|
Parameter
|
Obvious Suicide
|
Occult Suicide
|
|
suicide note
|
present
|
absent
|
|
insulin vial and syringe
|
present
|
hidden
|
|
injection site
|
obvious
|
occult site
|
Who to suspect of occult insulin injection:
(1) health care professional
(2) someone with access to insulin
(3) no obvious anatomic cause of death found at autopsy
Occult injection sites:
(1) into a mucosal surface
(2) scrotum in male
Testing which can confirm injection of insulin:
(1) elevated insulin, low C-peptide and low proinsulin in serum, vitreous humor or CSF
(2) analysis of injection site if found (demonstrating high levels of insulin by immunohistochemistry or chemical analysis)
False negative analysis:
(1) Post-mortem glucose measurements are unreliable because of post-mortem glycolysis may falsely elevate blood glucose measurements.
(2) Prolonged interval between injection and death (which may occur if the person was comatose for several days).
The only way to positively distinguish homicide with insulin from suicide is by identifying the injection site and demonstrating that it is physically impossible to reach by the person him/herself.
