Fatal Insulin Overdoses: Case Report and Update on Testing Methodology

Suicidal insulin overdoses are an under‐recognized and uncommon cause of death, often relying on scene and nonspecific autopsy findings. Here, we present a case report of a fatal exogenous insulin overdose in a patient with type 1 diabetes. In our case, there were no contributory autopsy findings; however, serum analog aspart insulin levels were c. 10× the predicted therapeutic upper limit (4000, reference 6.6–55 uU/mL), which correlated with scene findings. This was specifically determined by a newly developed immunocapture liquid chromatography–tandem mass spectrometry assay, able to discriminate between various synthetic insulin analogs. Total insulin levels by immunoassay were highly elevated on the Siemens Advia Centaur, but not the Roche platforms (4741 vs. 5.2 uU/mL, respectively), showing variable sensitivity of detection within the same analog depending on assay. We discuss the prevalence and features to look for at autopsy in these types of cases. Additionally, analytical options for testing insulin levels, including new methodologies, guidance on collection of samples, as well as an outline of available historical reference range data are discussed.     

化痰降浊逐瘀方治疗2型糖尿病痰浊瘀阻证合并血脂异常30例

目的 观察化痰降浊逐瘀方治疗2型糖尿病痰浊瘀阻证合并血脂异常的临床疗效。方法 将60例2型糖尿病痰浊瘀阻证合并血脂异常患者随机分为观察组和对照组,每组30例。对照组给予二甲双胍和血脂康治疗,观察组在对照组基础上加用化痰降浊逐瘀方,疗程为16周。评价两组患者治疗前后中医证候积分,观察两组患者治疗前后糖化血红蛋白、空腹血糖、餐后2 h血糖、血脂变化。结果 治疗后,两组患者中医证候积分较治疗前均明显下降（P<0.05）;两组患者治疗前后中医证候积分差值比较,差异具有统计学意义（P<0.05）;两组患者临床疗效的分布比较,差异具有统计学意义（P<0.05）;治疗后,两组患者实验室指标较治疗前均显著改善（P<0.05）;两组患者治疗前后各项实验室指标差值比较,差异具有统计学意义（P<0.05）。结论 化痰降浊逐瘀方可改善2型糖尿病痰浊瘀阻证合并血脂异常患者的症状,降低其血糖水平,调节血脂。     

益气养阴活血方治疗2型糖尿病气阴两虚夹瘀证临床观察

目的 观察益气养阴活血方治疗2型糖尿病气阴两虚夹瘀证的临床疗效。方法 将60例2型糖尿病气阴两虚夹瘀证患者随机分为观察组和对照组,每组30例。两组患者均予饮食、运动等健康教育,并予西药控制血糖,观察组患者同时口服益气养阴活血方。治疗前和治疗1周后分别检测两组患者空腹血糖（fasting plasma glucose, FPG）、血糖水平标准差（standard deviation of blood glucose,SDBG）和空腹血糖变异系数（coefficient of variation of fasting plasma glucose,CV-FPG）,同时观察两组患者治疗4周后临床症状的改善情况。结果 治疗后两组FPG、SDBG和CV FPG均较治疗前显著降低（P<0.05）,观察组FPG、SDBG降低程度显著大于对照组（P<0.05）;观察组患者治疗后口渴多饮、乏力倦怠、多食易饥、五心烦热和肢体麻木的改善程度均明显优于对照组（P<0.05）;观察组中医证候疗效明显优于对照组（P<0.05）。结论 益气养阴活血方能有效降低2型糖尿病气阴两虚夹瘀证患者的空腹血糖和血糖波动,改善其临床症状。     

丹蛭降糖胶囊对糖尿病大鼠血清TNF-α和CXCL-5的影响

目的 观察丹蛭降糖胶囊对糖尿病大鼠血清肿瘤坏死因子-α（tumor necrosis factor alpha, TNF-α）和趋化因子（C-X-C基序）配基5（chemokine (C-X-C motif) ligand 5,CXCL-5）表达的影响,探究其降糖作用机制。方法 将健康雄性SD大鼠随机分为正常对照组,模型组,吡格列酮组,丹蛭降糖胶囊高、低剂量组。采用链尿佐菌素单次腹腔注射法复制糖尿病模型,采用双抗体夹心法测定大鼠血清TNF-α、CXCL-5水平。结果 与模型组比较,吡格列酮组和丹蛭降糖胶囊高、低剂量组TNF-α、CXCL-5水平显著降低（P＜0.01）,3个给药组TNF-α、CXCL-5比较,差异均无统计学意义（P>0.05）。与模型复制后0周末比较,2、4、8周末,吡格列酮组和丹蛭降糖胶囊高、低剂量组血糖水平均显著降低（P<0.01）。2、4、8周末,与模型组比较,吡格列酮组及丹蛭降糖胶囊高、低剂量组血糖水平均显著降低（P＜0.01）,但3个给药组之间血糖水平比较,差异均无统计学意义（P>0.05）。Pearson相关分析显示,8周末血糖水平与TNF-α、CXCL-5均呈正相关（P<0.01）。结论 丹蛭降糖胶囊降低糖尿病大鼠血糖的机制与其降低血清TNF-α、CXCL-5水平有关。     

复方丹参滴丸治疗糖尿病视网膜病变Meta分析

目的评价复方丹参滴丸治疗糖尿病视网膜病变的疗效及安全性。方法在中国学术期刊全文数据库、中国生物医学文献数据库、万方数据库、维普数据库、Pubmed数据库中,检索2000—2014年复方丹参滴丸治疗糖尿病视网膜病变的随机对照研究文献,对这些研究的基本特征和方法学质量进行评价,采用RevMan 5.0软件对治疗效应(临床综合疗效、视力、视野灰度值、血管瘤数、出血灶面积)进行meta分析。结果共纳入17篇文献,共1 050例患者。Meta分析结果显示,研究组临床综合疗效显著优于对照组(OR值=2.79,95%CI为[1.98,3.92],P0.01),研究组对视力的效应(OR值=3.33,95%CI为[2.02,5.47],P0.01;WMD值=0.20,95%CI为[0.14,0.25],P0.01)、对视野灰度值的效应(WMD值=-2.33,95%CI为[-2.80,-1.87],P0.01)、对血管瘤数量的效应(WMD值=-3.36,95%CI为[-4.09,-2.62],P0.01)、对出血灶面积的效应(WMD值=-0.56,95%CI为[-0.79,-0.32],P0.01)均优于对照组。结论复方丹参滴丸对糖尿病视网膜病变具有较好疗效,其安全性较高。     

丹蛭降糖胶囊对2型糖尿病合并肥胖患者胰岛素抵抗及脂毒性改善作用

目的 观察具有益气活血功效中药复方制剂丹蛭降糖胶囊对2型糖尿病(type 2 diabetes mellitus,T2DM)合并肥胖患者胰岛素抵抗、脂毒性相关指标的改善效果.方法 选取T2DM合并肥胖患者80例,随机分为对照组及治疗组各40例,均给予降低血糖、调节血脂的基础治疗,治疗组在常规治疗上加用中药复方制剂丹蛭降...     

Psychological profile of sex offenders using weapons in their crimes

Abstract

A sample of 1533 sex offenders was examined for clinical characteristics associated with weapon use in their crimes. A total of 24.9% used weapons, most often knives (50.1%), with 13.6% using multiple weapons. Weapon-users were a very disturbed group, who showed a significantly higher prevalence than non-users of psychoses, suicide attempts, alcoholism, drug addiction and abuse, personality disorders, psychopathy, attention deficit hyperactivity disorder, cognitive impairment and violent criminal histories. The weapon-users recidivated more often than non-users and appeared in court on 8.7 separate occasions compared to 2.9 for non-users in an average follow-up of 21.5 years. The best predictors of weapon use were total violent offence convictions, sadism diagnoses and adult versus child victims. The importance of examining weapon use in assessing sex offenders is discussed.     

Fatal Diabetic Ketoacidosis—A Potential Complication of MDMA (Ecstasy) Use

A 19‐year‐old woman with insulin‐dependent diabetes mellitus was found dead in bed having allegedly recently taken ecstasy and consumed alcohol. At autopsy, there were microhemorrhages in the brain with subnuclear vacuolization and Armanni–Ebstein changes in renal tubules. Biochemical analyses confirmed diabetic ketoacidosis (vitreous glucose—46.5 mmol/L; β‐OH butyrate—13.86 mmol/L.). Toxicological analyses of blood showed a low level of 3,4‐methylenedioxy‐methamphetamine (MDMA) (0.01 mg/L), with acetone but no alcohol or other common drugs. Death was attributed to diabetic ketoacidosis most likely provoked by mixed MDMA/alcohol ingestion. Although the use of illicit drugs by young individuals with diabetes mellitus is being increasingly recognized, it has been noted that there is minimal information about the relationship between drug use and acute diabetic complications. Toxicological screening of cases of lethal diabetic ketoacidosis in the young may clarify lethal mechanisms in individual cases and also help to determine the extent of this problem.     

Academic Achievement and the Self-Image of Adolescents with Diabetes Mellitus Type-1 and Rheumatoid Arthritis

A total of 69 adolescents, 21 with diabetes mellitus type-1 (DM), 24 with rheumatoid arthritis (RA), and 24 controls matched for sex, age, social background, and living environment, were compared by means of their school grades and the Offer Self-Image Questionnaire. The ages of the children at the time of the diagnosis of the disease and its subsequent duration were the same in the DM and the RA groups. Results show that the academic achievement of adolescents with DM who are well balanced and adolescents with RA with mild or moderate symptoms are equal to those of their healthy peers. In the OSIQ scales there were no statistically significant differences between the groups. In the groups of controls, there were more significant correlations between the OSIQ scores and the school grades than those with the DM or RA adolescents. The direction was positive. The correlations of the 3 groups did not differ significantly from each other. In case of adolescents with various kinds of chronic diseases, it is important to support their motivation for learning and planning the future.Medical doctor, specializes in child and adolescent psychiatry. Since gaining her PhD at the University of Turku in 1987, she has also specialized in hospital administration and adolescent psychotherapy. Since 1982, she has been the senior doctor of the Child Psychiatric Clinic of Satakunta Hospital District. Currently she is the head of the Adolescent Psychiatry Clinic, Turku University Hospital. She has trained both child psychiatrists and adolescent psychiatrists. During the years 1990–1992 she has participated as a postdoctoral fellow in the Clinical Research Training Program for Adolescents sponsored by the NIMH.Experienced Psychologist and Researcher. She received her PhD in neuropsychology at the University of Turku. She is currently a clinical psychologist at the Adolescent Psychiatry Unit of Turku University Central Hospital. She is an expert on neuropsychological test methods and also responsible for teaching their application.     

Measurement of Postmortem 1,5‐anhydroglucitol in Vitreous Humor for Forensic Diagnosis

In forensic diagnosis, postmortem blood glucose is known to be susceptible to change after death. However, the 1,5‐anhydroglucitol (1,5‐AG) concentrations in plasma and cerebrospinal fluid (CSF) reflect the mean blood glucose level for a short period of time. In this study, we compared the postmortem 1,5‐AG concentrations in vitreous humor and CSF in 47 subjects to evaluate the utility of this concentration in the vitreous humor for forensic diagnosis. The postmortem 1,5‐AG concentrations in vitreous humor (mean±SD: 20.2 ± 8.7 μg/mL) and CSF (16.8 ± 8.7 μg/mL) did not differ significantly and showed a strong correlation (r² = 0.87, p < 0.01). These results suggest that the vitreous humor 1,5‐AG concentration provides useful information on the antemortem blood glucose level, in addition to the HbA1c value and the CSF 1,5‐AG concentration.