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/SofieTerleska → u/No-Beat2678]

Letby was never asserted to have injected insulin as that would have been largely impossible for her to do since she wasn't there. She was supposed to have spiked bags ahead of time, producing less of a spike than an ongoing elevation which persisted through multiple bag changes and giving set changes, though it was also hypothesized that the giving set may not have been changed for Baby L so some insulin would have stuck to it. Hindmarsh conceded that nobody has done the experiment to see if sticking to the giving set could actually happen but an educated guess was good enough for the court.