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Old 08-23-2013, 01:18 PM
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Murder or suicide via insulin

I am type 2 diabetic, and I'm on a very concentrated form of insulin. It occurs to me that if I were suicidal (I'm not), an easy method would be to give myself a whole lot more insulin than prescribed, causing a drop in my glucose, approaching zero.

Has there ever been a documented case of murder or suicide via insulin?
Old 08-23-2013, 01:29 PM
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Claus von Bülow was thought to have killed his wife, Sunny, with insulin.
Old 08-23-2013, 01:36 PM
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Quote:
Originally Posted by kayaker View Post
Claus von Bülow was thought to have killed his wife, Sunny, with insulin.
Of attempting to kill her. He was actually convicted of attempted murder but it was overturned on appeal. He was found not guilty at his second trial.

Last edited by Kolak of Twilo; 08-23-2013 at 01:40 PM.
Old 08-23-2013, 01:38 PM
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Many, many times. And there was a case where a woman put vecuronium, a paralytic agent used in anesthesia and artificial comas, into her husband's insulin pump.

To the OP: Are you on U-500?
Old 08-23-2013, 04:43 PM
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There was a Perry Mason mystery wherein the murder was committed by heating a diabetic's insulin, rendering it useless. Does that count?
Old 08-23-2013, 04:51 PM
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The film Memento has a subplot about a woman who killed herself by convincing her memory-damaged husband to repeatedly give her insulin injections, which he couldn't remember performing.
Old 08-23-2013, 08:02 PM
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Originally Posted by Kolak of Twilo View Post
Of attempting to kill her. He was actually convicted of attempted murder but it was overturned on appeal. He was found not guilty at his second trial.
You Claus apologists . . .
Old 08-23-2013, 08:19 PM
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Based on my experience when my blood sugar has gone too low, it wouldn't be a very comfortable way to go -- dizziness, sweating, shakes, chills, nausea, etc. Taking an overdose of any common sleeping pill would seem like an easier way to go,
Old 08-23-2013, 08:24 PM
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Originally Posted by [email protected] View Post
Based on my experience when my blood sugar has gone too low, it wouldn't be a very comfortable way to go -- dizziness, sweating, shakes, chills, nausea, etc.
Plus, the very real possibility of not dying, just entering a prolonged coma.
Old 08-23-2013, 08:52 PM
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Originally Posted by [email protected] View Post
Based on my experience when my blood sugar has gone too low, it wouldn't be a very comfortable way to go -- dizziness, sweating, shakes, chills, nausea, etc. Taking an overdose of any common sleeping pill would seem like an easier way to go,
Take enough and you pass thru conscious hypoglycemia quickly to unconsciousness, seizures, and brain death.

That's why glucagon injectors are often used to bring the blood sugar level up FAST.

Not an issue for most folks on insulin, gladly.
Old 08-23-2013, 09:06 PM
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Originally Posted by Qadgop the Mercotan View Post
Take enough and you pass thru conscious hypoglycemia quickly to unconsciousness, seizures, and brain death.

That's why glucagon injectors are often used to bring the blood sugar level up FAST.

Not an issue for most folks on insulin, gladly.
But glucagon is produced endogenously, right? So not knowing your body's capability to produce glucagon could defeat a suicide attempt. Or is glucagon predictable? (Don't need answer fast. )
Old 08-23-2013, 09:34 PM
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Originally Posted by kayaker View Post
But glucagon is produced endogenously, right? So not knowing your body's capability to produce glucagon could defeat a suicide attempt. Or is glucagon predictable? (Don't need answer fast. )
Somewhat predictable, as long as you don't rely on it.

Endogenous glucacon has kept a lot of diabetics from becoming gomertose due to insulin slips. But once the body's stores are exhausted, the surfeit of insulin from an intentional OD can work its evil magic.

Even so, the body fights to preserve itself, and folks have survived massive ODs of insulin, even if in a vegetative state.

Insulin OD is no sure path to death, that's the take-home message. But if you want to make a dramatic suicide-like gesture, using insulin sure can have unintended consequences.
Old 08-23-2013, 09:46 PM
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Quote:
Originally Posted by Qadgop the Mercotan View Post
Somewhat predictable, as long as you don't rely on it.

Endogenous glucacon has kept a lot of diabetics from becoming gomertose due to insulin slips. But once the body's stores are exhausted, the surfeit of insulin from an intentional OD can work its evil magic.

Even so, the body fights to preserve itself, and folks have survived massive ODs of insulin, even if in a vegetative state.

Insulin OD is no sure path to death, that's the take-home message. But if you want to make a dramatic suicide-like gesture, using insulin sure can have unintended consequences.
How could this have slipped my mind? I just read the new book "The Good Nurse" a few weeks ago. It's about Charles Cullen, the medical serial killer who was profiled on "60 Minutes". One of his favorite methods was insulin, which he injected into IV bags but did not use the port.
Old 08-23-2013, 09:59 PM
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I worked for a while at a local hospital where a nurse killed herself with insulin. She wasn't someone I knew, though I had met her once when working on her floor. She managed to get an IV line in herself, injected herself with a mixture of long and short acting insulins, and then gave herself some IV push Ativan. Her ex-boyfriend found her in time to get the paramedics there, but by then the damage had been done. She lingered in a coma for a few days before her family decided to take her off life support. It was a horrible thing and the hospital brought in counselors for her coworkers. I was told at the time that the fact she used a combination of insulins with different peaks and action times made it almost impossible to treat her - she must have really wanted to be sure. Sad.
Old 08-23-2013, 10:06 PM
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I should probably know this, but I don't: what's the mechanism of death? I understand that hypoglycemia causes seizures and coma and stuff, but...why, if it's caused by excess insulin and not insufficient glucose? All that insulin drags the glucose out of the blood and into the cells, right, and...then what?
Old 08-23-2013, 10:22 PM
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According to the literature, rate of successful attempts is only about 25%, but suspect there are more deaths that are unreported. Cancer patient with diabetes comes to mind. I did have a friend who accidentally overdosed (took Humalog instead of his Lantus). Once he realized his problem he began drinking Coke and eating anything in he house with sugar in it. Scared him big-time. Lesson learned: if your blindly drunk, skip your evening long-lasting insulin injection and wait until you are sober.
Old 08-23-2013, 11:04 PM
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There was an episode of Law & Order where a bunch of old rich folks were using insulin to put their spouses into comas in order for fun sexy times with people in comas. Then, of course, it went horribly wrong....

It was an episode from 2000, not sure exactly what headlines it was ripped from.

Last edited by ZipperJJ; 08-23-2013 at 11:05 PM.
Old 08-23-2013, 11:38 PM
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In the jurisdiction where I work as a medical examiner, we see this probably 1-3 times a year. Suicide by insulin that is. That said, you have to suspect it, because routine toxicology does not (at least the lab we use) test for insulin. So you have to request it specifically from a clinical lab. What they detect is an elevated insulin level, which, by itself, is not a slam dunk to interpret. The determination of an insulin overdose really must take into account the circumstances in which it occurs.

AS far as the mechanism of death, it's the hypoglycemia, not the insulin by itself. The brain needs that glucose and an excess of insulin will result in a depletion of blood levels as all the other cells of the body are stimulated to absorb the glucose. Or so that's the way I've always thought of it.

For the biochemistry aficionados out there: How do you tell an excess of exogenous insulin from, say, an intentional or accidental overdose, from an excess of endogenous insulin, from, say, an insulin secreting tumor? When insulin is endogenously secreted it has an extra bit on it that is cleaved off. That extra bit is called C-peptide, which can be detected by a lab, and it should be present in an equal amount as insulin. Exogenous insulin (at least nowadays that it is made by bacteria via recombinant DNA) does not have that extra bit. So when you test for insulin, you should also request a C-peptide level.
Old 08-23-2013, 11:45 PM
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Thank you! I found that post very interesting.
Old 08-24-2013, 12:55 AM
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Quote:
Originally Posted by GythaOgg View Post
I worked for a while at a local hospital where a nurse killed herself with insulin. She wasn't someone I knew, though I had met her once when working on her floor. She managed to get an IV line in herself, injected herself with a mixture of long and short acting insulins, and then gave herself some IV push Ativan. Her ex-boyfriend found her in time to get the paramedics there, but by then the damage had been done. She lingered in a coma for a few days before her family decided to take her off life support. It was a horrible thing and the hospital brought in counselors for her coworkers. I was told at the time that the fact she used a combination of insulins with different peaks and action times made it almost impossible to treat her - she must have really wanted to be sure. Sad.
Was she diabetic, or do you know?
Old 08-24-2013, 03:00 AM
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We've had some such cases in Finland, here's one example.
Old 08-24-2013, 10:42 AM
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Originally Posted by nearwildheaven View Post
Was she diabetic, or do you know?
She was not. She obtained the insulin from the stock kept on the floor on which she worked, I don't know with the ativan. This was back about ten years ago. That particular hospital was phasing in an automated dispensing system (Pyxis) but it had some issues and they were only using it for narcotics; she was also a charge nurse and had override codes for the system. Also, typically, hospitals see a lot of patients who are only on insulin for their admissions and go back to oral meds when they go home, and leave the half-empty vials at the hospital. There's always, or was, extra insulin vials floating around the med carts. I hope things have changed; I haven't done hospital nursing since around that time.
Old 08-24-2013, 10:51 AM
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When I was doing hospital clinicals about 3-4 years ago, about half of the hospitals I worked at considered insulin a "High Alert" drug that required two RN's to verify the dose before administration and leftovers were strictly tracked. Insulin wasn't allowed to be left at the bedside any more than a vial of morphine would be. I feel like now I finally know why. Yikes.
Old 08-24-2013, 10:57 AM
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fun sexy times with people in comas
Band name!
Old 08-24-2013, 11:07 AM
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The Travis McGee novel One Fearful Yellow Eye outlines a very elaborate (possible) murder of a woman by her doctor-husband. In short, she ate her usual sugar-loaded Sunday breakfast, then shot up with what may have been pure water, and died in a snowbound house while he was out on a call. The empty insulin vial tested at full strength... but had the doctor switched them? (It's not 100% resolved.)
Old 08-24-2013, 11:12 AM
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Originally Posted by GythaOgg View Post
She was not. She obtained the insulin from the stock kept on the floor on which she worked, I don't know with the ativan. This was back about ten years ago. That particular hospital was phasing in an automated dispensing system (Pyxis) but it had some issues and they were only using it for narcotics; she was also a charge nurse and had override codes for the system. Also, typically, hospitals see a lot of patients who are only on insulin for their admissions and go back to oral meds when they go home, and leave the half-empty vials at the hospital. There's always, or was, extra insulin vials floating around the med carts. I hope things have changed; I haven't done hospital nursing since around that time.
Humulin insulin is available OTC too; it's done this way so diabetics don't have to jump through any hoops to get it. Ativan would have come from the dispensing machine, and if she'd pocketed a few partial vials, she could have come up with enough to put her to sleep without raising any suspicions.

Last edited by nearwildheaven; 08-24-2013 at 11:13 AM.
Old 08-24-2013, 04:28 PM
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Originally Posted by NotDeadYet View Post
According to the literature, rate of successful attempts is only about 25%, but suspect there are more deaths that are unreported. Cancer patient with diabetes comes to mind. I did have a friend who accidentally overdosed (took Humalog instead of his Lantus). Once he realized his problem he began drinking Coke and eating anything in he house with sugar in it. Scared him big-time. Lesson learned: if your blindly drunk, skip your evening long-lasting insulin injection and wait until you are sober.
I almost did this once. Dialed up my usual 60-unit dosage for Lantus on the Humalog pen, had the needle screwed on and everything. Only at the last second before I actually injected did it break through my brainfog (I was just really tired, not drunk) that I was holding the blue pen instead of the grey one. The proximity of a moment of probably fatal stupidity was not comfortable...
Old 08-24-2013, 08:20 PM
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Originally Posted by kayaker View Post
But glucagon is produced endogenously, right? So not knowing your body's capability to produce glucagon could defeat a suicide attempt. Or is glucagon predictable? (Don't need answer fast. )
In fact, endogenous glucagon release is just one way the body attempts to counter the effects of low sugar. Another important defence is through the release of adrenalin (aka epinephrine). Either one alone, glucagon or adrenalin, is sufficient to overcome most hypoglycaemic episodes. However, when a huge quantity of insulin has been injected, even that dual system is overwhelmed. Insulin not only lowers the blood sugar directly, but it also inhibits precisely those metabolic processes which are essential for producing sugar and thus reversing hypoglycemia (in other words, during extreme insulin excess, the body's ability to manufacture new glucose, or release stored glucose, is shut down).

Interestingly, but teleologically making sense, is the fact that insulin also inhibits glucagon release. So, during a massive insulin overdose, the only mechanism operating in the short term to produce glucose and reverse the hypoglycemic state, is adrenalin release and action.

And, just to be complete, although it is definitely the case that cortisol (and growth hormone) are also released by the body during hypoglycemia, they take hours to work and are thus useless in reversing the acute, life-threatening hypoglycemia of an insulin reaction (or deliberate overdose).
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