This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.

Department of Clinical Biochemistry Institute of Laboratory Medicine University Hospital Ostrava Ostrava Czechia

Department of Clinical Pharmacology Faculty of Medicine University of Ostrava Syllabova 19 Ostrava 703 00 Czech Republic

Department of Clinical Pharmacology Institute of Laboratory Medicine University Hospital Ostrava 17 listopadu 1790 Ostrava 708 52 Czech Republic

Department of Forensic Medicine Faculty of Medicine University of Ostrava Ostrava 701 03 Czech Republic

Department of Forensic Medicine University Hospital Ostrava Ostrava 70852 Czech Republic

Institute of Laboratory Medicine Faculty of Medicine University of Ostrava Syllabova 19 Ostrava 703 00 Czech Republic

See more in PubMed

Jelínek J, Pelc V, Říha J, Sovák Z, Bruna E, Heranová S et al. Trestní zákoník a trestní řád s poznámkami a judikaturou [Internet]. Leges; 2022 [cited 2024 Feb 13]. https://is.vsfs.cz/publication/10270/en/Trestni-zakonik-a-trestni-rad-s-poznamkami-a-judikaturou/Jelinek-Pelc-Riha-Sovak

Fryšták M. Odborné vyjádření versus znalecký posudek. Dny Práva–2010–Days Law. 2010;1.

Belsey S, Flanagan R. Postmortem biochemistry: current applications. J Forensic Leg Med. 2016;41:49–57. PubMed

Maeda H, Ishikawa T, Michiue T. Forensic biochemistry for functional investigation of death: concept and practical application. Leg Med. 2011;13:55–67. PubMed

Giugliano D, Ceriello A, Esposito K. Glucose metabolism and hyperglycemia. Am J Clin Nutr. 2008;87:S217–22. PubMed

Rewers A. Acute metabolic complications in diabetes. 2021.

Wachtel TJ. The diabetic hyperosmolar state. Clin Geriatr Med. 1990;6:797–806. PubMed

Umpierrez GE, Murphy MB, Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes Spectr. 2002;15:28–36.

Koul PB. Diabetic ketoacidosis: a current appraisal of pathophysiology and management. Clin Pediatr (Phila). 2009;48:135–44. PubMed

Briscoe VJ, Davis SN. Hypoglycemia in type 1 and type 2 diabetes: physiology, pathophysiology, and management. Clin Diabetes. 2006;24:115–21.

Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: an update on pathophysiology, treatment, and prevention. World J Diabetes. 2021;12:2036. PubMed PMC

Sequeira RP. Central nervous system stimulants and drugs that suppress appetite. Side Eff Drugs Annu. 2009;31:1–15.

Schep LJ, Slaughter RJ, Beasley DMG. The clinical toxicology of metamfetamine. Clin Toxicol. 2010;48:675–94. PubMed

Schwarzbach V, Lenk K, Laufs U. Methamphetamine-related cardiovascular diseases. ESC Heart Fail. 2020;7:407–14. PubMed PMC

Herbeck DM, Brecht M-L, Lovinger K. Mortality, causes of death, and health status among methamphetamine users. J Addict Dis. 2015;34:88–100. PubMed PMC

Boyer EW, Seifert SA, Hernon C, Burns M. Methamphetamine: acute intoxication. UpToDate Accessed. 2019;6:22.