Youth insulin treatment and severe hypoglycemia risk. Medico-legal implications

D. Catrinoiu, C. Mihai, I.T. Tofoleanu, B. Cimpineanu, G.S. Gorun

Abstract: Tight control of insulin treatment’ results, in terms of hypo- or hyper-glycemia, is difficult to maintain in small children, because hypoglycemia may impair normal brain development which is not complete. Because pre-adolescents appear to be relatively protected from micro-vascular complications, the need for tight control might be less than in post-pubertal subjects. The danger of hypoglycemia is greater in infants and children because food intake, activity and adherance to treatment schedules are less predictable than in adults. Initially, we noticed an association between: increased number of injection, tight control and the occurence of hypoglycemia. We assess the effects of intensive, flexible insulin treatment with insulin analogues, after 3 months and 12 months, by measuring different parameters, including HbA1c and the number of severe hypoglycemic events (80 patients were enrolled.). After one year of intensive treatment with anlaogues of insuline, the number of severe hypoglycemic events decreased, combined with an intensified education. Because hypoglycemia is commonly seen in situations of medication error, homicide attempt and suicide attempt, sudden death, trafic accidents, strange behavior or aggressive status, memories black-outs etc., all incidents with great significance for forensic medicine, demonstration of it becomes a relevant objective. Physicians of children with diabetes should be aware of these consequences and a clinical judgment will be required in treatment options decision making.
Keywords: diabetes, hypoglycemia, intensive insulin treatment, forensic aspects of hypoglycemia