hydroxybutyrate, insulin-antibodies and sulphonylurea concentrations, have been carried out on them. More often it is extremely difficult or impossible, especially in retrospect or if the patient is dead when first seen and reliance is placed on retrospective analysis of the clinical case notes. Equally difficult is identifying the culprit in cases of established misfeasance whether due to accident or negligence or to malicious (including misguided mercy killing) insulin administration. In such cases conviction or exoneration depends heavily upon the quality of advocacy and the persuasiveness of expert opinion in court.