Chylomicronemia Syndrome in Diabetes Mellitus

Abstract

Lipemic plasma with marked elevations of plasma triglyceride levels (3221 +/- 1590 mg/dl) and fasting chylomicronemia was observed in nine patients with uncontrolled non-insulin-dependent diabetes mellitus. Every case had hypertriglyceridemic relatives, suggesting that the very high triglyceride values seen resulted from the coexistence of diabetes with a familial form of hypertriglyceridemia. A number of clinical and biochemical features observed in the diabetic patients and also in a group of nondiabetic controls with comparable degrees of hypertriglyceridemia suggests that these manifestations are related to high plasma triglyceride levels rather than to the diabetes per se. Chronic abdominal pain, mental confusion, and memory loss improved with lipid-lowering therapy and clearing the plasma of chylomicrons. Pulmonary function tests, red cell 2,3-diphosphoglycerate, and hemoglobin oxygen affinity were normal; the mild hypoxemia observed is believed to be an artifact. It is suggested that a syndrome due to chylomicronemia can occur in uncontrolled non-insulin-dependent diabetic patients, who in addition have a familial form of hypertriglyceridemia. To prevent manifestations of this syndrome in these patients, specific lipid-lowering therapy may be required in addition to control of their diabetes.

Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis

“…Means of the triglyceride levels before plasmapheresis were as high as 16.4 mM ( I ,450 mg/ dl, patient I ) and 27.8 mM (2,460 mg/dl, patient 2). One explanation of this unexpected result is that patients do not strictly adhere to diet, especially in type I hyperlipoproteinemia (patient 11, in which a very low fat diet is required (5,6). In fact, patients reported alcohol abuse or fat abuse during the days just before the plasma exchange.…”

Letters to the Editor

“…lozzo et al [1] found a decreased PaO, in 20 pa tients with hypertriglyceridemia, compared to 18 normal control subjects. We also noted an increased alveolar-arterial oxygen gradient in 12 hyperlipidém ie patients which resolved when the chylomicrons were cleared from the patient's blood [2]. However, measurement of the partial pressure of oxygen in hy perlipidémie blood is susceptible to an artifact that appears to be related to the length of time the lipemie blood is in contact with the blood gas electrode.…”

“…It is interesting that in their 'Discussion' these au thors do not mention a carefully performed placebocontrolled double-blind trial which compares the ef fect of gargled and swallowed fenoterol (500 tig) and aerosolized fenoterol (200 tig) showing that whereas the aerosolized drug produced marked bronchodilatation, the gargled and swallowed drug (w'hich surely would stimulate any buccal or pharyngeal receptors) produced no bronchodilator effect at all compared to placebo [2]. More recently, Newman et al [3| con firmed these results in a study in asthmatics which showed that marked bronchodilatation occurred when 500 tig of terbutaline were inhaled at almost any lung volume below total lung capacity whereas aerosol inhaled at total lung capacity produced no bronchodilatation whatever.…”

Diabetic Lipemia with Maturity-Onset Diabetes of the Young.

“…The clearance of very low density lipoprotein (VLDL) and chylomicrons from plasma is disturbed due to decreased activity of lipoprotein lipase (LPL) which is accounted for by severe insulin deficiency (1,2). In contrast, maturity-onset diabetes of the young (MODY) is a form of type II diabetes mellitus, which is phenotypically noninsulin dependent (3 , 4).…”