Feature Article

Forensic aspects of hypoglycemia

Vincent Marks, MA, DM, FRCP, FRCPath, MAE

Diabetic Hypoglycemia January 2010, Volume 2, Issue 3: page 3-8

Abstract

Hypoglycemia is of interest to the courts for a variety of reasons. It may be advanced as a total defense in criminal cases up to and including murder, or as a mitigating factor in sentencing; it can cause death through the malicious administration of insulin or a sulfonylurea, and its inappropriate treatment can lead to charges of negligence.

Within a few years of the introduction of insulin for treatment of diabetes, hypoglycemia was recognized as a cause of behavioral changes that amounted, in some cases, to criminality. Neuroglycopenic subjects have been charged with a range of offences both minor and serious. Manifestations of neuroglycopenia include confusion, irritability, and irrational anger, whether preceded by autonomic symptoms or not. It is these features that may bring patients with hypoglycemia into conflict with the law. People with neuroglycopenia may appear to be mentally disturbed or inebriated, but may also appear to exhibit normal behavior, although with a much lower degree of competence. They also have no recollection of what they had been doing while their blood glucose concentration was low.

This review discusses the forensic aspects of hypoglycemia and its role in criminal behavior, and addresses the question of whether a person suffering from neuroglycopenia can formulate the intention to commit an offence. The malicious administration of insulin to induce hypoglycemic coma is also discussed, highlighting that clinicians should be alert to this possibility whenever they encounter hypoglycemic coma in anyone not already known to be receiving treatment with a hypoglycemic agent.

Keywords: hypoglycemia, neuroglycopenia, forensic, criminal behavior