A 4-year-old obese boy with known type 1 diabetes has a 12-hour fast and turbid serum with a lipid panel showing total cholesterol 250 mg/dL, HDL 32 mg/dL, and triglycerides 395 mg/dL. Which explanation fits these findings best?

• A. Has secondary hyperlipidemia due to the diabetes
• B. Is a low risk for coronary artery disease
• C. Is a good candidate for a 3-hour oral glucose tolerance test
• D. Was not fasting when the specimen was drawn

Answer: (A)

High triglycerides with a turbid, lipemic serum in a child with known type 1 diabetes points to secondary hyperlipidemia driven by the diabetic metabolic state. When insulin is deficient or not functioning well, the liver increases production of triglyceride-rich VLDL and lipoprotein lipase activity needed to clear these particles is reduced. The result is accumulated triglycerides and a relatively low HDL level, with total cholesterol often elevated as a consequence of increased VLDL and remnant particles. The pattern described—markedly elevated triglycerides with low HDL and lipemic serum—fits diabetes-related secondary hyperlipidemia rather than a nonfasting artifact or other screening tests. This also means the patient isn’t at low risk for coronary disease; dyslipidemia in diabetes raises cardiovascular risk. An oral glucose tolerance test isn’t indicated for someone with established type 1 diabetes.