9m is a massive amount of insulin, they come in 10ml vials. Also 9ml is just what the baby would have had until the TPN stopped, there would have been more in the bag overall. Then there's the potential second bag. You'd notice entire vials of insulin going missing surely!
Yes, I was just thinking that - if you assume that the insulin was evenly distributed throughout the bag, then assuming the bag was to run for 48 hours to deliver 0.56ml/hour would require an addition of about 27ml of insulin. That is clearly bonkers for several reasons - firstly, it's a huge amount, about 3 vials worth! Secondly, wasn't the volume of these bags quite small? I seem to recall a figure of 150 mls being quoted but I can't lay my finger on where at this moment. In a volume that small, you would notice an additional 30 mls, surely?
Secondly, the scenario above relies on a number of assumptions, including that the insulin would be evenly distributed through the bag. The thing is, we don't know that it would - it isn't supposed to be given that way, and I don't know if there is data available about the pharmacokinetics of insulin, ie whether it would have behaved differently given via that route and whether the bag would have had a concentration gradient within it, with more insulin at the bottom. (I hope that makes sense)
What I am trying to get to is that the suggestion that the insulin was in the TPN bag is actually a theory, as it would explain the failure of the blood glucose levels the stabilise, but in order for that theory to work you have to make a number of assumptions, which might be impossible to prove, or which on reflection sound batshit.
The theory that the second bag was similarly contaminated also throws up further issues- I'm going to see if I can explain, so bear with me.
The blood test which would later show that the baby had apparently been given exogenous insulin was not taken until around 6pm, so that was roughly 18 hours since the first bag was started, and roughly 8 hours since the first bag was stopped. It wouldn't have been anticipated that another bag would be needed so soon and it was only stopped because of the tissuing of the long line.
The new bag was connected at around 11am, so in the 7 hours prior to the blood test being obtained, the baby had been receiving fluids from the new bag - 7 hours during which LL had not been in the building. We know that during this time, the baby continued to have low glucose readings, and the evidence offered by the prosecution is that the baby must have been receiving roughly the same amount of insulin per hour from midnight to 6pm, when the blood sample was obtained.
So for the prosecution theory to pan out she first would have had to contaminate the bag with a shitload of insulin - according to their claim that the baby was receiving about 0.56ml per hour.
If their evidence is that a new bag was connected after the line was changed, then they need to explain how she was supposed to have poisoned a second bag, the use of which would not have been anticipated?
Because of half-lives etc the blood test results can only relate to what the baby was receiving in the hours leading up to 6pm, not what was in the first bag, connected at around midnight, 18 hours earlier.
Bag one should not have been reconnected, and there should be a record of what fluids WERE connected, while they waited for the new bespoke bag to come up from pharmacy. Realistically, if a new bag was connected I cannot see any possible way they can link that to her.
Apologies, I know I have gone on at length, but it is bugging me.
On the insulin…just putting this into my own daily life as a type 1.
0.56ml per hour = 56 units of insulin per hour over a 10 hour period = 560 units
1000 units in a 10ml bottle.
She could have stole a bottle and poisoned both bags. Those figures would work out as being a full bottle split between both bags. So 5ml in each bag.
I do find these calculations questionable! Something is wrong here because a grown adult taking 56 units an hour without much eating would go into a coma! Then again there is the counteracting with the glucose the baby received.
Nah, just revisited and thought more about this. No way is the 0.56 ml per hour correct. I’ll have a research on my day off.
I'm glad you have picked up on that, because to me the sheer quantity of insulin reported sounds completely bonkers
. Babiven already contains lipids and can be used on a peripheral line.
I see numbers and my brain just says nope!
