Three Days of Sugar and a Nurse Who Knew Better

The prosecution just closed a gap that's been haunting this case since Day 2.

When toxicologist Scott Larson took the stand, he told the jury something nobody expected: no forensic lab in America can test for insulin. He looked for one. Couldn't find it. The analytical challenge of separating endogenous insulin from synthetic insulin, combined with blood stability issues, means the state's murder weapon theory has no lab confirmation behind it. That was a problem. A big one.

Today, the prosecution answered it. Not with a lab result. With a nurse practitioner who watched insulin fight back against everything her team threw at it for three consecutive days.

The Three-Day Battle the Jury Needed to See

Diane Led is a nurse practitioner at Holy Cross Mountain Point in Lehi, Utah. She's been doing this since 2013. She admitted Kacee Terry to the ICU on the night of August 12, 2024, and managed her care through August 15.

When Kacee arrived, her blood sugar was 14. Normal is 70 to 100. Led told the jury that at 14, a person is not awake, not alert, cannot follow commands. They started treatment immediately. IV dextrose drip at 10% concentration. Bolus pushes of sugar. The standard protocol that Led has used countless times throughout her career.

In her experience, patients with critically low blood sugar bounce back fast. She described a prior patient at 23 who was completely confused and unresponsive but woke up almost immediately once the sugar hit her system. Around 50 or 60, that patient was fully awake.

The prosecutor asked if that happened with Kacee.

One word. "No."

They doubled the dextrose concentration to D20. Still not enough. They gave bolus after bolus. Checked every 15 minutes. Every 30 minutes. For two straight days. At one point Kacee's blood sugar spiked to 500, wildly high, and crashed right back down. They never stabilized her. Not once. Not in three days of continuous intervention with an entire ICU team.

Led concluded that a significant amount of exogenous insulin was on board, likely including long-acting insulin, because the effects persisted for days. She could not give an exact number of units because everyone's body responds differently, especially someone who is insulin-naive. But she was clear about one thing: without exogenous insulin, Kacee would not have died.

Why This Bridges the Gap

The prosecution doesn't have a lab test proving synthetic insulin was present. What they have now is something arguably more powerful for a jury: a medical professional who watched what happened inside a patient's body for three days and reached a clinical conclusion the jury can understand.

Larson told the jury no lab can test for it. Led told the jury she doesn't need a lab. She watched it. Sugar in, blood sugar up, blood sugar crashes. Repeat. For 72 hours. That's not a medical mystery. That's insulin overpowering everything they could do.

The forensic gap still exists on paper. No lab confirmed synthetic insulin. But the clinical observation bridge is now in place, and for most jurors, watching a nurse practitioner describe three days of losing a battle they fight and win routinely is more persuasive than any lab report would have been.

The Nurse Knowledge Series

This is where the prosecution got surgical.

After walking through the medical timeline, prosecutor Thomas pivoted. She asked Led three rapid questions. Would a trained registered nurse understand vital signs? Yes. Would a trained nurse understand what insulin does to a non-diabetic patient? Yes. Would a trained nurse understand that continuously dropping blood sugar requires immediate intervention? Yes.

Meggan Sundwall is a registered nurse.

Thomas never said her name during those questions. She never connected the dots explicitly. She didn't have to. The jury was already there. And that's the point. When a prosecutor lets the jury draw the conclusion themselves, it lands harder than any argument could.

Think about what the jury is now holding in their heads. A nurse practitioner, part of an entire ICU team, fought for three days and couldn't save Kacee. A registered nurse sat in a dark room for seven hours, watched blood sugar crash on a glucose monitor, and called her parents for a blessing of release instead of calling 911.

Led also testified that if intervention had happened earlier, she would have expected a different outcome. That opinion connects the seven-hour vigil directly to the cause of death. It's not just that Sundwall allegedly didn't act. It's that her failure to act, according to the treating medical professional, may have been the difference between life and death.

What the Defense Got

Scott Williams scored on timing, and it matters.

Led admitted she cannot determine when insulin was introduced into Kacee's body. She confirmed the last known well time was 9:00 AM per hospital records. Williams pushed: could insulin have been given before 9:00 AM? Led conceded it could have been as early as 8:00 AM. Sundwall didn't arrive until 9:54 AM.

That window is everything for the defense. If insulin was administered before Sundwall arrived, the prosecution's case has a fundamental problem. Combined with the pre-arrival glucometer readings Mark Farnsworth described in earlier testimony and the fact that Sundwall's DNA was excluded from the syringes found at the scene, the defense has pieces for a self-administration argument.

Williams also established that Led cannot quantify the dose, cannot determine whether it was short-acting, long-acting, or both, and cannot say whether it was given once or multiple times. Every concession about what cannot be proven is material for closing arguments.

Where This Leaves the Case

The prosecution is in a stronger position today than they were yesterday. Led gave them the clinical bridge across the forensic gap and the implicit nurse knowledge argument that connects Sundwall's professional training to her seven hours of inaction. Those are closing argument weapons.

But the defense's timing concessions keep the door open. The prosecution now needs to narrow that window. When the medical examiner and endocrinologist take the stand, the question won't just be what killed Kacee. It will be when the process started and whether it was already irreversible before Sundwall walked through the door.

That's the battleground for the rest of this trial.

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