Ensuring the diagnosis of
diabetes mellitus by morphological findings is very difficult. Postmortem determination of
blood glucose is of no value because of the influence of glycolysis. In clinical studies,
Hb A1 determination is used for long-time
therapy control of diabetes. Values of less than 10%
Hb A1 show that assimilation of
glucose is in order. This study is based on the investigation of blood from 174 cadavers (125 men aged between 17 and 84 years; 49 women aged between 27 and 89 years) with many different causes of death, including some cases of
coma diabeticum. Blood was frozen immediately; in 48 cases it was stored at +4 degrees C, too. Besides, we took cerebrospinal fluid and urine from each
corpse (frozen at -80 degrees C) for determination of
glucose,
lactic acid, and
acetone.
Hemoglobin A1 was analyzed by a chromatographic method: the concentrations of
Hb A1 ranged from 7.5% to 20% independent of the actual amount of total
hemoglobin in our samples (total Hb from 5 to 32 g/dl). Obviously, there is very little influence of
autolysis or prefinal
glucose fluctuations in blood on its quantity. There is a positive correlation to the concentration of
glucose and
lactic acid in cerebrospinal fluid (according to the formula of Traub) and also to the presence of
acetone in case of
diabetic coma. According to our experience,
Hemoglobin A1 is a very useful marker to ensure the diagnosis of
diabetes mellitus post mortem. As
Hb A1 seems to be very constant and stable vs.
autolysis, it may help to clear up cases of unexpected death.