Child F insulin case, summary of Dr. Lee statements

The baby had sepsis and hypoglycemia. It was treated with antibiotics and glucose. 9 hours after treatment began, it was noticed that the baby was not receiving glucose properly, the line had been feeding body tissue in the leg area, rather than the vein, so no glucose had been entering the bloodstream. This was evidenced by swelling in the leg and groin area. This can explain why blood glucose levels had stayed low during the first bag, rather than the explanation that the bag was poisoned with insulin.

A new bag was fixed and the low blood sugar continued for the next 7 hours. Then a new bag with glucose was inserted, with increased glucose from 10% to 15% and the baby's blood sugar increased and hypoglycemia resolved. Dr. Lee says this increased dose should have been done a lot earlier and the increased dose can explain why the hypoglycemia resolved. He also says they should have treated the baby with a continuous, gradually increasing amount of glucose. He says that the staff should not have given single pump doses of 10% glucose as they did, this caused a surge of insulin to be created in the body which caused blood sugar to fall, creating an up down up down pattern.

Prosecution lawyer Johnson claimed that glucose levels rose from 10am to 12pm due to the insulin spiked bag being removed at 10 am, he said:

at 10am, there were problems with the cannula infusion which meant the line had to be resited, and fluids were discontinued. The two further glucose readings after are '1.4' and '2.4', "implying" that the blood glucose level had started to rise "spontaneously" as there was "no contribution from the intravenous route".Mr Johnson said after Child F was taken off the 'double' dose of dextrose during that time, his blood sugar levels "actually rose.

This analysis by the prosecution was misleading, the 1.4 reading occured at 11:46, compared to 1.3 at 10am. So the prosecution lawyer was wrong to say the glucose had been increasing spontaneously without the bag and insulin expert Dr. Hindmarsh was wrong to say he was correct. The 2.4 reading at around noon can be explained by the new glucose bag being given.

Regarding the insulin blood tests, the insulin c-peptide ratio is different for newborns compared to older children and adults, according to Professor Jeff chase. He says The c-peptide level was a normal level for pre term infants. If insulin poisoning had occured, potassium levels would have been reduced but the baby had normal levels. Glucose levels were not low enough to indicate insulin poisoning. The insulin c-peptide ratio was in a normal range for pre term babies. Pre term babies have a lot of antibodies which binds to insulin and leads to a falsely high insulin reading. Immunoassay testing is unreliable when sepsis and antibiotics cause extra antibodies to interfere with the result.

Hypoglycemia was caused by sepsis, prematurity, IV line tissuing and poor medical management of the hypoglycemia.