Problems of Establishing the Cause of Death at Postmortem

In attempting to establish a post-mortem diagnosis of hypoglycaemia, the pathologist needs to perform biochemical tests, examine the brain for evidence of hypoglycaemic brain damage, and exclude any other possible cause of death (Tattersall and Gale, 1993). Carbohydrate metabolism continues after death, and post-mortem changes in blood glucose can cause difficulties in confirming a hypoglycaemic death forensically. The continuing breakdown of glycogen (glycogenolysis) increases the blood glucose concentration in the inferior vena cava, so that the presence of a normal or high blood glucose concentration on the right side of the heart does not exclude ante-mortem hypoglycaemia (a false negative result for a diagnosis of hypoglycaemia). In the peripheral circulation, glucose continues to be utilised by red blood cells, so that the presence of a low glucose concentration does not necessarily indicate ante-mortem hypoglycaemia. Indeed low blood glucose is often found after death in those without diabetes (a false positive result for a diagnosis of hypoglycaemia).

The measurement of the glucose concentration in the vitreous humour presents similar problems because of continued post-mortem glucose utilisation, and so this cannot be used to confirm ante-mortem hypoglycaemia (false positive). A normal or raised glucose concentration in the vitreous humour after death, however, excludes hypoglycaemia at the time of death (true negative). Thus, the sensitivities and specificities of blood and vitreous humour measurements of glucose in diagnosing ante-mortem hypoglycaemia are unknown.

In addition to the biochemical problems in diagnosing hypoglycaemia after death, errors may be introduced by attribution bias of the pathologist performing the post-mortem. Death may be attributed to minor degrees of coronary heart disease, since it is so common in the diabetic population (false negative result for a diagnosis of hypoglycaemia). Alternatively, the pathologist, even when unsure may attribute death to hypoglycaemia rather than indicating no cause on a certificate (false positive).

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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