Download PDF
CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2022; 14(02): 079-082
DOI: 10.1055/s-0042-1756686
Case Report

Was It a Case of “Flatbush Diabetes” with Severe Hypertriglyceridemia?

Mouza Mohammed Al-Nuaimi
1   Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
,
Mohamed Milad Ismail
1   Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
,
Ali Elhouni
1   Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
› Author Affiliations Funding and Sponsorship None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

We present a case of a morbidly obese 27 years male patient who was admitted with sudden onset abdominal pain and crashed into diabetic ketoacidosis as new-onset diabetes and discuss the possible etiology of this combined picture of acute pancreatitis and severe hypertriglyceridemia. Flatbush diabetes was, meanwhile, thought of due to his morbid obesity that in turn raised our suspicion of acute insulin-requiring type 2 diabetes mellitus versus T1 diabetes mellitus. Ketosis-prone diabetes or Flatbush diabetes is a syndrome in which diabetes commences with ketoacidosis in patients who are glutamic acid decarboxylase and antiislet cell antibody negative and have no known precipitating causes. They are usually middle-aged, overweight, or mildly obese, and in many reports, they are likely to be male with a family history of type 2 diabetes mellitus; they present with new-onset severe hyperglycemia and ketosis or frank diabetic ketoacidosis. After intensive initial insulin therapy, many patients become insulin-independent and can be well controlled on diet plus oral medications or, more rarely, diet alone.

Keywords

Flatbush - hypertriglyceridemia - ketoacidosis (DKA) - insulin

Consent for Publication

The authors confirm that the patient provided an informed consent for publishing on anonymous basis.


Authors' Contributions

All authors participated in the clinical care of the patients, conceptualization, data collection, drafting, and finalization of the manuscript.


Compliance with Ethical Principles

There is no need for prior ethical approval in our institution for single case report.




Publication History

Article published online:
13 October 2022

© 2022. The Libyan Authority of Scientific Research and Technology and the Libyan Biotechnology Research Center. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Winter WE, Maclaren NK, Riley WJ. et al. Maturity-onset diabetes of youth in black Americans. N Engl J Med 1987; 316: 285-291
    CrossrefPubMedGoogle Scholar
  • 2 Lebovitz HE, Banerji MA. Ketosis-prone diabetes (Flatbush diabetes): an emerging worldwide clinically important entity. Curr Diab Rep 2018; 18 (11) 120
    CrossrefPubMedGoogle Scholar
  • 3 Banerji MA, Chaiken RL, Huey H. et al. GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4. Flatbush diabetes. Diabetes 1994; 43 (06) 741-745
    CrossrefPubMedGoogle Scholar
  • 4 Choukem S-P, Sobngwi E, Boudou P. et al. β- and α-cell dysfunctions in Africans with ketosis-prone atypical diabetes during near-normoglycemic remission. Diabetes Care 2013; 36 (01) 118-123
    CrossrefPubMedGoogle Scholar
  • 5 Umpierrez GE, Smiley D, Robalino G, Peng L, Gosmanov AR, Kitabchi AE. Lack of lipotoxicity effect on β-cell dysfunction in ketosis-prone type 2 diabetes. Diabetes Care 2010; 33 (03) 626-631
    CrossrefPubMedGoogle Scholar
  • 6 Banerji MA, Chaiken RL, Lebovitz HE. Prolongation of near-normoglycemic remission in black NIDDM subjects with chronic low-dose sulfonylurea treatment. Diabetes 1995; 44 (04) 466-470
    CrossrefPubMedGoogle Scholar
  • 7 Backes J, Anzalone D, Hilleman D, Catini J. The clinical relevance of omega-3 fatty acids in the management of hypertriglyceridemia. Lipids Health Dis 2016; 15 (01) 118
    CrossrefPubMedGoogle Scholar
  • 8 Matsuda A, Makino N, Tozawa T. et al. Pancreatic fat accumulation, fibrosis, and acinar cell injury in the Zucker diabetic fatty rat fed a chronic high-fat diet. Pancreas 2014; 43 (05) 735-743
    CrossrefPubMedGoogle Scholar
  • 9 Sandoval J, Pereda J, Pérez S. et al. Epigenetic regulation of early- and late-response genes in acute pancreatitis. J Immunol 2016; 197 (10) 4137-4150
    CrossrefPubMedGoogle Scholar
  • 10 Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol 2018; 11 (06) 441-448
    CrossrefPubMedGoogle Scholar
  • 11 Dehal H, Adashek M. Total plasma exchange in hypertriglyceridemia-induced pancreatitis: case report and literature review. Case Rep Med 2018; 2018: 4017573
    CrossrefPubMedGoogle Scholar
  • 12 Näsström B, Olivecrona G, Olivecrona T, Stegmayr BG. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med 2001; 138 (03) 206-213
    CrossrefPubMedGoogle Scholar
  • 13 Xiao C, Dash S, Morgantini C, Lewis GF. New and emerging regulators of intestinal lipoprotein secretion. Atherosclerosis 2014; 233 (02) 608-615
    CrossrefPubMedGoogle Scholar
  • 14 Umpierrez GE, Clark WS, Steen MT. Sulfonylurea treatment prevents recurrence of hyperglycemia in obese African-American patients with a history of hyperglycemic crises. Diabetes Care 1997; 20 (04) 479-483
    CrossrefPubMedGoogle Scholar
  • 15 Wang SH, Chou YC, Shangkuan WC, Wei KY, Pan YH, Lin HC. Relationship between plasma triglyceride level and severity of hypertriglyceridemic pancreatitis. PLoS One 2016; 11 (10) e0163984
    CrossrefPubMedGoogle Scholar