Rzepczyk Szymon, Dolińska-Kaczmarek Klaudia, Uruska Aleksandra, Żaba Czesław
Forensic Medicine Departament, Poznan University of Medical Sciences, 60-781 Poznan, Poland.
Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, 60-834 Poznan, Poland.
Toxics. 2022 Mar 3;10(3):123. doi: 10.3390/toxics10030123.
Insulin is the most effective glycemic-lowering drug, and for people suffering from type 1 diabetes it is a life-saving drug. Its self-dosing by patients may be associated with a higher risk of overdose, both accidental and deliberate. Insulin-induced hypoglycemia causes up to 100,000 emergency department calls per year. Cases of suicide attempts using insulin have been described in the literature since its introduction into therapy, and one of the important factors in their occurrence is the very fact of chronic disease. Up to 90% of patients who go to toxicology wards overdose insulin consciously. Patients with diabetes are burdened with a 2-3 times higher risk of developing depression compared to the general population. For this reason, it is necessary to develop an effective system for detecting a predisposition to overdose, including the assessment of the first symptoms of depression in patients with diabetes. A key role is played by a risk-conscious therapeutic team, as well as education. Further post-mortem testing is also needed for material collection and storage, as well as standardization of analytical methods and interpretation of results, which would allow for more effective detection and analysis of intentional overdose-both by the patient and for criminal purposes.
胰岛素是最有效的降糖药物，对于1型糖尿病患者而言，它是一种救命药物。患者自行注射胰岛素可能会导致更高的过量用药风险，包括意外和故意过量。胰岛素诱发的低血糖每年导致多达10万次急诊就诊。自胰岛素被引入治疗以来，文献中已有使用胰岛素自杀未遂的案例描述，而这些案例发生的一个重要因素就是慢性病这一事实。高达90%前往毒理学病房的患者是有意识地过量注射胰岛素。与普通人群相比，糖尿病患者患抑郁症的风险高出2至3倍。因此，有必要建立一个有效的系统来检测过量用药倾向，包括评估糖尿病患者抑郁症的首发症状。有风险意识的治疗团队以及教育起着关键作用。还需要进一步进行尸检检测，以收集和存储材料，以及实现分析方法的标准化和结果解读，这将有助于更有效地检测和分析患者故意过量用药以及用于犯罪目的的过量用药情况。
