A 58-year-old woman who h...

A 58-year-old woman who has had type 2 diabetes since 2003 and has a height of 150 cm, weight of 74 kg, and a waist circumference of 96 cm was managing her diabetes with Gliclazide MR 30mg and metformin 1500 mg daily. Her recent HbA1c levels were in the range of 7.6-8.1%. She also had microalbuminuria due to nephropathy and was prescribed Irbesartan 150 mg daily. There was no evidence of diabetic retinopathy, and she had no history of macrovascular diseases, gallstones, pancreatitis, or alcohol use. To improve her glycemic control, Sitagliptin was added to her medication regimen. After 50 days, she suddenly developed epigastric pain accompanied by nausea. The pain was described as dull and full, radiating to her back. She sought medical attention in the Emergency Department, where they found elevated serum amylase (739 U/L) and lipase (1444 U/L) levels. Her other laboratory results were as follows: Creatinine 1.37 mg/dL, ALT/AST 60/45 U/L, WBC 7450/uL, Hemoglobin 12.8 g/dL, and Platelet count 352K/uL. She was admitted with a suspected diagnosis of acute pancreatitis. An abdominal sonogram revealed a fatty liver but a normal pancreas, gall bladder, and common bile duct. Mild hypertriglyceridemia (201 mg/dL) was noted. Her serum amylase and lipase levels decreased after two days with supportive care, including hydration and discontinuing oral intake (Amylase 135 U/L, Lipase 43 U/L). After her discharge, Sitagliptin was stopped, and she was managed with Acarbose, glylazide, and Metformin for glycemic control. Over the next ten months, she did not experience another episode of acute pancreatitis, and her glycemic control improved.