Strawberry milk-like blood in a subject with diabetic lipemia: dramatic change to transparent color after insulin therapy

INTRODUCTION: It is known that chylomicronemia is caused by several pathologies and is classified as primary and secondary chylomicronemia. Since hypertriglycemia is associated with an increased risk of cardiovascular disease and severe pancreatitis, it is very important to make a proper diagnosis of the cause of hypertriglycemia. CASE DESCRIPTION: We herein present the case of a 40-year-old male who developed severe hypertriglycemia accompanied with acute exacerbation of type 2 diabetes mellitus. On admission, his blood glucose level was 306 mg/dl and HbA1c was 12.5 %. Moreover, serum triglyceride level was elevated up to 5661 mg/dl. When blood was drawn, it presented strawberry milk-like color. After receiving insulin treatment, he obtained good glycemic control and the serum became back to normal transparent color. DISCUSSION AND EVALUATION: Insulin resistance reduces triglyceride clearance and also increases triglyceride release from adipocyte. It is known that glucose toxicity and strong insulin resistance induce inactivation of LPL, which results in chylomicronemia. CONCLUSION: This case report suggests that when serum triglyceride level is markedly elevated due to diabetic lipemia, it is extremely important to obtain good glycemic control.