Evaluation of the efficacy and safety of a fixed-dose insulin infusion protocol for the management of severe hypertriglyceridemia

Purpose Current literature indicates a benefit with insulin infusions in treating severe hypertriglyceridemia (sHTG), but little guidance exists with respect to dosing, duration, or fluid management. The objective of this retrospective, descriptive analysis was to evaluate the safety and efficacy of a weight-based fixed-dose insulin infusion protocol for the treatment of severe hypertriglyceridemia. Methods Patients receiving the insulin infusion protocol for sHTG between February 2020 and August 2023 were included. The primary outcome was the effectiveness of insulin, assessed by the time to a triglyceride level of less than 1,000 mg/dL. Secondary outcomes included the time to a triglyceride level below 500 mg/dL and the incidence of hypoglycemia and hypokalemia. Results A total of 152 patients received an insulin infusion, of whom 48 met the inclusion criteria. The median triglyceride level before treatment was 4,243 mg/dL (interquartile range [IQR], 2,275-5,959 mg/dL). The insulin infusion was started at a median rate of 9.3 units/h and was titrated a median of 2 times. A median of 345 units (IQR, 164-637 units) in total was administered over a median duration of 45.5 hours. Triglyceride levels were below 1,000 mg/dL and 500 mg/dL within a median of 39 hours (IQR, 23-59 hours) and 62 hours (IQR, 38.5-74.5 hours), respectively. Seven patients (15%) experienced hypoglycemia, but only 3 of these patients (6%) experienced hypoglycemia with accurate fluid titration per the protocol. Hypokalemia was noted in 5 patients (10%). Conclusion A weight-based fixed-dose insulin infusion protocol with proper fluid titration was demonstrated to be safe and effective in reducing triglyceride levels.