Two Cases of Diabetes Developing Chylomicronemia

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  • Ohta Masayuki
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Haseda Yuichi
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Saiki Shigeki
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Oiwake Hisanori
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Haba Toshihiro
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Mabuchi Hiroshi
    The second Department of Internal Medicine, School of Medicine, Kanazawa University
  • Takeda Ryoyu
    The second Department of Internal Medicine, School of Medicine, Kanazawa University

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Other Title
  • 高カイロミクロン血症 (Fredrickson V型高脂血症) を伴った糖尿病の2例
  • コウ カイロ ミクロン ケッショウ Fredrickson Vガタ コウ シケ

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Abstract

Two cases of diabetes poorly controlled developing chylomicronemia were presented.<BR>The first case, a 16-year-old female, was admitted because of ketoacidotic semicoma. On admission, her serum had a milky appearance, and contained a very high concentration of triglyceride (over 4, 350 mg per 100ml). The concentration of serum cholesterol was 197 mg per 100ml. The agar gel electrophoretic pattern of lipoproteins demonstrated 4% of chylomicron, 19%β lipoprotein, 62% pre-β lipoprotein, and 16%α lipoprotein. The milky serum became clear as the patient recovered from coma on the day after injection of insulin.<BR>The second case was a 43-year-old male acromegalic patient with diabetes. Since the pituitary surgery 2 years ago, the patient has been treated with medroxyprogesterone and a sulfonylurea drug in addition to a maintenance dose of hydrocortisone. During this regimen the diabetic state deteriorated rapidly due to his neglect of caloric restriction, and laboratory evidence suggestive of liver injury was noted. The blood sugar level was 424 mg per 100 ml, growth hormone 53 ng per ml, triglyceride 1, 950mg per 100 ml, and cholesterol 298 mg per 100 ml. Agar gel electrophoresis of serum lipoproteins showed 19% chylomicron, 28%β lipoprotein, 45% pre-β lipoprotein, and 8%α lipoprotein. Withdrawal of all drugs and strict dietary restriction resulted in prompt improvement of the hypertriglyceridemia and in good control of the diabetes.<BR>As regards the biochemical sequence of chylomicronemia occurring in these cases, it is assumed that a primary event for the deterioration of diabetic states and lipid metabolism is insulin insufficiency which brings on a disturbance in the removal of serum lipids, and in turn hypertriglyceridemia, chiefly by reduction of lipoprotein lipase activity.

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