[A suicide by insulin injection--case report]

Suicide by injection of insulin overdose is uncommon. Insulin has been used as an agent for suicide both in diabetics and healthy subjects. The methods of postmortem forensic diagnosis of insulin overdose were reviewed. Police investigation could be crucial to document the amount and type of insulin used. In addition, the complete forensic autopsy, microscopic analysis of tissue samples, consecutive chemical-toxicological investigation and appropriate laboratory tests are required to make proper diagnosis in these cases. To assess pre-mortem hypoglycemic state at the time of dying, it is necessary to establish postmortal concentrations of glucose, lactate and potassium in vitreous humor. Since the use of insulin for medical treatment, only two cases with diagnosis of suicidal insulin overdose were confirmed at the Institute of Forensic Medicine in Belgrade. In this paper, the authors present one such case. An 84-year-old male was found dead in his flat. He had diabetes mellitus during the last fifty years, and he used insulin twenty years. A few empty insulin ampullae and plastic syringes were found nearby deceased, on the room-table during the crime scene investigation, as well as his suicidal note. The forensic autopsy, microscopic, chemical-toxicological and biochemical analyses of tissue and body-liquid samples as well as police investigation indicated suicide due to insulin-overdose.