Re: insulin. Here you are, @Quitelikeit , from the summary report.
My summary: the hospital got the treatment wrong. The prosecution misrepresented the test results, which actually show that there was no exogenous insulin. They also falsified the timings. That hid the fact that the baby recovered when the hospital started the right treatment.
....
CONVICTION
It was alleged that Baby 6 was given exogenous insulin through the infusion bag because there was a prolonged period of hypoglycemia, his blood glucose inexplicably rose from 1.3 to 2.4 when his dextrose infusion stopped from 1000 to 1200 hours, his blood sugar rose after his infusion bag was changed at 1900 hours, and he had high insulin but low c-peptide levels which indicates exogenous insulin was used.
PANEL OPINION
The hypoglycemia started with sepsis and was prolonged because the IV infiltrated for several hours.
When hypoglycaemia persisted despite 10% dextrose infusion, a higher glucose infusion should have been given earlier. Repeat boluses of 10% dextrose worsen hypoglycemia because they cause surges of
blood sugar, which trigger surges of insulin secretion, resulting in a yo-yo pattern of sharp rises and falls in insulin and blood sugar.
When the dextrose infusion was stopped from 1000 to 1200 hours, the blood
sugar did not rise from 1.3 to 2.4 as alleged, because the blood sugar was 1.4 at 1146 hours. The 2.4 level was measured after 1200 hours, when the IV was restarted.
Since infusion bags were prepared in
the pharmacy, stored in the unit, and changed at 1200 hours, multiple infusion bags would have to be contaminated if there was insulin poisoning.
The blood sugar rose after 1900 hours, not because the infusion bag was changed, but because the dextrose was increased to 15%. Chase and Shannon (see Annex) reported that preterm infants have different insulin and c-peptide normative standards than
adults.
Exogenous insulin is unlikely to be the cause of hypoglycemia because the C-peptide was not low for preterm infants (20-45 percentile), potassium levels were normal (insulin decreases potassium), glucose levels should be lower if exogenous insulin was used, the Insulin / C-Peptide (I/C) ratio was within the expected range for preterm infants, insulin autoimmune antibodies (IAA) which are common in preterm infants bind to insulin and increase measured insulin levels, and the immunoassay test is unreliable because interference factors like sepsis and antibiotics can give false positive insulin readings.
CONCLUSIONS
- Baby 6 had prolonged hypoglycemia because of sepsis, prematurity, borderline intrauterine growth restriction, lack of intravenous glucose when the long line infiltrated for a prolonged period of several hours, and poor medical management of hypoglycemia.
- Baby 6’s insulin level and I/C ratio do not prove that exogenous insulin was used, and are within the norm for preterm infants. Preterm infants and especially those with illness and drug treatments like antibiotics have different normative standards compared to healthy adults and older children.