Perth Father Guilty Of Failing To Help Daughter Left With Catastrophic Injuries After Insulin Overdose
A Perth father who failed to get medical help for his teenage daughter, who suffered catastrophic injuries after she took an overdose of insulin, has been found guilty of causing grievous bodily harm. Over two days in March last year, James Chad Deliu ignored repeated requests from relatives to take his daughter Cher, who was then 18, to hospital. She suffered permanent brain damage and is now in a nursing home, where she needs constant care. Deliu's District Court trial was told she breathes and is fed by tubes, and is unresponsive. Deliu denied any wrongdoing and suggested that he had not realised there were problems with Cher until another relative rushed her to hospital. The court was told that before that, Deliu had driven his daughter almost 100 kilometres to his brother's house in Baker's Hill and repeatedly tried to feed her sugar. However, when relatives asked him to get help, he refused out of fear he would get charged by police. Prosecutors said it was likely Cher had taken the insulin, which was her father's, in an attempt to take her own life. The jury deliberated for about five hours before finding Deliu guilty of causing grievous bodily harm with the aggravating factor that he was her father. Judge Julie Wager told Deliu he had been convicted of a very serious offence, but she said she needed to get more information on him before imposing a sentence. Deliu was remanded in custody until a sentencing hearing in October. Continue reading >>
Intentional Overdose With Insulin: Prognostic Factors And Toxicokinetic/toxicodynamic Profiles
Abstract Prognostic factors in intentional insulin self-poisoning and the significance of plasma insulin levels are unclear. We therefore conducted this study to investigate prognostic factors in insulin poisoning, in relation to the value of plasma insulin concentration. We conducted a prospective study, and used logistic regression to explore prognostic factors and modelling to investigate toxicokinetic/toxicodynamic relationships. Twenty-five patients (14 female and 11 male; median [25th to 75th percentiles] age 46 [36 to 58] years) were included. On presentation, the Glasgow Coma Scale score was 9 (4 to 14) and the capillary glucose concentration was 1.4 (1.1 to 2.3) mmol/l. The plasma insulin concentration was 197 (161 to 1,566) mIU/l and the cumulative amount of glucose infused was 301 (184 to 1,056) g. Four patients developed sequelae resulting in two deaths. Delay to therapy in excess of 6 hours (odds ratio 60.0, 95% confidence interval 2.9 to 1,236.7) and ventilation for longer than 48 hours (odds ratio 28.5, 95% confidence interval 1.9 to 420.6) were identified as independent prognostic factors. Toxicokinetic/toxicodynamic relationships between glucose infusion rates and insulin concentrations fit the maximum measured glucose infusion rate (Emax) model (Emax 29.5 [17.5 to 41.1] g/hour, concentration associated with the half-maximum glucose infusion rate [EC50] 46 [35 to 161] mIU/l, and R2 range 0.70 to 0.98; n = 6). Intentional insulin overdose is rare. Assessment of prognosis relies on clinical findings. The observed plasma insulin EC50 is 46 mIU/l. Introduction Contrasting with the common occurrence of insulin-induced hypoglycaemia in type 1 diabetes patients, deliberate overdose with insulin are rarely reported [1]. In the 2005 Annual Report of the American Continue reading >>
Hypoglycemic Coma Treatment Causes Brain Damage, Research Says
Brain damage that was thought to be caused by hypoglycemic coma actually occurs when glucose is administered to treat the coma, according to a study in rodents led by researchers at the San Francisco VA Medical Center. The results are surprising, say the authors, and may be of clinical significance for the treatment of diabetics in hypoglycemic coma, though they caution that the results cannot be immediately extrapolated to humans. Insulin is an essential hormone that moves glucose from the bloodstream to individual cells, where it is broken down and used for energy. Diabetics do not produce enough of their own insulin and must take it several times a day. A severe insulin overdose can reduce levels of glucose in the blood to extremely low levels –– a condition known as hypoglycemia –– and cause hypoglycemic coma, resulting in destruction of neurons in the hippocampus and cerebral cortex, which are essential to memory and cognition. "This study tells us for the first time that, in rats, the brain damage occurs not during the coma, but after it, when we give them glucose and their blood glucose levels return to normal," says principal investigator Raymond A. Swanson, MD, chief of the neurology and rehabilitation service at SFVAMC. Furthermore, says Swanson, he and his fellow researchers have identified the cause of the damage: the sudden return of glucose to the brain activates the enzyme NADPH oxidase, which in turn initiates a process of oxidative stress that is fatal to neurons. Oxidative stress occurs when cells are poisoned by highly reactive forms of oxygen. Previously, it had been assumed that oxidative stress in neurons was initiated primarily by mitochondria, which process oxygen for energy within cells. The paper appears in the April 2007 issue of the J Continue reading >>
Hazards Of Hypoglycemia (low Blood Sugar)
Hypoglycemia is a serious risk factor in diabetes management. Recent studies suggest that approximately 10 percent of diabetic dogs experienced hypoglycemic episodes that required hospitalization. One large survey found that the majority of diabetic dogs presented for hypoglycemia were receiving high doses of insulin (0.7 units or more per pound of body weight). Overdosing, double-dosing, and persistent dosing despite weight loss or reduced food intake are common iatrogenic causes of hypoglycemia. (Iatrogenic diseases are caused by medical treatment.) Strenuous exercise or maldigestion caused by EPI, bacterial overgrowth, inflammatory bowel disease, or other digestive disorders can also lead to hypoglycemia in diabetic dogs. If you’re ever uncertain about whether insulin was administered, the safest option is to withhold the injection. The consequences of missing a single insulin dose are negligible, while overdosing can be fatal. Never add more if you are unsure, including if some insulin spills while you give the injection. Changes in body weight may require insulin dosage modifications. Dietary changes, particularly reduced carbohydrates, may require a reduced insulin dosage to prevent hypoglycemia. Severe hypoglycemia resulting from too much insulin can cause seizures, irreversible brain damage, and death. Warning signs include nervousness, hyperexcitability, anxiety, vocalization, muscle tremors, lack of coordination, wobbliness (the dog may appear drunk), and pupil dilation. If these signs are seen, the dog should be fed immediately. If the dog can’t or won’t eat, rub Karo syrup, pancake syrup, honey, or even sugar water on her gums before calling your veterinarian. If immediate improvement is not seen, transport your dog to the vet after feeding for further Continue reading >>
Teenage Girl Died Of Insulin Overdose After Injecting Herself With Diabetic Boyfriend's Pen 'in Cry For Attention'
A teenage girl who died after injecting herself with insulin may have taken it to try to lose weight. Charlie Dunne, 19, used an insulin pen belonging to her diabetic boyfriend while he was out at a hospital appointment. An inquest heard the trainee hairdresser may have taken the hormone previously after hearing that it could help slimmers. But the teenager, who was fit and healthy, would have been unaware of the ‘catastrophic’ danger the drug posed to non-diabetics, a coroner said. Miss Dunne was discovered collapsed at the home in Atherton, Greater Manchester, she shared with boyfriend Terence Rhoden, 28, when he returned hours later. She suffered brain damage caused by a dramatic drop in blood sugar and died in hospital six days later. Police later investigated claims by Miss Dunne’s family that Mr Rhoden had confessed to injecting her with insulin in the past to help her lose weight. But he denied doing so and officers found no evidence that he was involved in his girlfriend’s death. Bolton Coroner’s Court was told that ‘bubbly’ Miss Dunne was a regular at her local Methodist church, where she was given the community title of ‘rose queen’ for her charity fundraising. However, the inquest was told she suffered mood swings and had tried to overdose on tablets during a previous relationship. She also claimed to have suffered a miscarriage and was worried she could not have children, despite a lack of medical evidence to support her fears. The court heard that Mr Rhoden was woken when Miss Dunne returned from her local pub in an ‘agitated’ state on December 17 last year and threatened to take painkillers. She told him to leave, saying he was ‘too good for her’. After talking, she calmed down and fell asleep on the sofa. Mr Rhoden left for his a Continue reading >>
Insulin
Link to 2.1.7.1.1 Insulin Teaching Resources Link to Problems for Discussion DRUGS INCLUDED Insulin Aspart Protamine, Recombinant/Insulin Aspart, Recombinant Insulin Aspart, Recombinant Insulin Degludec1 Insulin Degludec/Insulin Aspart, Recombinant Insulin Detemir Insulin Glargine, Recombinant Insulin Glulisine Insulin Human Isophane (NPH) Insulin Human Isophane (NPH)/Insulin Human Regular Insulin Human Regular2 Insulin Lispro Protamine, Recombinant/Insulin Lispro, Recombinant Insulin Lispro, Recombinant 1Also available in a 200 Unit/mL concentration (rather than the usual 100 U/mL) 2Also available in a 500 Unit/mL concentration (rather than the usual 100 U/mL) OVERVIEW As expected, the toxicity of insulin in overdose is primarily due to hypoglycaemia, although hypokalaemia may also cause problems. The duration of the hypoglycaemic effect depends on the type of insulin injected (duration of action), the amount and age, diabetes (insulin resistance) and other factors that may increase or decrease the patient`s sensitivity to insulin. Mortality in attempted suicidal overdose with insulin is 25%. Death has occurred after as little as 20 units but doses of 400 to 900 units or more are more common in fatal cases. Irreversible neurological injury occurs when glycogen stores are depleted since the brain is totally dependent on glucose metabolism. It is the duration of hypoglycaemia in the presence of signs or symptoms of neurological compromise that determines post hypoglycaemic encephalopathy, rather than the quantity of insulin injected. The period from injection of an overdose of insulin to irreversible brain damage is frequently about 7 hours (about the time glycogen stores are completely). Treatment is with 50% glucose IV, food (and lots of it) and close observation. MECH Continue reading >>
Mother-of-three Found By Family After Insulin Overdose
A diabetic Exeter mother-of-three died after taking an insulin overdose, an inquest heard. The body of Jacqueline Appiah was found on October 6, 2016, by her 11-year-old grandson at her home after he squeezed through an open back window. The 58-year-old's family became concerned when she wouldn’t answer the door or telephone calls. Although a pulse was regained she remained unconscious having suffered strokes on both sides of her brain, and died at the Royal Devon & Exeter Hospital on November 9, 2016. A suicide note was found by the body of the mental health nurse but the family was told it had been misplaced by the health services so they were unable to be given it after the inquest. A post-mortem examination confirmed the cause of death was hypoxic brain injury, cardiac arrest, an insulin overdose and type 1 diabetes. Jacqueline’s GP recalled in a statement how Miss Appiah had been diabetic since 1975. Her last diabetic review had been in June 2016, when she said she wanted to manage her condition in “her own way”. She admitted to only checking her blood glucose levels occasionally and not taking her medication as frequently as she should. Her daughter Rachel described how her mother lived alone two doors away from her. In a statement she recalled how Jacqueline had nursed her mother who died three years ago, and then looked after Rachel when she was in a coma in hospital last year. She said: “To my knowledge, mum had never attempted to take her own life and had not spoken of doing so. “I noticed she had become more depressed within the months before her death.” She added: “She talked about her funeral plans but made no direct threat to harm herself.” Coroner Luisa Nicholson said she was not convinced Jacqueline had intended to take her life. Record Continue reading >>
Diabetic Emergencies: Hypoglycemia Caused By Insulin, Part 3
Consequences of acute hypoglycemia Acute hypoglycemia can lead to health damage either directly (from deleterious effects of low blood glucose supply to the brain) or indirectly, usually via trauma due to loss of consciousness or seizures. As an example, hypoglycemia may occur during driving and may obviously cause road traffic accidents…. In the vast majority of cases, recovery from a severe hypoglycemic event, even if it manifests with seizures or coma, is complete. Sometimes, neurologic abnormalities can be observed immediately after recovery of consciousness and improve afterwards. Hypoglycemic hemiplegia is an uncommon condition that has been described as a hemiparetic state, presenting in the morning when the patient awakens after a nocturnal hypoglycemic event. The episode typically resolves after a few minutes or hours and may recur. 28 Permanent neurologic damage and death have been reported rarely, 29 especially after massive insulin overdose and delayed restoration of normoglycemia. 30 Another possible mechanism of acute health damage, including sudden death, due to hypoglycemia is via the induction of cardiovascular events. Hypoglycemia has been implicated in the so-called "dead-in-bed syndrome," the unexpected death of a young person with Type 1 diabetes found dead in an undisturbed bed. 29 It has also been suggested that the increased total mortality risk observed in the intensive glycemic control arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study might be due to the high rate of hypoglycemic events. 18 However, this insinuation has not been verified in post hoc analysis of the trial data. 31 It has been shown that hypoglycemia, especially in patients with pre-existing cardiovascular disease, induces multiple proarrhythmic change Continue reading >>
Insulin Overdose Among Patients With Diabetes: A Readily Available Means Of Suicide
Go to: CASE VIGNETTE Ms A, an 18-year-old woman with insulin-dependent diabetes, was found by her brother while having a generalized tonic-clonic seizure (the direct result of an intentional insulin overdose). He called emergency rescue services, who determined that her fingerstick glucose level was 25 mg/dL and brought her to the emergency department. Her glucose level was stabilized in the emergency department, and she was transferred to the medical service for further observation before transfer to an inpatient psychiatric unit. Although Ms A had not received any psychiatric treatment before this event, she reported infrequent panic attacks and moderate social anxiety, and she used cannabis and clonazepam daily. Ms A had attempted suicide twice in the past several months; both of these attempts involved overdoses of insulin, and neither resulted in her receiving medical attention. For several years, she had been poorly adherent with her insulin regimen (and her hemoglobin A1c level in the past year was 9.2%–10.4%). Ms A, who lived at home with her mother, father, and brother, was failing several classes in her senior year of high school, and she had recently quit the soccer team. Continue reading >>
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Symptoms Of Diabetic Shock
Diabetic shock is a medical emergency in patients suffering from diabetes mellitus. It occurs when body contains too much insulin decreasing the blood glucose levels (hypoglycemia). It is also called insulin shock, severe hypoglycemia or simply, low blood sugar. The insulin is a hormone produced by the pancreas. The insulin decreases the blood glucose by moving the glucose into the cells. The endogenous insulin secretion is tightly regulated according to the blood glucose levels so that glucose levels neither increase nor decrease disproportionately. In diabetic individuals, this mechanism is disturbed and blood glucose levels rise. To normalize the increased blood glucose levels, insulin and other oral anti-diabetic medicines are given. In diabetic person, the blood glucose may decrease dramatically and diabetic shock may develop if the person: Takes too much insulin or other anti-diabetic medicines by mistake Misses the meal completely after taking insulin Exercises excessively Drinks too much alcohol without eating Symptoms of Diabetic Shock: The glucose is the necessary energy fuel for our brain and nervous system. When blood glucose levels decrease in diabetic shock, energy supply to the brain is decreased causing most of the symptoms that may be divided into mild, moderate or severe depending upon the glucose levels. The mild symptoms are as follows: Excessive sweating The patients with low blood sugar sweat profusely, even in cold temperatures. They may develop the tremors and shakiness within their whole body. Pallor These patients also become pale and cold. These are due to the effects of some blood hormones, catecholamine, that are released in response to low blood sugar. Hunger The low blood glucose levels naturally stimulate the hunger center in the brain ca Continue reading >>
Aspirin Overdose Brain Damage
Aspirin Overdose Brain Damage High Aspirin Doses and Brain Damage | Psych CentralResearchers have found that older people who take aspirin or certain other drugs to prevent blood High Aspirin Doses and Brain Damage. Psych Central Suicide and Pain | The Life Resources Charitable TrustPermanent brain damage occurs when of an overdose. One pharmacologist calls aspirin lung damage. The most painful form of a suicide Drug Overdose Topic Guide - eMedicineHealthDrug overdoses can be accidental or intentional, and they can be caused by either recreational or over-the-counter drugs. Many drugs offer the potential for overdose Aspirin poisoning - WikipediaAspirin poisoning, Complications can include swelling of the brain or lungs, Aspirin overdose had potentially serious consequences, Signs and symptoms Aspirin Poisoning Diagnosis - eMedicineHealthAspirin Poisoning Diagnosis Aspirin The doctor will order laboratory tests to look for damage to organ systems that can be harmed by aspirin overdose Aspirin Poisoning - Injuries and Poisoning - Merck …An acute aspirin overdose, (pulmonary edema), seizures, and brain swelling can develop. Unless there is kidney damage, Salicylate Toxicity: Practice Essentials, Etiology and 21/12/2016 Salicylate toxicity has been reported with the topical Early treatment can prevent organ damage and as well as Aspirin Poisoning, Drug Overdose, Aspirin - NHS ChoicesFind out about aspirin, or you have symptoms of bleeding in your stomach or brain. If you think you've taken too much aspirin (overdose) Aspirin Poisoning - WebMDStudy Says Artificial Sweeteners Trick the Brain; The doctor will order laboratory tests to look for damage to organ aspirin poisoning, aspirin overdose, Doctor insights on: Long Term Effects Of An Aspirin OverdoseDoctors give un Continue reading >>
Brain Damage From Lack Of Oxygen
This image depicts a normal brain (on the left side) and a brain damaged from lack of oxygen (on the right side). The white spot, which we see in the damaged-brain image, depicts an implant - known as a "Thalamic Stimulator" - which is used to reduce tremors. Tremors can occur when a person has sustained brain damage. How does the brain get the oxygen it needs to survive and function? Oxygen is contained in blood. Arteries serve as blood-carriers to the brain. Without oxygen, brain cells will start to die. That can happen quickly, within a few minutes of an oxygen-depriving event. That is why a person who has experienced a stroke, for example, needs immediate medical attention so that oxygen can keep flowing to the brain. The U.S. National Library of Medicine - at the National Institutes of Health - specifically tells us why it is so important for the brain to have oxygen: Brain cells are extremely sensitive to a lack of oxygen. Some brain cells start dying less than 5 minutes after their oxygen supply disappears. As a result, brain hypoxia [lack of oxygen in the brain] can rapidly cause severe brain damage or death. ...Most people who make a full recovery were only briefly unconscious. The longer a person is unconscious, the higher the risk for death or brain death, and the lower the chances of recovery. A powerful part of the body, the brain can do many things, but one thing it cannot do is store oxygen. That is one reason why it’s so critical for the brain to keep getting oxygen supplies. The brain is also incapable of storing a nutrient like glucose (another term for “blood sugar”). That is why a person with diabetes must avoid getting too much insulin. Too much insulin can cause a drop in blood-sugar levels. If the insulin overdose - and resulting blood-sugar Continue reading >>
Eastlake Woman Admits Giving Diabetic Daughter Fatal Overdose Of Insulin
For 21 years, Sandra Speck devoted her life to her severely autistic daughter, Mindy, who also had cerebral palsy and Type I diabetes. On Aug. 21, the 50-year-old Eastlake mother just snapped. “She administered more insulin than was necessary,” Assistant Lake County Prosecutor Rocco DiPierro Jr. said. Waiving her right to have her case presented to a grand jury, Speck pleaded guilty to involuntary manslaughter May 8 in Lake County Common Pleas Court. Advertisement Speck now faces anything from community control sanctions (formerly probation) to up to 11 years in prison when she is sentenced June 19 by Judge Richard L. Collins Jr. DiPierro said he will recommend Speck serve no more than four years in prison. “The defendant was her primary caregiver,” he said. “All indications are that the defendant took loving care of Mindy for years.” The assistant prosecutor said Mindy was prone to violent outbursts. The day before her death, Speck had taken her to the emergency room at Hillcrest Hospital in Mayfield Heights for a urinary tract infection. “Mindy was in a particularly aggressive and violent mood after that,” DiPierro said. “At the apartment, she was banging her head into walls and trying to open doors and locks, endangering herself. Mindy punched (her mother) when she tried to restrain her. “Her blood sugar was high. The defendant gave her an insulin injection to bring the blood sugar down.” After Mindy was still combative, Speck gave her several more injections — even though she knew there was a risk of Mindy dying by becoming severely hypoglycemic from too much insulin, DiPierro said. “Mindy finally did calm down and collapse,” he said. “(Speck) knew Mindy wouldn’t recover from brain damage. EMS was not called and Mindy died. She called Continue reading >>
Attempted Suicide By Insulin Overdose In Insulin-requiring Diabetics.
Abstract Four cases of suicidal insulin overdose in insulin-requiring diabetics presented to one hospital in three years. In three cases there was a history of depression; but despite huge doses of insulin (3,000 and 1,500 units) in two, no patient died and only one had residual signs of clinical brain damage. The estimated plasma insulin level was not well correlated with the severity of the hypoglycaemia. It is probable that suicidal insulin overdose is more common than reports in the literature suggest, and may often be unrecognized. The dissociation between huge doses of insulin and the severity of the subsequent hypoglycaemia in diabetics is unexplained. Continue reading >>
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What Happened to Toonces at Kindness Animal Hospital? A Cautionary Tale for Pet Owners . . . Dr. Marc Katz, DVM, of Kindness Animal Hospital in Wheaton, MD Found in Violation of the Veterinary Practice Act by Maryland Vet Board In the case of Toonces, the Board says: "Dr. Katz permitted an individual, who is neither a veterinarian nor a registered veterinary technician, to provide veterinary care on an animal . . . . while that individual was not under the responsible direct supervision of a licensed and registered veterinarian, a violation of COMAR 15.14.01.17." Board Suspends License (but stays suspension); Places Katz on Six Months Probation Effective 2/03/2006; Levies Civil Penalty On June 28, 2004 Dr. Marc Katz of Kindness Animal Hospital in Wheaton, MD admitted to me that my beloved cat Toonces, who I left in their care, had apparently been given a massive insulin overdose by a "veterinary technician" at Kindness Animal Hospital who -- acting without medical supervision -- used the wrong syringe to give Toonces his insulin shot. According to hospital records and notes made by Dr. Katz himself, Toonces was found hypoglycemic, hypothermic, seizuring, and fighting for his very life. Toonces was a normally functioning cat when I dropped him off at Kindness Animal Hospital for a medical board. The next time I was to see him -- two days later, he was severely brain damaged, having massive seizures, rigid and unresponsive. He was hospitalized for a month after that for intensive care -- which Kindness Animal Hospital's insurance company and owner Marc Katz paid for after having acknowledged that this had been the result of a massive overdose of insulin administered by someone they referred to as a "technician." (Toonces regular dose of insulin was 3 units, and they admit Continue reading >>
