New Onset Diabetes Mellitus Complicated by Hypertriglyceridemia-Induced Pancreatitis

There is an increasing prevalence of type 2 diabetes mellitus (DM) among adolescents due to obesity. Diabetes can cause hypertriglyceridemia, defined as triglyceride (TG) levels above 150 mg/dl, leading to severe complications, including cardiovascular events, fatty liver disease, and acute pancreatitis. We present a case of acute pancreatitis manifested by both hypertriglyceridemia and new-onset DM. The risk of hypertriglyceridemia-induced pancreatitis (HTGP) significantly increases at triglyceride levels above 500 mg/dl. Both primary causes, including genetic disorders such as familial chylomicronemia, and secondary disorders of lipid metabolism, including diabetes, hypothyroidism, and pregnancy, could cause HTGP. The toxic levels of triglycerides that break into free fatty acids by pancreatic lipases are critical in pancreatitis pathogenesis. The lipotoxicity, in turn, causes systemic inflammation with further complications related to it. The clinical features of HTGP are similar to other pancreatitis causes, including abdominal pain, nausea, and vomiting. Usually, patients with HTGP tend to have worse outcomes compared to other causes. Due to too high levels of triglycerides, the serum becomes milky and causes an alteration in serum electrolytes levels, including pseudo-hyponatremia. The recommended treatment for HTGP is plasma apheresis as well as IV insulin infusion, and heparin, specifically for less worrisome patients. IV insulin potentially avoids the interventional complexities of apheresis. The usual treatment goal is to reduce the triglycerides to a safe level, and then further management is tailored to lifestyle modification and oral lipid reducing agents. Our case report explains how well insulin works in stable patients with severe pancreatitis and thus prevents associated morbidity and mortality.