Endocrine Abstracts

Diabetic lipemia, remains a well recognized but rare manifestation of uncontrolled diabetes mellitus. Although prompt diagnosis and insulin treatment have probably reduced the incidence of hyperlipemia in symptomatic diabetes, reports of this poorly understood syndrome continue to appear. 48 year old male presented with a 2 day history of severe epigastric pain, radiating to his back. Associated symptoms included nausea with vomiting. Lethargic, tired and associated headaches. He was fit and well with no past medical history. Not taking any regular medications and no allergies. He was overweight, hypertensive with central abdominal pain radiating to his back. BM high. Initial blood results were inconclusive due to lipolysis. Venous blood appeared grossly lipemic. Triglyceride levels were high (result). Blood sugar elevated at 22. HbA1c was found to be at 161. Lipoclear, a solution which clears lipaemic serum, was applied to the venous blood. This allowed for the blood to be anlaysed and pancreatic enzymes (amylase and lipase) was checked. These came back as normal. USS abdomen was also reported as normal. Due to on-going epigastric pain a CT scan was done and this showed acute pancreatitis. The patient was started on IV insulin via the hyperglycaemia protocol. With improvements in blood sugar levels and treatment of his undiagnosed type 2 diabetes his triglyceride levels improved. Pancreatitis was treated with supportive measures and IV fluids. Pathophysiology is caused by abnormal metabolism of the triglyceride-rich lipoprotein associated with insulin deficiency, which reduces LPL activity and causes disturbed clearance of chylomicrons and VLDL from plasma. The surgical team were initially dismissive of the diagnosis of the pancreatitis due to the ‘normal’ pancreatic enzymes. It is however well documented that results following Lipoclear need to be interpreted with caution and due to the patients on-going pain a CT scan was able to confirm the diagnosis.