Endocrine Abstracts

We report two cases of severe hypertriglyceridemia (HTG) successfully managed using an intravenous insulin-based protocol in settings where plasmapheresis was unavailable. Case 1: A 39-year-old woman, at term pregnancy with a history of gestational diabetes, hypertension, and hypothyroidism, was found to have TG of 164 mmol/lintrapartum. Following elective caesarean section, TG reduced to 20 mmol/lbut then plateaued postpartum despite insulin, anticoagulation, and lipid-lowering therapy. She was encouraged to breastfeed, which was associated with a marked and rapid TG reduction to 2.5 mmol/lwithin weeks, highlighting a potential postpartum metabolic benefit of lactation. Case 2: A 31-year-old male with poorly controlled type 2 diabetes mellitus (HbA1c 116 mmol/mol) was admitted with asymptomatic TG of 50 mmol/l. Using our standardized protocol—nil per os, intravenous insulin infusion at 0.05 units/kg/hour with dextrose and potassium supplementation, and escalation of anticoagulation from once to twice daily—TG levels decreased steadily to 5 mmol/lprior to discharge. Both patients tolerated therapy without hypoglycaemia or major adverse events. We have observed a rising trend of lipotoxicity in both well-controlled and poorly controlled type 2 diabetes, suggesting a need for earlier screening and intervention. This series demonstrates that protocol-driven intravenous insulin therapy can achieve rapid TG reduction, prevent complications such as pancreatitis, and facilitate recovery in diverse clinical contexts. Wider implementation and further study may improve outcomes in severe HTG.