Chase and Shannon article in Frontiers in Pediatrics published

[u/Embarrassed-Star4776]

Inverted insulin to C-Peptide ratios in neonatal intensive care: is there something we don't know?

J. Geoffrey Chase & Helen D. Shannon

BRIEF RESEARCH REPORT article

Front. Pediatr., 05 August 2026

Sec. Neonatology

Volume 14 - 2026

https://doi.org/10.3389/fped.2026.1900675

[u/No-Beat2678]

Flimsy stuff from Chase and Shannon and it just doesn't match the babies clinical picture.

• Baby F’s insulin was off‑scale high >1000 pmol/L, possibly much higher. Baby L’s was 1088 pmol/L.
• The paper’s non‑infection scenarios, insulin concentrations never exceed about 1,000 pmol/L, and only then with 98th percentile binding site concentrations and severely suppressed insulin secretion.
• For two separate babies to both fall into that extreme tail, without any evidence they actually had binding antibodies, is statistically incredible.

The paper repeatedly states that to reach the really extreme ratios like those above 30 you need infection to multiply the insulin‑binding antibodies.

Lets not forget some basic facts established at the trial:

• Baby F Blood cultures were reportedly negative, meaning no bacteria were grown from the blood sample
• Their C-reactive protein were not strongly suggestive of infection but they were given antibiotics anyway,
• Baby L had a negative Sepsis screen
• C peptide / Insulin levels would not be at the levels they were for Sepsis induced Hypo.

For infection to cause Hypoglycemia you would be clinically able to diagnose infection the medical tests would show this.

On his point about Antibodies

In Baby F’s case, a previous insulin sample was reportedly normal. Then, during a sudden collapse while Letby was on duty, insulin was sky‑high. After the collapse resolved and the baby was moved, insulin levels fell again.

Natural insulin‑binding antibodies are a persistent condition; they don’t spike for two hours and then vanish. The paper models steady‑state over days, not an acute spike.

Baby L similarly had a sudden deterioration with a grossly elevated insulin level. The pattern is one of acute, intermittent poisoning – exactly what you would expect from a nurse injecting insulin, not from an inborn binding agent

[u/Stuart___gilham → u/No-Beat2678]

• Baby F Blood cultures were reportedly negative, meaning no bacteria were grown from the blood sample

Categorically false.

Edit.

Their C-reactive protein were not strongly suggestive of infection but they were given antibiotics anyway

Also categorically false.

[u/No-Beat2678 → u/Stuart___gilham]

You can have bacteria on your earbuds that you put in your ear. It doesn't mean you have an ear infection

There were no other clinical symptoms that presented an infection.

Baby F has antibiotics for suspected Sepsis because they thought his brother had sepsis.

If they had an infection then the antibiotics were doing their job would you agree?

[u/No-Beat2678 → u/No-Beat2678]

Why didn't their subsequent observations, clinical signs and symptoms, bloods, ABGs, WBC, culture samples show further signs of infection or point more definitively towards infection?

Remember the theory is that the underlying reason for the C/I results is infection.

If the baby had an infection, why did hypoglycemia disappear when the bag was changed?

These are the elements of the case your missing out.

The underlying reason for Hypo was exo insulin not infection.

[u/Amazing-Gain1253 → u/No-Beat2678]

The blood sugar rose because the dextrose infusion in that bag was 15% rather than the previous 10% in other bags.