The haze of diabetic state in legal medicine - a review

Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State regarded as severe metabolic disorders, remain the two main causes of death in the diabetic population, thus proper postmortem evaluation of these conditions represents a key part in generating an accurate statistic for this chronic disease. In the field of forensic medicine, deaths due to acute complications of diabetes mellitus may be difficult to diagnose due to the lack of specific macroscopic and microscopic findings. The situation changes radically when postmortem biochemistry complements the autopsy. This article wants to provide a short overview of the literature regarding specific postmortem biomarkers levels and their optimal sampling sites, used in order to identify disorders of glucose metabolism, focusing on the manifestation of acute complications of DM as causes of death. Thus, determination of glucose, BHB, glycated hemoglobin in blood or other body fluid, such as vitreous humor should be standardized in all legal medicine laboratories, therefore improving the specificity in diagnosing the acute and fatal complications of DM. In Romania this standardization does not exist, so, this is one more reason why is necessary to re-analyze the literature and to raise the awareness of the problem.