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previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso (Panels A and B). He was otherwise asymptomatic and had no abdominal pain. The results of laboratory tests performed while the patient was fasting included a total cholesterol level of 1268 mg per deciliter (32.8 mmol per liter), a total triglyceride level of 8869 mg per deciliter (100.1 mmol per liter), a glucose level of 241 mg per deciliter (13.4 mmol per liter), and a glycosylated hemoglobin value of 13.4 percent. Triglyceride-lowering therapy with gemfibrozil was initiated to enhance lipoprotein lipase activity, and insulin therapy was initiated to treat the hyperglycemia. Twenty-four hours later, his total triglyceride level was 6466 mg per deciliter (73.0 mmol per liter). At follow-up visits three and five months later, the patient's eruptive xanthomas had decreased in size and number. After eight months of treatment with gemfibrozil, glyburide, and glucophage, his total cholesterol level was 218 mg per deciliter (5.6 mmol per liter), his total triglyceride level was 302 mg per deciliter (3.4 mmol per liter), and his glycosylated hemoglobin value was 8.3 percent; the eruptive xanthomas had completely resolved. Review of his records revealed a preexisting, untreated dyslipidemia (total cholesterol level, 216 mg per deciliter [5.6 mmol per liter]; total triglyceride level, 422 mg per deciliter [4.8 mmol per liter]), which was consistent with the presence of Frederickson's type IV familial hypertriglyceridemia. This case, however, would be better classified as a type V phenotype, mixed hypertriglyceridemia, owing to the coincident new-onset diabetes mellitus.