An 8-year-old girl presented with diabetic ketoacidosis (DKA) following 6 months of malaise, 1 month of perineal candidiasis and 1 week of polyuria and polydipsia. She had Kussmaul respirations, but was fully conscious. Blood glucose was 34.9 mmol/l, pH 7.0 and bicarbonate 6.8 mmol/l.

Her venous blood appeared grossly lipaemic (figure 1). Triglyceride levels on admission were 122.63 mmol/l (ref <2.3 mmol/l). HbA1c on …