Key result
Failure of plastic cannulas in continuous subcutaneous insulin infusion devices to penetrate the skin and deliver insulin can result in fatal diabetic ketoacidosis.
Case Report (n=6)
Yes
Malfunctions in continuous subcutaneous insulin infusion devices, such as failure of plastic cannulas to penetrate the skin, can lead to fatal diabetic ketoacidosis, highlighting the need for careful examination of these devices in death investigations.
May prompt device checks in unexplained DKA deaths; leaves open incidence and prevention strategies.
Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.
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Ziegler et al. (2018) conducted a case report in Diabetes mellitus (n=6). Continuous subcutaneous insulin infusion (CSII) device failure was evaluated on Fatal diabetic ketoacidosis (DKA). Failure of plastic cannulas in continuous subcutaneous insulin infusion devices to penetrate the skin and deliver insulin can result in fatal diabetic ketoacidosis.
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