Cognitive impairment unattended by subjective symptoms or objective signs is an uncommon but important consequence of hypoglycaemia. It can lead to a condition in which a patient behaves as an automaton in a manner totally alien to their usual personality and of which they have no recollection when their blood glucose level is restored to normal. It can cause a wide range of criminal behaviour, although the commonest offences relate to a loss of control, for example driving offences. Determination of criminal responsibility is extremely difficult and relies very heavily upon the quality of the medical evidence and interpretation of the law, which is out of step with current medical science.
MarksV. Hypoglycaemia; accident, violence and murder; Part 1. Pract Diab Int2005; 22: 303–306.
8.
Hill v Baxter. High Court of Justice Queens Bench Division (20 Dec 1957) The Times; page 5, column 1.
9.
Court of Appeal Mansfield v Weetabix Ltd [1997] P.I.Q.R. Part 6. 526–530.
10.
R v C. prosecution right of Appeal. Court of Appeal Criminal Division. [2007] EWCA Crim 1862.
11.
(8 Dec 2007) The Times.
12.
R v Trevor Norman Clarke. Court of Appeal Criminal Division. [2009] EWCA Crim 921.
13.
RedelmeierDAKensholeABRayJG. Motor vehicle crashes in diabetic patients with tight glycemic control: a population-based case control analysis. PLoS Med2009; 6: e1000192–e1000192.
14.
LonnenKFPowellRJTaylorD. Road traffic accidents and diabetes: insulin use does not determine the risk. Diabet Med2008; 25: 578–584.
15.
CoxDJ. Driving mishaps among individuals with type 1 diabetes. A prospective study. Diabetes Care2009; 32: 2177–2180.
