DIABETIC DEATH BED - POSTMORTEM DETERMINATION OF HYPOGLYCEMIA

The post-mortem biochemical determination of hypoglycaemia in the prac tice of forensic medicine is notoriously imprecise and attracts perenn ial criticisms, particularly from those who may be alien to the peculi arities of medical jurisprudence. There has been re-emphasis recently on the neuropathological pathoclisis ascribed to prolonged hypoglycaem ia. Unfortunately the value perceived is limited by pathognomonic unre liability owing to agonal multifactorial influences and rapidly fatal nocturnal hypoglycaemia. The predicament is oppressive to a considerat ion of preponderant evidence and an unpopular diagnosis of perimortem hypoglycaemia, unless audacious, may be precluded simply because the p roof is difficult. This is likely to contribute to diagnostic under-es timation of enigmatic diabetic deaths. A suspected case of lethal noct urnal hypoglycaemia in a young diabetic on 'animal' insulin is present ed to restore some perspective to the clinico-pathological deference f or an endangered post-mortem diagnosis of hypoglycaemia inferred from minimal evidence.