SUN-579 Patient with No Prior History of Diabetes Mellitus Develops Acute Pancreatitis and Diabetic Ketoacidosis on Compounded Semaglutide

Abstract Disclosure: M. Stefanelli: None. S. Shanmugam: None. S.J. Steven: None. Introduction: Glucagon like peptide - 1 (GLP-1) receptor agonist medications have become a cornerstone in the management of type 2 diabetes mellitus and obesity. Due to their limited availability and high out of pocket costs, many individuals resort to compounding pharmacies to obtain them. Some people take them without any clear indication and may be unaware of the risks. While pancreatitis is a well documented risk that clinicians routinely discuss with patients, diabetic ketoacidosis (DKA) is a rare adverse event that has been mentioned in case reports [2]. Case: A 39 year old female with a history of anxiety and depression and a body mass index of 20.08 kg/m2 presented to the hospital with severe nausea and abdominal pain. She reported taking compounded semaglutide for the past three months with dosing recently increased to 0.5 mg once weekly from 0.25 mg once weekly. This was obtained from a compounding pharmacy in an effort to lose weight. Lipase was significantly elevated at 2,633 U/L and abdominal computed tomography scan demonstrated findings consistent with acute pancreatitis. She was found to be in DKA with anion gap of 28 mmol/L, bicarbonate of 10 mmol/L, venous pH of 7.12, beta-hydroxybutyrate of 7.58 mmol/L, and glucose of 303 mg/dL. Her fasting c-peptide was undetectable, but hemoglobin A1c was only 4.2% and antibody testing for latent autoimmune diabetes in adults was negative. She was treated with intravenous fluids and a continuous infusion of intravenous insulin before she was transitioned to a subcutaneous insulin regimen. Her insulin requirements gradually decreased during her four day hospitalization and she was discharged on 20 units of basal insulin once nightly. She was unable to be contacted after discharge so it is unclear whether she required insulin treatment long-term. Conclusion: In this unique case, a patient with no prior history of diabetes mellitus developed acute pancreatitis on compounded semaglutide which resulted in beta cell dysfunction severe enough to cause DKA. The American Diabetes Association has recommended against the use of compounded GLP-1 receptor agonist medications due “uncertainty about their content and resulting concerns about safety, quality, and effectiveness” [1]. This case illustrates the importance of educating patients regarding the potential risks of GLP-1 receptor agonist medications prior to prescribing them as well as the potential risks of obtaining them from compounding pharmacies. References: 1. Neumiller, JJ et al. (2025). Compounded GLP-1 and Dual GIP/GLP-1 Receptor Agonists: A Statement from the American Diabetes Association. Diabetes Care, 48(2): 177-181.2. Zhang, J et al. (2024). GLP-1 receptor agonist - induced diabetic ketoacidosis: A case report. Medicine, 103(39): e39799. Presentation: Sunday, July 13, 2025