We have the same problems in the US. Imo
UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #7
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The urge to harm may have come later though, once she realised she had access to easy victims (allegedly).
Certain personality types are drawn to jobs where they can be seen as the hero so that could of been a factor in becoming a neonatal nurse, and then a darker part of the personailty took advantage of the situation later on??
Agreed - the NHS is NOT fit for purpose.
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On Thursday, an on-call Countess of Chester Hospital consultant at the time of Child F's deterioration in August 2015 said the baby boy was found to have an "extremely high" level of insulin in his system.
He told the court Child F "had been given a synthetic form of insulin but he was never prescribed this at this time and he should never have received it."
Read more here: Lucy Letby trial: ‘Poisoned’ baby had ‘extremely high level’ of insulin in his system
He told the court Child F "had been given a synthetic form of insulin but he was never prescribed this at this time and he should never have received it."
Read more here: Lucy Letby trial: ‘Poisoned’ baby had ‘extremely high level’ of insulin in his system
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looks like we may have some updates from today soon...
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Lucy Letby, 32, is said to have tried to murder the premature twin by intentionally giving him insulin on the Countess of Chester Hospital’s neonatal unit.
The prosecution say she struck after midnight on a night shift starting on August 4, 2015 as the youngster, referred to as Child F, received a new feed of nutrients via a bag connected to an intravenous line.
Shortly after, his heart rate surged and his blood sugars plummeted, jurors at Manchester Crown Court have been told.
Giving evidence on Thursday, November 24, the shift’s on-call consultant Dr John Gibbs said the sudden rise in heartbeat from a normal rate was “very unusual” and Child F’s blood sugar was “worryingly low”.
It was initially treated as a suspected infection and dehydration but a blood test revealed a week later that a large level of insulin was in his body, the court heard.
Dr Gibbs said: “The fact that (Child F) was found to have an abnormally high level of insulin – in fact an extremely high level – in the blood, in retrospect makes it likely the symptoms he was displaying after midnight were related to a very low blood sugar level caused by him receiving a high dose of insulin.
“I didn’t suspect that at the time because there was no reason why he should have had a high dose of insulin administrated to him.”
BBM
I wonder if the defence is going to put on his own expert for insulin then bring back Dr Gibbs.
He didn't mention in the opening statement any witnesses he would be calling but he must be calling someone.
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It would make sense if they did do so.
If so, I would have expected defense to at least hint at their upcoming expert testimony. Usually the defense atty would say something like " Dr Gibbs, are you aware of other experts that would disagree with your assertion that the only answer is that it was an injection of insulin? Are you aware that some experts would assert that there is a naturally occurring possibility for those readings? " Or something along those lines to try and prevent the jury from blindly accepting those prosecution statements.
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2:36am
The trial has now resumed.
The court is hearing from Anna Milan, a clinical biochemist, how insulin and insulin c-peptide tests were taken for analysis.
The trial has now resumed.
The court is hearing from Anna Milan, a clinical biochemist, how insulin and insulin c-peptide tests were taken for analysis.
The journalists doing the Trial of Lucy Letby podcast have said the defence will be calling their own witnesses. While I haven't heard any mention of it otherwise I assume they know what they're talking about (one of them is in court* watching every day)
* well, in the bonus area most of the journalists are in
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Recap: Lucy Letby trial, Friday, November 25
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
The court is hearing from Anna Milan, a clinical biochemist, how insulin and insulin c-peptide tests were taken for analysis.
Child F's blood sample, which was dated August 5, 2015, was taken at 5.56pm.
The court is shown a screenshot of Child F's blood sample results. Child F is referred to as 'twin 2' - Child E, the other twin boy, had died at the Countess of Chester Hospital on August 4.
Dr Milan says Child F's insulin c-peptide level reading of 'less than 169' means it was not accurately detectable by the system.
The insulin reading of '4,657' is recorded.
A call log information is made noting the logged telephone call made by the biochemist to the Countess of Chester Hospital, with a comment made - 'low C-Peptide to insulin'
2:55am
The note adds '?Exogenous' - ie query whether it was insulin administered.
The note added 'Suggest send sample to Guildford for exogenous insulin.'
The court hears Guildford has a specialist, separate laboratory for such analysis in insulin, although the advice given to send the sample is not usually taken up by hospitals.
Dr Milan said that advice would be there as an option for the Countess of Chester Hospital to take up.
Dr Milan said she was 'very confident' in the accuracy of the blood test analysis produced for Child F's sample.
Ben Myers, for Letby's defence, asks about the risk of the sample deteriorating if it is not frozen.
Dr Milan said the sample arrived frozen. If it wasn't frozen, it would be accepted in 12-24 hours.
She said the laboratory knew it arrived within 24 hours, and adds Chester has its own system in place to store the blood sample before transport.
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Recap: Lucy Letby trial, Friday, November 25
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
Mr Myers said the Child F blood sample would have been stored for seven days [in Liverpool], then disposed of. Dr Milan agrees.
2:58am
On a query from the judge, Mr Justice James Goss, Dr Milan explains how the blood sample is frozen and kept frozen for transport.
She said the sample would not have been taken out of the freezer in Chester until it was ready to be transported.
3:02am
The next witness to give evidence is Professor Peter Hindmarsh, an expert witness.
He explains to the court he is professor of paediatric endocrinology at University College London and consultant in paediatric endocrinology and diabetes at University College London Hospitals.
Nicholas Johnson KC, for the prosecution, asks whether Professor Hindmarsh was contacted by Cheshire Police in connection with the case of Child F. Professor Hindmarsh confirms he was.
3:04am
Professor Hindmarsh confirms he had been told there was a suspicion Child F had received insulin in an 'exogenous' way - ie the insulin was not produced within the body.
3:06am
He said he concluded the cause of the hypoglycaemia was exogenous, and the chemical findings were compatible with the administration of exogenous insulin.
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3:13am
The court hears about Child F's blood sugar being slightly below normal, just after birth, and he was given 10% dextrose, and that resolved the blood sugar level to a normal rate.
There was also a point around July 30-31 when Child F's blood sugar level rose to a higher than normal rate, and he was given a tiny amount of insulin to lower the rate. Subsequent blood sugar readings returned to normal.
The court is now shown Child F's observation chart for the night of August 4-5. Child F's heart rate rose from around 150bpm to 200-210bpm between 1.15am-4am.
Child F had received a TPN bag of nutrition at 12.25am on August 5.
Child F's blood sugar reading at 1.54am was 0.8. Professor Hindmarsh says it is a "significant" difference and "extremely low".
Mr Johnson: "Was it a cause for concern?"
Professor Hindmarsh: "Absolutely."
The court hears about Child F's blood sugar being slightly below normal, just after birth, and he was given 10% dextrose, and that resolved the blood sugar level to a normal rate.
There was also a point around July 30-31 when Child F's blood sugar level rose to a higher than normal rate, and he was given a tiny amount of insulin to lower the rate. Subsequent blood sugar readings returned to normal.
The court is now shown Child F's observation chart for the night of August 4-5. Child F's heart rate rose from around 150bpm to 200-210bpm between 1.15am-4am.
Child F had received a TPN bag of nutrition at 12.25am on August 5.
Child F's blood sugar reading at 1.54am was 0.8. Professor Hindmarsh says it is a "significant" difference and "extremely low".
Mr Johnson: "Was it a cause for concern?"
Professor Hindmarsh: "Absolutely."
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3:16am
A table, created by Professor Hindmarsh, records all of Child F's blood sugar readings from 11.32pm on August 4 to 9.17pm on August 5.
They are:
5.5 (August 4, 11.32pm)
0.8 (August 5, 1.54am)
2.3 (2.55am)
1.9 (4.02am)
2.9 (5am)
1.7 (8.09am)
1.3 (10am)
1.4 (11.46am)
2.4 (noon)
1.9 (2pm)
1.9 (4pm)
1.9 (6pm)
2.5 (7pm)
4.1 (9.17pm)
A reading of 'above 2.6' is considered 'normal'.
Professor Hindmarsh says the hypoglycaemia is "persistent" right through the day until the conclusion of the TPN bag at 6.55pm.
A table, created by Professor Hindmarsh, records all of Child F's blood sugar readings from 11.32pm on August 4 to 9.17pm on August 5.
They are:
5.5 (August 4, 11.32pm)
0.8 (August 5, 1.54am)
2.3 (2.55am)
1.9 (4.02am)
2.9 (5am)
1.7 (8.09am)
1.3 (10am)
1.4 (11.46am)
2.4 (noon)
1.9 (2pm)
1.9 (4pm)
1.9 (6pm)
2.5 (7pm)
4.1 (9.17pm)
A reading of 'above 2.6' is considered 'normal'.
Professor Hindmarsh says the hypoglycaemia is "persistent" right through the day until the conclusion of the TPN bag at 6.55pm.
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3:19am
The 5am reading of 2.9, which the court hears is considered a 'normal' blood sugar reading, is gone into further detail.
Mr Johnson asks the court to show the intensive care chart for Child F for August 5.
For the 5am reading, the blood sugar reading signature has the initials 'LL'.
3:24am
The chart also shows Professor Hindmarsh's notes to provide context for the blood sugar readings throughout the day, when changes are made to the infusions for Child F.
Professor Hindmarsh says the hypoglycaemia continues "despite" five boluses of 10% dextrose and "ongoing" glucose delivery from the 10% dextrose infusion, and the glucose contained within the TPN bag.
He says that would, in total, give a glucose infusion which would be, at minimum, "twice the normal [daily] requirements of a baby".
He said it is likely more glucose was being delivered from the bolus injections.
3:26am
Professor Hindmarsh had noted three events during August 5, after 1.54am, when the TPN bag was administered.
At 10am, there were problems with the cannula infusion which meant the line had to be resited, and fluids were discontinued. The two further glucose readings after are '1.4' and '2.4', "implying" that the blood glucose level had started to rise "spontaneously" as there was "no contribution from the intravenous route".
3:28am
Mr Johnson said after Child F was taken off the 'double' dose of dextrose during that time, his blood sugar levels "actually rose".
Professor Hindmarsh: "That's how I see it, and I believe that is correct".
3:30am
The reading was "heading in the wrong direction" down to 1.9 by 2pm, the court hears.
The infusions stopped at 6.55pm.
Mr Johnson: "Is there a paradox between a child receiving glucose and their blood sugar falling?"
Prof Hindmarsh: "Correct."
3:34am
The 5.56pm blood sample for Child F is referred to, which has a blood sugar reading of 1.3.
Mr Johnson asks about the apparent disparity.
Prof Hindmarsh says the laboratory reading of blood plasma of '1.3' differs from the neopatient reading of '1.9' (taken at 6pm).
He explains a discrepancy of up to 0.8 between the two is considered acceptable.
He says whichever the more accurate reading is 1.3 or 1.9, it is still "very low".
The 5am reading of 2.9, which the court hears is considered a 'normal' blood sugar reading, is gone into further detail.
Mr Johnson asks the court to show the intensive care chart for Child F for August 5.
For the 5am reading, the blood sugar reading signature has the initials 'LL'.
3:24am
The chart also shows Professor Hindmarsh's notes to provide context for the blood sugar readings throughout the day, when changes are made to the infusions for Child F.
Professor Hindmarsh says the hypoglycaemia continues "despite" five boluses of 10% dextrose and "ongoing" glucose delivery from the 10% dextrose infusion, and the glucose contained within the TPN bag.
He says that would, in total, give a glucose infusion which would be, at minimum, "twice the normal [daily] requirements of a baby".
He said it is likely more glucose was being delivered from the bolus injections.
3:26am
Professor Hindmarsh had noted three events during August 5, after 1.54am, when the TPN bag was administered.
At 10am, there were problems with the cannula infusion which meant the line had to be resited, and fluids were discontinued. The two further glucose readings after are '1.4' and '2.4', "implying" that the blood glucose level had started to rise "spontaneously" as there was "no contribution from the intravenous route".
3:28am
Mr Johnson said after Child F was taken off the 'double' dose of dextrose during that time, his blood sugar levels "actually rose".
Professor Hindmarsh: "That's how I see it, and I believe that is correct".
3:30am
The reading was "heading in the wrong direction" down to 1.9 by 2pm, the court hears.
The infusions stopped at 6.55pm.
Mr Johnson: "Is there a paradox between a child receiving glucose and their blood sugar falling?"
Prof Hindmarsh: "Correct."
3:34am
The 5.56pm blood sample for Child F is referred to, which has a blood sugar reading of 1.3.
Mr Johnson asks about the apparent disparity.
Prof Hindmarsh says the laboratory reading of blood plasma of '1.3' differs from the neopatient reading of '1.9' (taken at 6pm).
He explains a discrepancy of up to 0.8 between the two is considered acceptable.
He says whichever the more accurate reading is 1.3 or 1.9, it is still "very low".
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3:37am
Child F's blood test result from the laboratory, as shown earlier to the court today, is presented to Professor Hindmarsh. The sample was taken at 5.56pm on August 5 and collected at the Liverpool laboratory at 4.15pm on August 6.
He says the insulin reading should be in proportion to the insulin C-Peptide reading, and should be several times higher in this context.
3:41am
Prof Hindmarsh explains to the court the dangers of prolonged low blood sugar in the body, which can lead to damage to the brain.
Breakdown of fats can be used as a temporary measure, as a substitute.
The problem, he says, is if the low blood sugar is caused by excess insulin.
The insulin will 'switch off' key body formation.
He says the brain would be in a "very, very susceptible state to receiving damage".
That depends on the depth and length of the hypoglycaemia episode.
An equivalent reading of 2.3 or so would lead to 'confusion' and difficulties reading/writing.
Professor Hindmarsh says lower readings than that could lead to seizures, death of brain cells, coma, and in some cases, death.
3:47am
Professor Hindmarsh added, in his report, the insulin used in the hospital, has been used in the past 20-25 years, and is synthetic insulin.
Stocks of pig/cow insulin would not be held as regular stock or in a pharmacy. They would have to be requested.
The two types of synthetic insulin are fast-acting - ones that work within 30 minutes, applied via an injection, the effectiveness lasting 4-6 hours. The other type is long-acting, which lasts up to 12-24 hours.
The second type of insulin, he explains, is not generally used for intravenous infusions, and he has never seen any evidence of that having been done.
3:50am
Professor Hindmarsh is shown a 10ml bottle of insulin, which normally comes with an orange, self-sealing cap.
To extract the liquid from the bottle, to administer 'therapeutically', a medical professional would have to use a syringe, the court hears.
Mr Johnson says by 'therapeutically', Professor Hindmarsh means 'legitimately'. Professor Hindmarsh agrees, and says the dose would have to be measured out carefully.
3:52am
The insulin bottle exhibit is shown to members of the jury and the defence.
www.chesterstandard.co.uk
I am in California, the sun will be up in a few hours...better get to sleep...The link is above if someone wants to copy/paste the next portion. I think they are on a break right now...
Child F's blood test result from the laboratory, as shown earlier to the court today, is presented to Professor Hindmarsh. The sample was taken at 5.56pm on August 5 and collected at the Liverpool laboratory at 4.15pm on August 6.
He says the insulin reading should be in proportion to the insulin C-Peptide reading, and should be several times higher in this context.
3:41am
Prof Hindmarsh explains to the court the dangers of prolonged low blood sugar in the body, which can lead to damage to the brain.
Breakdown of fats can be used as a temporary measure, as a substitute.
The problem, he says, is if the low blood sugar is caused by excess insulin.
The insulin will 'switch off' key body formation.
He says the brain would be in a "very, very susceptible state to receiving damage".
That depends on the depth and length of the hypoglycaemia episode.
An equivalent reading of 2.3 or so would lead to 'confusion' and difficulties reading/writing.
Professor Hindmarsh says lower readings than that could lead to seizures, death of brain cells, coma, and in some cases, death.
3:47am
Professor Hindmarsh added, in his report, the insulin used in the hospital, has been used in the past 20-25 years, and is synthetic insulin.
Stocks of pig/cow insulin would not be held as regular stock or in a pharmacy. They would have to be requested.
The two types of synthetic insulin are fast-acting - ones that work within 30 minutes, applied via an injection, the effectiveness lasting 4-6 hours. The other type is long-acting, which lasts up to 12-24 hours.
The second type of insulin, he explains, is not generally used for intravenous infusions, and he has never seen any evidence of that having been done.
3:50am
Professor Hindmarsh is shown a 10ml bottle of insulin, which normally comes with an orange, self-sealing cap.
To extract the liquid from the bottle, to administer 'therapeutically', a medical professional would have to use a syringe, the court hears.
Mr Johnson says by 'therapeutically', Professor Hindmarsh means 'legitimately'. Professor Hindmarsh agrees, and says the dose would have to be measured out carefully.
3:52am
The insulin bottle exhibit is shown to members of the jury and the defence.
Recap: Lucy Letby trial, Friday, November 25
The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…
I am in California, the sun will be up in a few hours...better get to sleep...The link is above if someone wants to copy/paste the next portion. I think they are on a break right now...
So I can't understand why it hasn't been asked if the TPN that had gone into the tissues at midday could have caused the insulin to keep working.
The Prof said subcutaneous insulin could last up to 6 hours
The line was changed at 12pm whose to say the final 7 hours of low blood sugar wasn't due to the subcutaneous tpn in the tissues?
The Prof said subcutaneous insulin could last up to 6 hours
The line was changed at 12pm whose to say the final 7 hours of low blood sugar wasn't due to the subcutaneous tpn in the tissues?
Observant-ADHD-ENFP-BSc
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That's exactly what I took from that too. I know when I am being taught something or listening to something I need to understand, I will ask questions to clarify etc. It shows they are being diligent
12:00pm
Once a syringe is put into the bottle, the bottle self seals after the syringe is removed, the court hears.
Professor Hindmarsh says it is not possible to give insulin by mouth as it is a large molecule, so cannot be absorbed easily and the protein would be broken down by the acid in the stomach. It could not have been administered via the naso-gastric tube for the same reason.
The only ways would have been through a skin injection or intraveneously, he says.
For a skin injection, he says the duration of action [for the insulin] of 4-6 hours would not fit with the 17 hours of hypoglaycaemia. It would require multiple injections.
He says an intravenous route "would be the most likely explanation".
The way to do so would be a bolus of insulin - from testing in endrocrinology, the blood sugar level would fall within 90 minutes, then rise back to normal.
To maintain hypoglycaemia "over a protracted period of time" would require multiple insulin boluses "roughly every two hours".
The second route would be via infusion - "probably the most likely way of achieving the blood glucose effect that we have observed".
The infusion would be "continuous", using the bags available, and "fit nicely" with the time course of events.
It would "also be consistent" with the measurements that took place during and after the TPN bag was replaced.
12:03pm
Professor Hindmarsh says the exogenous insulin, if the fast-acting type, would have reduced from the '4,657' reading to 'almost none' after a couple of hours after the TPN bag was removed.
The rise of the blood glucose level in Child F to 4.1 by 9pm was "entirely consistent" with that.
12:16pm
Professor Hindmarsh says a rate of about 0.56ml/hr of insulin would have been required to lower Child F's blood sugar levels on the TPN bag.
This was calculated given the insulin level administered to lower Child F's blood sugar levels on July 31.
Mr Johnson: "Would that level have been visible to the naked eye?"
Prof Hindmarsh: "No."
Mr Johnson asks if the stock TPN bag was contaminated to the same degree as the bespoke bag.
Prof Hindmarsh says the glucose concentrations are not much different from 1.54am-10am, when the bag is changed, and after then.
"The contents [and contamination] are probably about the same."
Mr Johnson asks about Professor Hindmarsh's conclusion, that the fluid he was receiving could only have been contaminated with insulin.
"Yes I do."
Once a syringe is put into the bottle, the bottle self seals after the syringe is removed, the court hears.
Professor Hindmarsh says it is not possible to give insulin by mouth as it is a large molecule, so cannot be absorbed easily and the protein would be broken down by the acid in the stomach. It could not have been administered via the naso-gastric tube for the same reason.
The only ways would have been through a skin injection or intraveneously, he says.
For a skin injection, he says the duration of action [for the insulin] of 4-6 hours would not fit with the 17 hours of hypoglaycaemia. It would require multiple injections.
He says an intravenous route "would be the most likely explanation".
The way to do so would be a bolus of insulin - from testing in endrocrinology, the blood sugar level would fall within 90 minutes, then rise back to normal.
To maintain hypoglycaemia "over a protracted period of time" would require multiple insulin boluses "roughly every two hours".
The second route would be via infusion - "probably the most likely way of achieving the blood glucose effect that we have observed".
The infusion would be "continuous", using the bags available, and "fit nicely" with the time course of events.
It would "also be consistent" with the measurements that took place during and after the TPN bag was replaced.
12:03pm
Professor Hindmarsh says the exogenous insulin, if the fast-acting type, would have reduced from the '4,657' reading to 'almost none' after a couple of hours after the TPN bag was removed.
The rise of the blood glucose level in Child F to 4.1 by 9pm was "entirely consistent" with that.
12:16pm
Professor Hindmarsh says a rate of about 0.56ml/hr of insulin would have been required to lower Child F's blood sugar levels on the TPN bag.
This was calculated given the insulin level administered to lower Child F's blood sugar levels on July 31.
Mr Johnson: "Would that level have been visible to the naked eye?"
Prof Hindmarsh: "No."
Mr Johnson asks if the stock TPN bag was contaminated to the same degree as the bespoke bag.
Prof Hindmarsh says the glucose concentrations are not much different from 1.54am-10am, when the bag is changed, and after then.
"The contents [and contamination] are probably about the same."
Mr Johnson asks about Professor Hindmarsh's conclusion, that the fluid he was receiving could only have been contaminated with insulin.
"Yes I do."
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