A correction. Child L's insulin was recorded at 1,099 and C-peptide as 269. Prof. Hindmarsh described the insulin level of 1,099 as a minimum, not a maximum, because the time at which the blood sample was taken was in dispute. The prosecution argued it was taken around 3:30. The defence said it was taken earlier, as recorded by Dr. Mayberry's retrospective notes.
Child L's poisoning also continued after the final offending bag was disconnected, as the insulin had stuck to the giving set.
The hypoglycemia started with sepsis and was prolonged because the IV infiltrated for several hours.
When hypoglycaemia persisted despite 10% dextrose infusion, a higher glucose infusion should have been given earlier. Repeat boluses of 10% dextrose worsen hypoglycemia because they cause surges of blood sugar, which trigger surges of insulin secretion, resulting in a yo-yo pattern of sharp rises and falls in insulin and blood sugar. When the dextrose infusion was stopped from 1000 to 1200 hours, the blood sugar did not rise from 1.3 to 2.4 as alleged, because the blood sugar was 1.4 at 1146 hours. The 2.4 level was measured after 1200 hours, when the IV was restarted. Since infusion bags were prepared in the pharmacy, stored in the unit, and changed at 1200 hours, multiple infusion bags would have to be contaminated if there was insulin poisoning. The blood sugar rose after 1900 hours, not because the infusion bag was changed, but because the dextrose was increased to 15%. Chase and Shannon (see Annex) reported that preterm infants have different insulin and c-peptide normative standards than adults. Exogenous insulin is unlikely to be the cause of hypoglycemia because the C-peptide was not low for preterm infants (20-45 percentile), potassium levels were normal (insulin decreases potassium), glucose levels should be lower if exogenous insulin was used, the Insulin / C-Peptide (I/C) ratio was within the expected range for preterm infants, insulin autoimmune antibodies (IAA) which are common in preterm infants bind to insulin and increase measured insulin levels, and the immunoassay test is unreliable because interference factors like sepsis and antibiotics can give false positive insulin readings.
CONCLUSIONS
1. Baby 6 had prolonged hypoglycemia because of sepsis, prematurity, borderline intrauterine growth restriction, lack of intravenous glucose when the long line infiltrated for a prolonged period of several hours, and poor medical management of hypoglycemia.
2. Baby 6’s insulin level and I/C ratio do not prove that exogenous insulin was used, and are within the norm for preterm infants. Preterm infants and especially those with illness and drug treatments like antibiotics have different normative standards compared to healthy adults and older children.
Analysis of Babies 6 and 12: A full Bioengineering and Clinical Analysis of evidence in the insulin cases
The authors fully empathise with the stress and anxiety the parents of these, and all, infants in these cases are facing.
Thus, this analysis does not ascribe innocence or guilt but presents a full clinical and bioengineering analysis of the evidence presented at court based on the full body of knowledge available regarding insulin delivery and action in preterm infants, rather than simplified first order analyses.
The following summary analysing the evidence against Lucy Letby for Babies 6 and 12 (“the insulin cases”) focuses on a detailed analysis of the evidence presented, as well as the full medical records made available. Thus, this release presents only the briefest high-level overview of a full ~100 page report with 250+ supporting references from peer-reviewed science publications to support the points below, many of which were published since the trial.
1. Independent data shows exogenous insulin as the cause is very unlikely:
• C-Peptide levels were not suppressed and were typical for this cohort.
• Potassium (K) levels were not suppressed and typical for this cohort. Insulin reduces potassium levels.
• Extremely high levels of exogenous insulin might be expected to lead to far lower glucose than observed based on a wide range of studies where smaller doses led to far lower glucose levels
• The high glucose infusion rates required with minimal response continued after hypoglycemia for both babies, where such unresponsive hypoglycemia is not uncommon
• The babies showed no symptoms of severe insulin poisoning, such as seizures or heart arrythmia.
→ All these points indicate insulin levels and dose suggested by the assays was in error, too high, or not present.
2. The interpretation of data presented in court is inconsistent with exogenous insulin:
• Neonatal hypoglycemia is not uncommon, affecting up to 40% or more of some NICU cohorts
• Failure to respond to dextrose boluses is also not uncommon in ~50% hypoglycemic infants
• In the exogenous insulin hypothesis, far more Insulin would have been required than postulated because it “sticks” to infusion lines and other things. This phenomenon is well-known.
• Insulin / C-Peptide (I/C) ratios > 0.2 (0.2 is presented as normal) are not uncommon in preterm infants, as seen in independent datasets and studies.
• Insulin autoimmune antibodies (IAA) and other are relatively common and bind to insulin increasing measured insulin levels several times over, leading to false-positive insulin poisoning.
→ All these points indicate insulin levels and dose suggested by the assays were misinterpreted or not given.
3. The immunoassay test is not reliable:
• The immunoassay insulin tests are not of forensic quality
• Standards and guidelines state unexpected insulin results should be checked with gold standard methods.
• Standards and guidelines state unexpected insulin results should lead to checking antibody levels.
• Several external factors in either mother and/or baby could account for apparent elevated insulin levels, due to assay interference and/or antibody binding, all of which are increasingly well-known.
→ These points indicate the measurements themselves can be unreliable and were not confirmed / checked.
Are all the Internation Panel of Experts, "armchair detectives" too?
Yeah that analysis doesn't matter. The only credible analysis is the one made by Phil Edwards. He sounds very knowledgeable so it must be true. As he says it's "overwhelming evidence". No one in the scientific community disputes the evidence for sure. In fact, I'll believe him over the International Panel of Experts disagreeing in the 1,000 page report... pfff too long. And who are they in comparison to this 30 minute write-up by Phil Edwards who doesn't even need to show his credentials cause everyone knows he's the most knowledgeable?
"Her handwritten confessions reflect a state of genuine mental turmoil, being wracked with guilt."
The green Post-it note had many things written on it. The prosecution focused on her words that supported their case, taken out of context. She also wrote on the green Post-it:
I can’t breathe
I can’t focus
Not good enough
I haven't done anything wrong
No hope
Slander
Discrimination
Victimisation
Panic
Fear
Despair
Lost
Why me
They said I did this
They went I did this because I am not good enough I killed them on purpose because I am not good enough to care for them
They accused
Adding the, "I am evil, I did this" in context with everything else she wrote, I fail to see how that is still considered a "confession."
I don't care about Lucy Letby, I don't know her. I don't care about the babies or the parents either, whom I also don't know. I do have a particular interest in miscarriages of justice. The court relied upon the junk science of Dewi R. Evans, and falsehoods by the likes of Bohin, Hindmarsh the others.
You can see clearly that it belongs with the phrase I mentioned & says ‘they won't ‘. There is even an apostrophe! Nobody would write they went in this context anyway.
Why wasn’t the green post-it note analysed in a forensic lab and interpreted with AI? The hidden layers can be automatically uncovered and ordered. Why didn’t a psychologist give testimony? Utter incompetent amateurism by police and CPS. Forensic science in the UK has gone completely down the drain.
“When you so desperately want something to be true, you’ll let nothing interfere with that belief.” You are talking about yourself, right? And you are clearly clinging to your last straw. Yes, the insulin cases are important, they are crucial. A UK criminal trial is not the right place to resolve subtle medical scientific issues. Quash the convictions. The CPS can bring charges again, if they want to. I doubt they will do so. If they don’t, let’s have a public inquiry. We can take a good look at insulin science within an inquiry.
I’m a lawyer in DC who spent hours listening to the reading of trial transcripts while driving and exercising. The prosecuting barrister is brilliant and I thought she did it.
What I did not realize is the UK courts do not screen expert testimony like US courts. The rash evidence turns out to be a sad joke and that blunder alone makes it hard to accept Dr. Evans over the international panel as to any of the cases (insulin included).
In any event, I think you’re wrong to say the insulin convictions make it highly likely she committed the other offenses by different (and various) means. It’s more likely that charging her with so many offenses made the jury more likely to convict as to insulin.
As time passes I wonder less about Lucy Letby’s psychology and more about Dr. Evans’ seemingly pathological (and misplaced) confidence. It turns out the presiding judge should have heeded the warning of his colleague about Evans.
I hope you yourself have the open mind thar you think many others lack. If you do, I don’t see how the international panel’s findings can fail to shake your confidence in the verdict.
What about the third baby Dewi R. Evans' included in his report that endocrinologist, Hindmarsh signed off, as another definite case of murder, but was dropped?
I completely disagree that without the insulin cases the rest would come crashing down. In my view the rest stand on their own merits as a group, with the cases of Baby E and the triplets possibly forming the 'lynchpin' on which the other convictions hang.
The bigger question is, who was responsible for admitting Baby E and twin whose mother had hemophilia to the CoCH Level 2 unit, which clearly goes against NHS protocols when the mother and therefore baby, let alone babies, is more prone to bleeding. Baby E, weighing less than 3lbs at birth, which is way below the expected 5.1 lbs at the projected CS at 35 weeks, died of exsanguination, losing 50% of it's blood.
As for the triplets, who are associated with higher fetal morbidity and mortality rates as well as life-threatening maternal complications; monochorionic diamniotic (MCDA) triplet pregnancies are very rare compared to other types of triplet pregnancies. The triplets were scheduled to be born at a highly specialised tertiary unit. Why were they admitted to a Level 2 unit that was already full to capacity? In this case we know who admitted the triplets because the doctor that enjoyed anonymity bragged to Letby about it in his text messages.
A single Roche Elecsys Immunoassay test for insulin and C-peptide is not a valid determinant of exogenous insulin administration in a preterm neonate due to several critical factors:
The Roche Elecsys assay has not been validated explicitly for preterm neonates, a population with unique metabolic profiles due to immaturity. No studies have confirmed its accuracy, sensitivity, or specificity in this group, and reference intervals are based on general or adult populations.
Preterm neonates exhibit significant variability in insulin and C-peptide levels due to factors like gestational age, insulin resistance, and transient hyperinsulinism.
Without continuous monitoring, short-term peaks or troughs in insulin or C-peptide are missed, as studies only sample over hours or days. A single test cannot capture dynamic changes, risking misinterpretation of high insulin as exogenous when it could be a natural transient response.
The assay can be affected by interferences (e.g., cross-reactivity with proinsulin or split products, and matrix effects in neonatal blood, which are not accounted for in preterm-specific validations, potentially skewing results.
Even if a high insulin to low C-peptide ratio suggests exogenous insulin, preterm neonates can naturally have low C-peptide due to insulin deficiency or rapid clearance, alongside high insulin from resistance or stress. This overlap means the ratio is not a definitive indicator without context.
From Dr Michael McConville's podcast, The Other Side of Lucy Letby
A correction. Child L's insulin was recorded at 1,099 and C-peptide as 269. Prof. Hindmarsh described the insulin level of 1,099 as a minimum, not a maximum, because the time at which the blood sample was taken was in dispute. The prosecution argued it was taken around 3:30. The defence said it was taken earlier, as recorded by Dr. Mayberry's retrospective notes.
Child L's poisoning also continued after the final offending bag was disconnected, as the insulin had stuck to the giving set.
Split hairs aside, fantastic piece.
The bags that were never even tested, for exogenous insulin or anything else?
Oodles of psychological projectin of Phil's part as he describes Letby 'supporters' as desperate etc.
Others commentators have gone into great details about his faulty reason with regards to the science.
I would just like to ask: so how much insulin wuld she have needed to injedct. And why was none reported to be missing?
The INTERNATIONAL PANEL'S OPINION
The hypoglycemia started with sepsis and was prolonged because the IV infiltrated for several hours.
When hypoglycaemia persisted despite 10% dextrose infusion, a higher glucose infusion should have been given earlier. Repeat boluses of 10% dextrose worsen hypoglycemia because they cause surges of blood sugar, which trigger surges of insulin secretion, resulting in a yo-yo pattern of sharp rises and falls in insulin and blood sugar. When the dextrose infusion was stopped from 1000 to 1200 hours, the blood sugar did not rise from 1.3 to 2.4 as alleged, because the blood sugar was 1.4 at 1146 hours. The 2.4 level was measured after 1200 hours, when the IV was restarted. Since infusion bags were prepared in the pharmacy, stored in the unit, and changed at 1200 hours, multiple infusion bags would have to be contaminated if there was insulin poisoning. The blood sugar rose after 1900 hours, not because the infusion bag was changed, but because the dextrose was increased to 15%. Chase and Shannon (see Annex) reported that preterm infants have different insulin and c-peptide normative standards than adults. Exogenous insulin is unlikely to be the cause of hypoglycemia because the C-peptide was not low for preterm infants (20-45 percentile), potassium levels were normal (insulin decreases potassium), glucose levels should be lower if exogenous insulin was used, the Insulin / C-Peptide (I/C) ratio was within the expected range for preterm infants, insulin autoimmune antibodies (IAA) which are common in preterm infants bind to insulin and increase measured insulin levels, and the immunoassay test is unreliable because interference factors like sepsis and antibiotics can give false positive insulin readings.
CONCLUSIONS
1. Baby 6 had prolonged hypoglycemia because of sepsis, prematurity, borderline intrauterine growth restriction, lack of intravenous glucose when the long line infiltrated for a prolonged period of several hours, and poor medical management of hypoglycemia.
2. Baby 6’s insulin level and I/C ratio do not prove that exogenous insulin was used, and are within the norm for preterm infants. Preterm infants and especially those with illness and drug treatments like antibiotics have different normative standards compared to healthy adults and older children.
Analysis of Babies 6 and 12: A full Bioengineering and Clinical Analysis of evidence in the insulin cases
The authors fully empathise with the stress and anxiety the parents of these, and all, infants in these cases are facing.
Thus, this analysis does not ascribe innocence or guilt but presents a full clinical and bioengineering analysis of the evidence presented at court based on the full body of knowledge available regarding insulin delivery and action in preterm infants, rather than simplified first order analyses.
The following summary analysing the evidence against Lucy Letby for Babies 6 and 12 (“the insulin cases”) focuses on a detailed analysis of the evidence presented, as well as the full medical records made available. Thus, this release presents only the briefest high-level overview of a full ~100 page report with 250+ supporting references from peer-reviewed science publications to support the points below, many of which were published since the trial.
1. Independent data shows exogenous insulin as the cause is very unlikely:
• C-Peptide levels were not suppressed and were typical for this cohort.
• Potassium (K) levels were not suppressed and typical for this cohort. Insulin reduces potassium levels.
• Extremely high levels of exogenous insulin might be expected to lead to far lower glucose than observed based on a wide range of studies where smaller doses led to far lower glucose levels
• The high glucose infusion rates required with minimal response continued after hypoglycemia for both babies, where such unresponsive hypoglycemia is not uncommon
• The babies showed no symptoms of severe insulin poisoning, such as seizures or heart arrythmia.
→ All these points indicate insulin levels and dose suggested by the assays was in error, too high, or not present.
2. The interpretation of data presented in court is inconsistent with exogenous insulin:
• Neonatal hypoglycemia is not uncommon, affecting up to 40% or more of some NICU cohorts
• Failure to respond to dextrose boluses is also not uncommon in ~50% hypoglycemic infants
• In the exogenous insulin hypothesis, far more Insulin would have been required than postulated because it “sticks” to infusion lines and other things. This phenomenon is well-known.
• Insulin / C-Peptide (I/C) ratios > 0.2 (0.2 is presented as normal) are not uncommon in preterm infants, as seen in independent datasets and studies.
• Insulin autoimmune antibodies (IAA) and other are relatively common and bind to insulin increasing measured insulin levels several times over, leading to false-positive insulin poisoning.
→ All these points indicate insulin levels and dose suggested by the assays were misinterpreted or not given.
3. The immunoassay test is not reliable:
• The immunoassay insulin tests are not of forensic quality
• Standards and guidelines state unexpected insulin results should be checked with gold standard methods.
• Standards and guidelines state unexpected insulin results should lead to checking antibody levels.
• Several external factors in either mother and/or baby could account for apparent elevated insulin levels, due to assay interference and/or antibody binding, all of which are increasingly well-known.
→ These points indicate the measurements themselves can be unreliable and were not confirmed / checked.
Are all the Internation Panel of Experts, "armchair detectives" too?
Yeah that analysis doesn't matter. The only credible analysis is the one made by Phil Edwards. He sounds very knowledgeable so it must be true. As he says it's "overwhelming evidence". No one in the scientific community disputes the evidence for sure. In fact, I'll believe him over the International Panel of Experts disagreeing in the 1,000 page report... pfff too long. And who are they in comparison to this 30 minute write-up by Phil Edwards who doesn't even need to show his credentials cause everyone knows he's the most knowledgeable?
"Her handwritten confessions reflect a state of genuine mental turmoil, being wracked with guilt."
The green Post-it note had many things written on it. The prosecution focused on her words that supported their case, taken out of context. She also wrote on the green Post-it:
I can’t breathe
I can’t focus
Not good enough
I haven't done anything wrong
No hope
Slander
Discrimination
Victimisation
Panic
Fear
Despair
Lost
Why me
They said I did this
They went I did this because I am not good enough I killed them on purpose because I am not good enough to care for them
They accused
Adding the, "I am evil, I did this" in context with everything else she wrote, I fail to see how that is still considered a "confession."
I don't care about Lucy Letby, I don't know her. I don't care about the babies or the parents either, whom I also don't know. I do have a particular interest in miscarriages of justice. The court relied upon the junk science of Dewi R. Evans, and falsehoods by the likes of Bohin, Hindmarsh the others.
It doesn't say 'they went'. It says 'they won't'. It's a continuation of the line 'how will things ever be the same'.
Not according to this: https://x.com/ChrisJClarkEsq/status/1697623417648795918/photo/1
"How will things ever be like they used to[,] they won't" "FEAR" overlaps the 'to'
You can see clearly that it belongs with the phrase I mentioned & says ‘they won't ‘. There is even an apostrophe! Nobody would write they went in this context anyway.
"They went" is common vernacular for they said, where I come from, and other places I've lived in GB.
Why wasn’t the green post-it note analysed in a forensic lab and interpreted with AI? The hidden layers can be automatically uncovered and ordered. Why didn’t a psychologist give testimony? Utter incompetent amateurism by police and CPS. Forensic science in the UK has gone completely down the drain.
You might want to do better than referencing the fictional work of a deranged Nazi fantasist.
Who is? Chris Clark?
“When you so desperately want something to be true, you’ll let nothing interfere with that belief.” You are talking about yourself, right? And you are clearly clinging to your last straw. Yes, the insulin cases are important, they are crucial. A UK criminal trial is not the right place to resolve subtle medical scientific issues. Quash the convictions. The CPS can bring charges again, if they want to. I doubt they will do so. If they don’t, let’s have a public inquiry. We can take a good look at insulin science within an inquiry.
I’m a lawyer in DC who spent hours listening to the reading of trial transcripts while driving and exercising. The prosecuting barrister is brilliant and I thought she did it.
What I did not realize is the UK courts do not screen expert testimony like US courts. The rash evidence turns out to be a sad joke and that blunder alone makes it hard to accept Dr. Evans over the international panel as to any of the cases (insulin included).
In any event, I think you’re wrong to say the insulin convictions make it highly likely she committed the other offenses by different (and various) means. It’s more likely that charging her with so many offenses made the jury more likely to convict as to insulin.
As time passes I wonder less about Lucy Letby’s psychology and more about Dr. Evans’ seemingly pathological (and misplaced) confidence. It turns out the presiding judge should have heeded the warning of his colleague about Evans.
I hope you yourself have the open mind thar you think many others lack. If you do, I don’t see how the international panel’s findings can fail to shake your confidence in the verdict.
What about the third baby Dewi R. Evans' included in his report that endocrinologist, Hindmarsh signed off, as another definite case of murder, but was dropped?
I completely disagree that without the insulin cases the rest would come crashing down. In my view the rest stand on their own merits as a group, with the cases of Baby E and the triplets possibly forming the 'lynchpin' on which the other convictions hang.
The bigger question is, who was responsible for admitting Baby E and twin whose mother had hemophilia to the CoCH Level 2 unit, which clearly goes against NHS protocols when the mother and therefore baby, let alone babies, is more prone to bleeding. Baby E, weighing less than 3lbs at birth, which is way below the expected 5.1 lbs at the projected CS at 35 weeks, died of exsanguination, losing 50% of it's blood.
As for the triplets, who are associated with higher fetal morbidity and mortality rates as well as life-threatening maternal complications; monochorionic diamniotic (MCDA) triplet pregnancies are very rare compared to other types of triplet pregnancies. The triplets were scheduled to be born at a highly specialised tertiary unit. Why were they admitted to a Level 2 unit that was already full to capacity? In this case we know who admitted the triplets because the doctor that enjoyed anonymity bragged to Letby about it in his text messages.
https://jollycontrarian.substack.com/p/lucy-letby-how-the-charges-were-selected?
That would be interesting if it answered the question "how were the charges selected?".
He did, in the audio if you listen to it.
A guess based on your own assumptions iis not an answer..
Tell that to Dewi R. Evans.
A single Roche Elecsys Immunoassay test for insulin and C-peptide is not a valid determinant of exogenous insulin administration in a preterm neonate due to several critical factors:
The Roche Elecsys assay has not been validated explicitly for preterm neonates, a population with unique metabolic profiles due to immaturity. No studies have confirmed its accuracy, sensitivity, or specificity in this group, and reference intervals are based on general or adult populations.
Preterm neonates exhibit significant variability in insulin and C-peptide levels due to factors like gestational age, insulin resistance, and transient hyperinsulinism.
Without continuous monitoring, short-term peaks or troughs in insulin or C-peptide are missed, as studies only sample over hours or days. A single test cannot capture dynamic changes, risking misinterpretation of high insulin as exogenous when it could be a natural transient response.
The assay can be affected by interferences (e.g., cross-reactivity with proinsulin or split products, and matrix effects in neonatal blood, which are not accounted for in preterm-specific validations, potentially skewing results.
Even if a high insulin to low C-peptide ratio suggests exogenous insulin, preterm neonates can naturally have low C-peptide due to insulin deficiency or rapid clearance, alongside high insulin from resistance or stress. This overlap means the ratio is not a definitive indicator without context.
From Dr Michael McConville's podcast, The Other Side of Lucy Letby
https://pmc.ncbi.nlm.nih.gov/articles/PMC6056384/
https://karger.com/neo/article/108/2/93/227641/Hyperglycaemic-Preterm-Babies-Have-Sex-Differences
https://bmjpaedsopen.bmj.com/content/8/1/e002470
https://bmjpaedsopen.bmj.com/content/1/1/e000160
https://labogids.sintmaria.be/sites/default/files/files/c-peptide_2018-08_v10.pdf
https://diagnostics.roche.com/global/en/products/lab/elecsys-c-peptide-cps-000460.html
https://www.labcorp.com/tests/010108/c-peptide
https://www.annlabmed.org/journal/view.html?doi=10.3343%2Falm.2018.38.6.530
https://wwwn.cdc.gov/nchs/data/nhanes/public/2009/labmethods/ins_f_met_insulin_elecsys_2010_immunoassay.pdf