06 January 2026
: Case report 
Diabetic Ketoacidosis Unveiling Severe Hypertriglyceridemia and Acute Mild Pancreatitis: A Rare Initial Manifestation of Type 2 Diabetes Mellitus
Rare coexistence of disease or pathology
Parth Adrejiya
AEFG 1*, Sunil Shahi F 1, Abdullah Lodhi EF 1, Mohammad Abubaker E 1, Jill Vora EF 2, Gurkeerat Singh FG 3, Cyril Anara AG 1, Swathi Gorle AG 1, Ashok Kanugula EFG 1
DOI: 10.12659/AJCR.950094
Am J Case Rep 2026; 27:e950094
Table 1 Laboratory test results on admissionLaboratory findings on admission demonstrated clinically significant metabolic derangements. The patient exhibited severe hypertriglyceridemia, strongly elevated HbA1c, and elevated beta-hydroxybutyrate, consistent with a diagnosis of diabetic ketoacidosis. Electrolyte abnormalities included hyponatremia and an elevated anion gap. Pancreatic enzyme levels remained within normal limits despite clinical pancreatitis. Autoimmune diabetes marker and toxicology screen findings were negative. Urinalysis confirmed ketonuria, glucosuria, and proteinuria.
| Test | Result | Reference range |
|---|---|---|
| Triglycerides | 2464 mg/dL | <150 mg/dL |
| Total cholesterol | 570 mg/dL | <200 mg/dL |
| Beta-hydroxybutyrate | 4.90 mmol/L | <0.4 mmol/L |
| HbA1c | 13.5% | <5.7% |
| C-peptide | 2.04 ng/mL | 0.80–3.85 ng/mL |
| TSH | 1.07 μIU/mL | 0.4–4.0 μIU/mL |
| Complete blood count | Normal | – |
| Liver function tests | Normal | – |
| Amylase | 28 U/L | 25–110 U/L |
| Lipase | 20 U/L | 7–60 U/L |
| Sodium | 128 mmol/L | 135–145 mmol/L |
| Potassium | 5.2 mmol/L | 3.5–5.0 mmol/L |
| Bicarbonate | 18 mmol/L | 22–28 mmol/L |
| Anion gap | 27 mmol/L | 8–16 mmol/L |
| POC blood glucose | 505 mg/dL | 70–99 mg/dL |
| Total calcium | 8.6 mg/dL | 8.6–10 mg/dL |
| Urine drug screen | Negative | – |
| Serum ethanol | <10 mg/dL | – |
| IA-2 antibody | Negative | – |
| Insulin autoantibody | Negative | – |
| GAD65 antibody | Negative | – |
| Zinc transporter antibody | Negative | – |
| Islet cell antibody | Negative | – |
| Urinalysis | 3+ glucose, 4+ ketones, 2+ protein | – |
| GAD65 – glutamic acid decarboxylase 65; HbA1c – glycated hemoglobin, POC – point-of-care; TSH – thyroid-stimulating hormone. | ||