Ziegler Andrew, Williams Timothy, Yarid Nicole, Schultz Daniel L, Bundock Elizabeth A
Boston University School of Medicine, Department of Anatomy & Neurobiology, Program of Biomedical Forensic Sciences, 72 E Concord Street, Boston, MA, 02118.
King County Medical Examiner's Office, 908 Jefferson Street, Seattle, WA, 98104.
J Forensic Sci. 2019 Jan;64(1):275-280. doi: 10.1111/1556-4029.13841. Epub 2018 Jun 25.
Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.
1型和2型糖尿病分别是由于胰岛素分泌减少和胰岛素抵抗导致血糖调节受损的疾病。糖尿病的治疗通常需要注射外源性胰岛素。持续皮下胰岛素输注（CSII或胰岛素泵）是一种糖尿病治疗方式，利用一种装置来辅助调节血糖控制。设备部件故障可能会产生罕见的致命后果。本报告描述了因一种此类故障导致的6例死亡，即CSII设备的塑料套管未能穿透皮肤并输送胰岛素，从而导致致命的糖尿病酮症酸中毒（DKA）。这些病例来自四个不同的死亡调查系统。对于每个病例，都呈现了现场和尸检结果，以及选定的毒理学和组织学结果。这些病例说明了在死亡调查中仔细检查CSII设备的重要性，并引发了关于死亡分类差异方式的讨论。
