Learn 'How Not to Die'

Over time, elevated glucose causes widespread organ damage, like that which I observed in Kim Atani. To confirm that Kim had diabetes, I would need to know her blood sugar levels. Testing for blood sugar is easy to do when you're living–blood is drawn and checked for its glucose concentration–but it's more complicated when you're dead.

After you die, your blood sugar begins to drop continuously toward zero. I can't even test for glucose levels in the blood because the blood breaks down right after death and interferes with testing. But I can test for glucose by using eye fluid drawn into a syringe–a procedure that can make you shudder if you've never seen it before. Each adult human eye contains about one-fifth of a teaspoon of jellylike fluid called vitreous humor. This fluid is very reliable for testing because it is isolated and protected, and therefore less subject to contamination or cell breakdown. I collected eye fluid from Kim's eyes and sent it to our toxicology lab. Glucose levels in the eye decrease after death, too, so a finding of elevated glucose would strongly indicate diabetes. Sure enough, when the toxicology report came back, it revealed that Kim's eye-fluid glucose was 378–massively elevated for a postmortem level.

Once I put all the facts of the case together and reviewed her tissues under a microscope, it was clear to me that over time, elevated glucose had caused widespread organ disease. It not only left Kim blind but it also caused a loss of sensation in her extremities and impaired her blood flow. Gangrene set in and allowed a deadly infection to take hold. The infection invaded her bloodstream, causing sepsis–an often fatal condition. Sepsis takes its name from the Greek word meaning "to putrefy." Known for generations as "blood poisoning," it generally means bacteria have breached the natural barriers of the skin and organs to enter the bloodstream.

Once there, they produce an overwhelming infection, the biological equivalent of tossing a grenade into your body. Blood pressure drops, vessels leak, and the lungs and kidneys fail. The result can be septic shock so severe that no amount of intravenous fluid or medication can reverse the condition. This is what happened to Kim Atani. Normally, a case like this would be closed, but I had to get to the bottom of why she had not sought medical care. Was it a case of negligence on the part of her husband, Simon? Could his inaction have contributed to her untimely death? If it was found that he had acted negligently, charges could be brought against him. I called Simon and told him that his wife had had diabetes. He was in denial about it, but more from ignorance about the disease than anything else. I pointedly asked why she didn't seek medical care and why he didn't seek medical care for her. He told me that his wife had had some bad experiences with doctors, that she refused to see one, and that she hated the medical establishment.

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