Disorders of glucose metabolism-post mortem analyses in forensic cases: part I

In developed countries, diabetes is one of the ten most common causes of death. Post mortem diagnosis of glucose metabolism disorders can be difficult and vague because of the lack of characteristic morphological findings. Reviews of the literature are presented concerning biochemical problems in cases of unclear hyper- or hypoglycemia. After repetition of causes, frequency, and mortality of diabetic metabolism disorders, we give hints for the detection of diabetic ketoacidosis, hyperosmolar coma, insulinoma, and insulin- or oral diabetic-induced hypoglycemia. The first part discusses the analytes glucose and lactate, glycated proteins and oral antidiabetics, with special regard to their matrices post mortem, to reference concentrations, stability data and to analytic procedures that should be used in clinical or toxicological laboratories to detect diabetic metabolism disorders after death.