This study deals with the postmortem findings in cases of lethal hypog
lycaemia due to injections of insulin. In 12 cases (four female; eight
male; mean age 42 years) the following aspects were evaluated retrosp
ectively: circumstances of life, scene of death, pathomorphological fi
ndings and postmortem biochemistry on cerebrospinal fluid, vitreous hu
mour, blood, and urine (levels of glucose, lactate, hemoglobin A(lc) a
nd insulin). Furthermore, analyses of ethanol in blood and urine as we
ll as toxicological and histological examinations were performed. Unex
pectedly, the dead persons rarely represented diabetics, relatives of
diabetics, or medical personnel. It is concluded, that the diagnosis o
f fatal hypoglycaemia can only be established by a synopsis of postmor
tem biochemistry, pathomorphological alterations and anamnesis. Beside
s, this diagnosis must always be made ''per exclusionem''. (C) 1998 El
sevier Science Ireland Ltd.