The identification and quantification of insulin and its analogs have always been a challenge in the forensic field. Murder, suicide attempts and induced hypoglycemia in the context of factitious disorders have been described with the use of synthetic analogs of human insulin. There is very less information in the literature about aspart insulin concentrations in overdose cases. In this paper, we present a case of a nurse who tried to murder her 10-year-old daughter by injecting her aspart insulin and who, later, tried to commit suicide by injecting herself the same hormone. Two empty syringes and a FIASP® Flextouch pen were found in the woman’s apartment. A liquid chromatography coupled to high resolution mass spectrometry (LC–HRMS) method was developed in order to identify and discriminate aspart insulin from human insulin in blood samples as well as in syringes and pen, while an liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS) method was developed for the quantification of insulin in blood samples. Aspart insulin tested positive at 5.7 and 2.4 ng/mL in the blood specimens of the mother and the child, respectively. The substance contained in the syringes and pen also corresponded to aspart insulin. Although the mother claims to have injected an overdose of aspart insulin, the concentrations found were in the therapeutic range for subjects under therapy. Due to the high instability of insulin and the long time elapsed between sampling and forensic analysis (8 months) due to administrative reasons, the concentration at the time of collection was probably much higher. In this case, it was possible to identify aspart insulin and discriminate it from human insulin in a context of attempted murder and subsequent attempted suicide using high-resolution mass spectrometry, which is of paramount importance in forensic medicine.

中文翻译：

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企图谋杀一名幼儿，随后企图通过注射门冬胰岛素自杀母亲：两例血液中 LC-HRMS 和 UPLC-MS/MS 对胰岛素定量的鉴定

胰岛素及其类似物的鉴定和定量一直是法医领域的挑战。在使用人胰岛素的合成类似物的情况下，已经描述了在人为疾病背景下的谋杀、自杀企图和诱发的低血糖症。文献中关于过量病例中门冬胰岛素浓度的信息非常少。在本文中，我们介绍了一个护士的案例，她试图通过给她 10 岁的女儿注射门冬胰岛素来谋杀她，后来她又试图通过给自己注射同样的激素来自杀。在该女子的公寓中发现了两个空注射器和一支 FIASP® Flextouch 笔。开发了一种液相色谱与高分辨率质谱联用 (LC-HRMS) 方法，以识别和区分血液样品以及注射器和笔中的门冬胰岛素和人胰岛素，而液相色谱与串联质谱联用 (LC) –MS/MS) 方法被开发用于定量血液样品中的胰岛素。在母亲和孩子的血液样本中，门冬胰岛素分别为 5.7 和 2.4 ng/mL。注射器和笔中包含的物质也对应于门冬胰岛素。虽然这位母亲声称注射了过量的门冬胰岛素，但发现的浓度在接受治疗的受试者的治疗范围内。由于胰岛素的高度不稳定性，以及由于行政原因，采样和法医分析之间的时间间隔很长（8 个月），收集时的浓度可能要高得多。在这种情况下，在谋杀未遂和随后自杀未遂的情况下，可以使用高分辨率质谱法识别门冬胰岛素并将其与人胰岛素区分开来，这在法医学中至关重要。