SFEBES2021 Poster Presentations Metabolism, Obesity and Diabetes (78 abstracts)
Diabetes and Endocrinology Department, Arrowe Park Hospital, Wirral, United Kingdom
Pancreatitis has multiple aetiologies of which commonest are gall stones and alcohol. Hypertriglyceridaemia is a less common (1-14 %) cause of pancreatitis. We present three case histories of acute pancreatitis due to severe triglyceridaemia and its management challenge in people with diabetes.
Case history: 1. A 33-year-old man with BMI of 41 kg/m2 with Hodgkin lymphoma, thyrotoxicosis and diabetes, but no history of alcohol use was diagnosed to have pancreatitis. Biochemical profile revealed total cholesterol (TC) 26.8 mmol/l (nr 0-5), triglyceride 90.5 mmol/l (0.8-1.8), HDL-cholesterol (HDL-C) <0.08 mmol/l. No gall stones were detected. He was treated with intravenous insulin and plasma exchange which lowered triglyceride levels to 6.8 mmol/l. He was later initiated on atorvastatin, fibrate and biphasic insulin.
Case history: 2. A 23-year-old man with type 2 diabetes and no history of alcohol use or gall stones was diagnosed with pancreatitis. Biochemical profile revealed TC 11.5 mmol/l, triglycerides 44.9 mmol/l and HDL-C 0.31 mmol/l. He was treated with intravenous insulin infusion initially and later with atorvastatin, fibrate and biphasic insulin. Triglyceride levels were lowered to 3.5 mmol/l.
Case history: 3. A 53-year-old man with pancreatitis thought to be due to non-obstructive gall stones 6 months previously, was awaiting elective laparascopic cholecystectomy. Pre-operative bloods tests revealed TC 20.7 mmol/l, triglyceride 59.4 mmol/l and HDL-C 0.22 mmol/l. He was initiated on metformin, biphasic insulin, atorvastatin, fibrate and ezetimibe. TC went down to 3.9 mmol/l, triglyceride to 4.39 mmol/l and HDL-C to 0.66 mmol/l.
Conclusion: Our case histories highlight the importance of checking lipid profile in every patient with diabetes presenting with acute pancreatitis. Insulin therapy, either intravenously or sub-cutaneously seems to rapidly reduce triglyceride levels in such patients.