Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.

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The desire and feasibility of fasting during Ramadan are sensitive issues for diabetic Muslims. The aim of this study was to describe the behavior of patients with type 2 diabetes towards fasting. A prospective longitudinal study was conducted including 100 patients with type 2 diabetes. Data collection was carried out using an anonymous questionnaire administrated by the attending physician during two visits before and after Ramadan. A total of seventy-nine of the hundred enrolled patients fasted, and 62% of uncontrolled patients fasted against medical advice. The reasons given by patients to justify their behavior referred to socio-cultural imperatives. Most of our patients practice Ramadan fasting under the pressure of sociocultural habits, despite their doctors' disapproval. This fact highlights the difficulties to manage these patients.