48 y/o male with recent shoulder arthroscopy presents to the | Figure 1

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48 y/o male with recent shoulder arthroscopy presents to the ER with sudden, severe epigastric pain that started today. Has a hx of DM and was on metformin in the past but has recently been managing with diet and exercise. Due to shoulder injury he has not been able to exercise as much as he would like. Lab called and stated patient's blood was so lipemic it had to be constantly diluted. Lipid panel reveals extremely high triglycerides causing a pancreatitis and fatty liver with a lipase over 269,000. Patient only takes a daily multivitamin and fish oil. Has no other medical hx.