Fatal Insulin Overdoses among Diabetics and Non-Diabetics in South Australia

Deaths due to insulin overdose and subsequent hypoglycaemia have been reported in the literature since it was first introduced as an antidiabetic agent.1,2 While non-fatal accidental insulin overdoses are recognised as a common cause of hospital admission among insulin-dependent diabetics, fatal cases are much less frequent.3 Between 2000 and 2019, 40 cases of fatal insulin overdose were identified in South Australia from records at Forensic Science South Australia and the National Coronial Information System. While no longitudinal or demographic trends were identified within the cohort, fatal insulin overdoses of suicidal intent were much more frequent than hypothesised, comprising 72.5% of cases (n=29). There were also significant findings from decedent histories, evidence at the death scene and biochemistry and neuropathology studies. This study also highlights significant analytical and investigative limitations of insulin deaths which are critical to ascertaining manner of death. References 1. Rosenfeld L. Insulin: discovery and controversy. Clin Chem 2002; 48: 2270–88. 2. Cox AR, Ferner RE. Prescribing errors in diabetes. Br J Diabetes Vasc Dis 2009; 9: 84–8. 3. Arem R, Zoghbi W. Insulin overdose in eight patients: insulin pharmacokinetics and review of the literature. Medicine (Baltimore) 1985; 64: 323–32.