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Hypoglycaemia and automatism

Cognitive impairment unattended by subjective symptoms or objective signs is an uncommon but important consequence of hypoglycaemia. It can lead to a condition in which a patient behaves as an automaton in a manner totally alien to their usual personality and of which they have no recollection when their blood glucose level is restored to normal. It can cause a wide range of criminal behaviour, although the commonest offences relate to a loss of control, for example driving offences. Determination of criminal responsibility is extremely difficult and relies very heavily upon the quality of the medical evidence and interpretation of the law, which is out of step with current medical science.