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?
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.
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?
There was a Perry Mason mystery wherein the murder was committed by heating a diabetic’s insulin, rendering it useless. Does that count?
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.
You Claus apologists . . .
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,
Plus, the very real possibility of not dying, just entering a prolonged coma.
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. ;))
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.
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.
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?
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.
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.
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.
Thank you! I found that post very interesting.
Was she diabetic, or do you know?