From the report in the Chester Standard:
Child F's blood sample, which was dated August 5, 2015, was taken at 5.56pm.
The court is shown a screenshot of Child F's blood sample results. Child F is referred to as 'twin 2' - Child E, the other twin boy, had died at the Countess of Chester Hospital on August 4.
Dr Milan says Child F's insulin c-peptide level reading of 'less than 169' means it was not accurately detectable by the system.
The insulin reading of '4,657' is recorded.
A call log information is made noting the logged telephone call made by the biochemist to the Countess of Chester Hospital, with a comment made - 'low C-Peptide to insulin'
The note adds '?Exogenous' - ie query whether it was insulin administered.
The note added 'Suggest send sample to Guildford for exogenous insulin.'
The court hears Guildford has a specialist, separate laboratory for such analysis in insulin, although the advice given to send the sample is not usually taken up by hospitals.
Dr Milan said that advice would be there as an option for the Countess of Chester Hospital to take up.
Dr Milan said she was 'very confident' in the accuracy of the blood test analysis produced for Child F's sample.
Professor Hindmarsh confirms he had been told there was a suspicion Child F had received insulin in an 'exogenous' way - ie the insulin was not produced within the body.
He said he concluded the cause of the hypoglycaemia was exogenous, and the chemical findings were compatible with the administration of exogenous insulin.
11:04am
Professor Hindmarsh confirms he had been told there was a suspicion Child F had received insulin in an 'exogenous' way - ie the insulin was not produced within the body.
Professor Hindmarsh says it is not possible to give insulin by mouth as it is a large molecule, so cannot be absorbed easily and the protein would be broken down by the acid in the stomach. It could not have been administered via the naso-gastric tube for the same reason.
The only ways would have been through a skin injection or intraveneously, he says.
For a skin injection, he says the duration of action [for the insulin] of 4-6 hours would not fit with the 17 hours of hypoglaycaemia. It would require multiple injections.
He says an intravenous route "would be the most likely explanation".
The way to do so would be a bolus of insulin - from testing in endrocrinology, the blood sugar level would fall within 90 minutes, then rise back to normal.
To maintain hypoglycaemia "over a protracted period of time" would require multiple insulin boluses "roughly every two hours".
The second route would be via infusion - "probably the most likely way of achieving the blood glucose effect that we have observed".
The infusion would be "continuous", using the bags available, and "fit nicely" with the time course of events.
It would "also be consistent" with the measurements that took place during and after the TPN bag was replaced.
Professor Hindmarsh says the exogenous insulin, if the fast-acting type, would have reduced from the '4,657' reading to 'almost none' after a couple of hours after the TPN bag was removed.
The rise of the blood glucose level in Child F to 4.1 by 9pm was "entirely consistent" with that.