What is some available guidance in insulin therapy for managing hypertriglyceridemia-induced pancreatitis?

Comment by InpharmD Researcher

No guidelines are currently available explaining the role of insulin in the management of hypertriglyceridemia-induced pancreatitis (HTGP). Based upon experiences from case reports, both intravenous and subcutaneous insulin appear safe and effective in lowering levels of serum triglycerides in patients with HTGP. A successful dosing regimen utilized in a case series (N= 34) was 0.1 to 0.3 units/kg/hour; the majority (97%) of these patients made a full recovery. Literature also found insulin to be safe and effective when initiated at a lower dose with gradual titration. Efficacy was also seen when used in combination with unfractionated and low-molecular-weight heparin. Close monitoring of blood glucose levels and use of dextrose as needed are important considerations.

Background

In the absence of established guidance on insulin therapy among patients with hypertriglyceridemic pancreatitis (HTGP), a 2018 comparative review identified 34 HTGP cases demonstrating the safe use of insulin management with close monitoring of serum blood glucose. Insulin therapy becomes a reasonable approach for HTGP, particularly in a clinical setting with no or limited availability of plasmapheresis. The case patients examined had a mean age of 39.6 years (range: 13-65 years) with no clear gender preponderance (male, n=18; female, n=16). Major patient-specific comorbidities included moderate-to-severe hypertriglyceridemia, hypertension, diabetes mellitus, dyslipidemia, alcohol abuse, and obesity. Three patients out of the 16 females were pregnant upon the diagnosis of HTGP. Based on this review of insulin treatment in patients with HTGP, intravenous (IV) insulin was usually given at a rate of 0.1 to 0.3 units/kg/hour, and the serum triglyceride levels were monitored every 12 hours. Initial symptomatic management also included bowel rest, IV fluids, and analgesics. The authors of this review emphasized continuous monitoring of blood glucose levels and prompt administration of adjuvant 5% dextrose infusion once blood glucose falls below 200 mg/dL. All but one of the 34 patients fully recovered with intensive IV insulin therapy. [1]

Another 2018 clinical review also stated a lack of established guidelines in managing HTGP. The authors observed various treatments including insulin, heparin, fibric acids, and omega 3 fatty acids have been utilized to successfully reduced serum triglycerides (TG). Acute HTGP was defined in this article as the first 14 days from symptom onset, where nearly 50% of mortality occurs. Insulin administration in acute HTGP stimulates lipoprotein lipase (LPL) activity, which in turn lowers serum TG levels. A dosing regimen cited within the review was continuous IV insulin at a rate of 0.1 to 0.4 unit/kg/hour, which was shown to be effective in patients with severe HTGP with and without type 2 diabetes mellitus. It was reported that IV insulin (3 to 9 units/h for four days) decreased serum TG levels from 7,700 to 246 mg/dL in a patient without affecting the normal blood glucose concentration. ​​​​Additional data cited from case reports found IV insulin decreased serum TG levels by 40% over 24 hours. A greater TG reduction of 87% was achieved within the same period when insulin was given in fasting state. In one example (Table 3) comparing IV insulin, IV insulin with plasmapheresis, and subcutaneous (SC) insulin, the efficacy of both IV and SC insulin in reducing TG was 85% upon discharge, compared to 92.6% reduction when using IV insulin combined with plasmapheresis. However, patients with plasmapheresis had complications, including respiratory failure and acute kidney disease. The authors concluded that insulin monotherapy for HTGP was overall safe and effective. [2]

The Bi-TPAI trial is a yet unpublished study registered on Clinicaltrials.gov as a multicenter, parallel-group randomized, controlled, non-inferiority trial to investigate whether intensive insulin therapy is as effective as plasmapheresis in lowering TG in patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Per the trial protocol, the estimated enrollment is 220 patients with HTG-AP from 17 large tertiary hospitals located in China. Eligible patients will be randomized to receive either continuous IV infusion of regular human insulin at a rate of 0.1 units/kg*hour, maximum of up to 0.3 units/kg*h, with simultaneous infusion of IV dextrose 5% or higher or standard-volume plasmapheresis (1–1.5 plasma volume) every 24-hours until the TG level is <5.6 mmol/L for both interventions. Diabetic patients allocated to plasmapheresis group will also simultaneously receive minimal IV insulin drips to manage patients’ diabetes. The predefined primary endpoint is the time for TG level to reduce to 500 mg/dl, and the secondary endpoints are ICU and hospital lengths of stay, 28-day mortality, severity of HTG-AP, incidence of hypoglycemia, HTG-AP complications, and cost-effectiveness. This trial, however, has not been updated since its registration (back in 2017), and the recruitment status is still listed as unknown. [3], [4]

References:

[1] Inayat F, Zafar F, Baig AS, et al. Hypertriglyceridemic pancreatitis treated with insulin therapy: a comparative review of 34 Cases. Cureus. 2018;10(10):e3501. doi:10.7759/cureus.3501.
[2] Rawla P, Sunkara T, Thandra KC, et al. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol. 2018;11(6):441-448. doi:10.1007/s12328-018-0881-1.
[3] Song X, Shi D, Cui Q, et al. Intensive insulin therapy versus plasmapheresis in the management of hypertriglyceridemia-induced acute pancreatitis (Bi-TPAI trial): study protocol for a randomized controlled trial. Trials. 2019;20(1):365. doi:10.1186/s13063-019-3498-x.
[4] Clinicaltrial.gov. Intravenous administration of insulin and plasma exchange on triglyceride levels in early stage of hypertriglyceridemia-induced pancreatitis. Available: https://clinicaltrials.gov/ct2/show/NCT03342807. Updated November 17, 2017. Accessed September 22, 2021.

Literature Review

A search of the published medical literature revealed 5 studies investigating the researchable question:

What is some available guidance in insulin therapy for managing hypertriglyceridemia-induced pancreatitis?

Please see Tables 1-5 for your response.


 

Heparin and Insulin in the Management of Hypertriglyceridemia-associated Pancreatitis: Case Series and Literature Review
Design

Case series

Common Treatment Strategies

Insulin infusion initiated at 2–5 units/hour, increased to 8–12 units/hour

Case 1

A 32-year old male with a prior history of diabetes, pancreatitis, and hypertriglyceridemia presented with triglyceride (TG) levels of 5,860 mg/dL at admission. Pancreatic inflammation changes were found in the abdomen using ultrasonography and contrast-enhanced computed tomography (CECT). Serum amylase and lipase were also elevated.

Management initially included suspension of enteral intake and fluid repletion. Insulin infusion was started at 2 to 5 units per hour and gradually increased to 8 to 12 units per hour based on blood glucose levels. Due to existing diabetes, 5% dextrose with 0.45% normal saline was started when glycemic levels reached 180 mg/dL to maintain the 140 to 180 mg/dL range. Subcutaneous (SC) unfractionated heparin (UFH, 60 U/kg) was initiated simultaneously with insulin and given every 8 hours for five days.

The TG levels had decreased to 3,416 mg/dL after 24 hours, 2,280 mg/dL at 48 hours, 1,578 mg/dL at 72 hours, and 501 mg/dL at day 12. 

Case 2

A 38-year old male with a history of diabetes presented with TG levels of 3,891 mg/dL upon admission. Again, pancreatic inflammation changes were discovered with ultrasonography and CECT. Serum amylase and lipase were again elevated. 

Patient was initiated with common management strategies mentioned previously and initial insulin infusion of 2 to 5 units per hour increased to 8 to 12 units per hour based on blood glucose. Patient was also started on 5% dextrose with 0.45% normal saline when glycemic levels reached 180 mg/dL to maintain the 140 to 180 mg/dL range. Patient was administered SC low-molecular-weight heparin (LMWH, enoxaparin, 1 mg/kg) every 12 hours for four days.

At 24, 48, and 72 hours, TG levels were 1,851 mg/dL, 979 mg/dL, and 686 mg/dL, respectively. By day 12, TG levels were 320 mg/dL. 

Case 3

A 28-year old female presented with TG levels of 1,820 mg/dL, evidence of pancreatic inflammation on imaging, and elevated serum amylase and lipase. 

Patient was initiated on common management strategies and treatment with insulin infusion of 2 to 5 units per hour, increased to 8 to 12 units per hour based on blood glucose. Due to her lack of diabetes, patient received 5% dextrose simultaneously with insulin infusion to maintain glycemic levels at 160 ± 20 mg/dL. Subcutaneous UFH, 60 U/kg was given every 8 hours for three days.

At 24, 48 and 72 hours, TG levels were 1,011 mg/dL, 876 mg/dL, and 534 mg/dL, respectively. By day 12, TG levels were 221 mg/dL. 

Case 4

A 46-year old male with a history of diabetes and hypertriglyceridemia presented with triglyceride (TG) levels of 2,430 mg/dL, evidence of pancreatic inflammation on imaging, and elevated serum amylase and lipase. 

Patient was initiated on common management strategies and treatment with insulin infusion of 2 to 5 units per hour, increased to 8 to 12 units per hour based on blood glucose. Patient was also started on 5% dextrose with 0.45% normal saline when glycemic levels reached 180 mg/dL to maintain the 140 to 180 mg/dL range. Patient was administered SC low-molecular-weight heparin (LMWH, enoxaparin, 1 mg/kg) every 12 hours for three days.

At 24, 48, and 72 hours, TG levels were 1,121 mg/dL, 992 mg/dL, and 601 mg/dL, respectively. By day 12, TG levels were 252 mg/dL. 

Study Author Conclusion

Heparin and insulin appear to be an effective therapy in the management of hypertriglyceridemia-associated pancreatitis (HTGP). Bleeding is a risk to be considered in this treatment, although no problems were observed in this regard. There is a definite need for clinical guidelines for HTGP management, as none exist to date.

InpharmD Researcher Critique

In this case series, total mean serum TG levels decreased from 3,500 mg/dL to 849.7 mg/dL over 72 hours showing efficacy of combined heparin and insulin treatment. No complications were reported. 

 

References:

Kuchay MS, Farooqui KJ, Bano T, et al. Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review. Arch Endocrinol Metab. 2017;61(2):198-201. doi:10.1590/2359-3997000000244

 

Emergent Triglyceride-lowering Therapy With Early High-volume Hemofiltration Against Low–Molecular-Weight Heparin Combined With Insulin in Hypertriglyceridemic Pancreatitis: A Prospective Randomized Controlled Trial

Design

Prospective, randomized, controlled trial 

N= 66

Objective

To compare the value of emergent triglyceride (TG)- lowering therapies between early high-volume hemofiltration (HVHF) and low–molecular-weight heparin (LMWH) combined with insulin (LMWH+insulin) as well as their effects on the outcomes of hypertriglyceridemic pancreatitis (HTGP) patients

Study Groups

HVHF (n= 32)

LMWH + insulin (n= 34)

Inclusion Criteria

Aged ≥ 18 to 85 years presented within 72 hours of the onset of pain, diagnosis of HTGP with the blood TG level of ≥ 11.3 mmol/L and/or milky serum 

Exclusion Criteria

All other causes of acute pancreatitis, allergic to study agents, disseminated intravascular coagulation or severe active bleeding, respiratory failure on ventilation, severe systemic circulatory failure, coma, or other dangerous symptoms that were difficult to reverse, predicted mortality in 24 hours, pregnancy, lactating, chronic kidney disease on hemodialysis 

Methods

Patients were randomized (1:1) to receive either HVHF or LMWH + insulin. HVFH was initiated immediately upon admission, and once the TG level was < 5.65 mmol/L, the hemofiltration was stopped. Patients with low bleeding risk received LMWH 4,000 IU every 12 hours for 3 days. Biosynthetic insulin Novolin R was infused through a micropump to maintain a blood sugar level from 140 to 200 mg/dL. 

Radiologic assessments with computed tomography severity index (fluid collection, inflammation, necrotic changes) were conducted by two blinded independent abdominal radiologists. Periodic serum TG, C-reactive protein (CRP), and procalcitonin (PCT), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were evaluated on admission and days 1, 2, and 5. 

Duration

Study enrollment: August 2011 to October 2013

Follow-up: until discharge

Outcome Measures

Primary outcome: serum TG levels

Secondary outcome: organ failure, surgical intervention, mortality, the length of hospital stay, and hospitalization charges

Safety: adverse effects in both groups

Baseline Characteristics

 

HVHF

(n = 32)

LMWH + Insulin

(n = 34)

p-value 

Mean age, years

42.34 ± 8.32  39.79 ± 7.84 0.204 

Female

7 (21.9%) 8 (23.5%) 0.821 

Body-mass index, kg/m2

24.78 ± 2.14 25.2 ± 2.24 0.437

Coexisting conditions 

Cardiovascular 

Diabetes 

 

1 (3.1%)

5 (15.6%)

 

1 (2.9%)

7 (20.6%)

 

0.96

0.6

Baseline labs 

Triglycerides 

SpO2

Serum creatinine 

PCT (pg/mL)

CRP (mg/L)

 

22.42 ± 9.40

83.04 ± 15.24

82.08 ± 67.42

3.57 ± 5.55

187 ± 125

 

21.97 ± 8.80

80.35 ± 13.41

66.79 ± 50

3.27 ± 7.98

152 ± 125

 

0.846

0.454

0.302

0.87

0.45

Baseline scores 

Bedside Index for severity in AP score

Ranson score

APECHE II score

 

1.4 ± 0.7

3.1 ± 2.0

7.09 ± 4.34

 


1.4 ± 0.9

1.6 ± 1.2

5.20 ± 3.57

 

0.27

0.03

0.207

Results

Primary outcome

HVHF

(n = 32)

LMWH + Insulin

(n = 34)

p-value

Serum TG

Day 1

Day 2

Day 5

 

4.67 ± 3.44

4.05 ± 1.93

2.4 ± 0.64

 

7.39 ± 3.89

5.07 ± 2.14

5.28 ± 11.4 

 

0.01

0.103

0.417

Secondary outcome 

HVHF

(n = 32)

LMWH + Insulin

(n = 34)

Risk ratio (95% confidence interval), p-value

Organ failure 

Persistent organ failure

Persistent respiratory failure

 

16 (50%)

14 (43.8%)

 

7 (20.6%)

7 (20.6%)

 

2.42 (1.15 to 5.11), 0.01 

2.13 (0.99 to 4.58), 0.04

Severe acute pancreatitis

16 (50%)

7 (20.6%)

2.42 (1.15-5.11), 0.01

Mean hospital day

13.71 ± 8.75

10.27 ± 9.95 --, 0.14

Hospital charges (*10000¥)

5.20 ± 4.90

2.92 ± 3.21

--, 0.03 

No statistically significant differences were noted in other secondary outcomes between the two treatment groups. 

Adverse Events

HVHF: hematoma or exudation (n=2), hypocalcemia (n=2)

LMWH + insulin: slight rebound in serum TG levels treated with oral lipid-lowering agents (n=3)

Study Author Conclusions

In conclusion, HVHF could lower TG levels more rapidly and efficiently than LMWH + insulin therapy. However, HVHF was not superior in terms of clinical outcomes and costs in the present study. Whether HVHF may have resulted in a higher incidence of persistent respiratory failure and a higher tendency of SAP is debatable. Based on our findings, HVHF should not be administered routinely or nonselectively to HTGP patients. LMWH+insulin regimens also have fairly good lipid-lowering effects and are more economically feasible without a serious rebound phenomenon. Further multicenter studies with large samples remain necessary to clarify the feasibility of HVHF treatment in HTGP patients.

InpharmD Researcher Critique

Even though LMWH + insulin was treated as an active "control group" in this study, its considerable TG-lowering effects to achieve the pre-specified TG goal of < 5.65 mmol/L was reached in 48 hours, representing the clinical efficacy. 

Since the study was conducted in China, the cost-analysis of HVHF may not be readily applicable to US hospitals. Treating clinicians were not blinded in this trial, which may affect the outcome measures as well. 



References:

He WH, Yu M, Zhu Y, et al. Emergent Triglyceride-lowering Therapy With Early High-volume Hemofiltration Against Low-Molecular-Weight Heparin Combined With Insulin in Hypertriglyceridemic Pancreatitis: A Prospective Randomized Controlled Trial. J Clin Gastroenterol. 2016;50(9):772-778. doi:10.1097/MCG.0000000000000552

 

Hypertriglyceridemia-Induced Pancreatitis: A Decade of Experience in a Community-Based Teaching Hospital

Design

Retrospective, single-institution, non-placebo study

N= 14

Objective

To observe the role of insulin with or without plasmapheresis for treatment of hypertriglyceridemia-induced pancreatitis

Study Groups

Insulin drip (n= 8)

Insulin drip + plasmapheresis (n= 3)

Subcutaneous insulin (n= 3)

Inclusion Criteria

Age > 18 years, primary diagnosis of acute pancreatitis, serum triglyceride > 1000 mg/dL upon admission, received insulin as a therapeutic agent for acute pancreatitis

Exclusion Criteria

Unavailable serum triglyceride levels at discharge

Methods

Patient charts with recorded acute pancreatitis upon admission were analyzed for admission. Patients with secondary hypertriglyceridemia were also screened. Different treatment modalities with insulin included:

1. Insulin drip

2. Subcutaneous insulin

3. Insulin drip + plasmapheresis

All patients received subcutaneous heparin and oral anti-lipid agents upon admission.

Duration

Recruitment period: 2005 to 2015

Follow-up: Until discharge

Outcome Measures

 

Baseline Characteristics

 

Study participants (n= 14)

 

 

Age, years

39 ± 8    

Male

57%    

Admitted to the intensive care unit (ICU)

71%    

Computed tomography confirmed pancreatitis

71%    

Lipase levels above 3x ULN upon admission

86%    

Diabetes mellitus comorbidity

50%    

Results

Endpoint

Insulin drip (n= 8)

Insulin drip + plasmapheresis (n= 3)

Subcutaneous insulin (n= 3)

Duration of stay, days

10.3 ± 5.4 20.7 ± 3.1 5.7 ± 1.2

Mean lipase levels upon admission, mg/dL

552.5 ± 373.5 375.3 ± 369.1

261.7 ± 245.9

Mean triglyceride level upon admission, mg/dL

5,307 ± 4,932.3 6,575 ± 4,214

6,123 ± 1,431

Decrease in triglyceride levels at 24 hours, mg/dL

Levels at 24 hours

Percent difference from admission

 

2,139.9 ± 1,702.5

50.6% ± 16.0%

 

-

-

 

-

-

Percent decrease in triglyceride levels at discharge versus admission levels

85.2% ± 7.1%

92.6% ± 5.6%

79.8%

Adverse Events

Four of eight (50%) patients treated with insulin drip experienced complications (small bowel obstruction, spontaneous bacterial peritonitis, and respiratory failure requiring intubation).

Two of three (66%) patients treated with insulin + plasmapheresis had complications (respiratory failure requiring intubation and acute tubular nephritis requiring dialysis).

No patients on subcutaneous insulin experienced complications.

Study Author Conclusions

Our study strengthens the evidence for using insulin (infusion or subcutaneous) with or without plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis.

InpharmD Researcher Critique

Unfortunately, the small patient population makes it difficult to determine whether a specific insulin treatment strategy confers quicker and greater normalization of triglycerides. Lack of a standard treatment comparison group means the magnitude of benefit cannot be determined. 



References:

Afari ME, Shafqat H, Shafi M, Marmoush FY, Roberts MB, Minami T. Hypertriglyceridemia-Induced Pancreatitis: A Decade of Experience in a Community-Based Teaching Hospital. R I Med J (2013). 2015;98(12):40-43. Published 2015 Dec 1.

 

Extreme Hypertriglyceridemia Managed with Insulin

Design

Retrospective review

N= 10

Objective

To retrospectively review 10 cases of extreme hypertriglyceridemia (HTG) with mean serum triglyceride (TG) on presentation of 101.5 ± 23.4 mmol/L (8982 ± 2070 mg/dL) managed with insulin

Study Groups

HTG treated with insulin (n=10)

Inclusion Criteria

Extreme HTG (serum TG level ≥50 mmol/L) (≥4,428 mg/dL) manged with insulin.

Exclusion Criteria

Not specified. 

Methods

Extreme HTG cases were identified from a list of inpatients for which an endocrinology consult was sought. The type and effectiveness of treatment modalities used in the acute management of extreme HTG were examined. 

Duration

January 2010 to December 2013

Outcome Measures

Serum TG level on day 1, 2, 3, and at discharge; reduction of TG level; time to achieve TG <11.3 mmol/L

Baseline Characteristics

 

Extreme HTG (serum TG level ≥50 mmol/L) (≥4,428 mg/dL) manged with insulin

(n=10)

         

Median age, years (range)

39 (24 to 55)          

Male

9 (90%)          

Ethnicity

Caucasian

Torres Strait Islander

Maori origin

Indians

 

6 (60%)

1 (10%)

1 (10%)

2 (20%)

         

Body mass index, kg/m^2

31.8±  6.5          

Presented with pancreatitis 

5 (50%)          

Mean serum TG level on presentation, mmol/L

With pancreatitis

Without pancreatitis

101.5 ± 23.4 

112.9 ± 19.6

90.2 ± 21.6

         

Type 2 diabetes

Mean HbA1C, mmol/mol

Mean blood glucose level

9 (90%)

109 ± 31 (12.2 ± 2.8%)

17.4 ± 7 mmol/L

         

Nine patients were managed with intravenous (IV) insulin infusion (5 were also kept fasting, 4 had pancreatitis) and 1 patient was managed with a subcutaneous basal prandial insulin regimen.

Results

Endpoint

TG level at presentation, mmol/L (day 1)

TG level at presentation, mmol/L (day 1)

TG level at presentation, mmol/L (day 1)  TG level at presentation, mmol/L (day 1) Reduction of TG level in 24 hours, %  Time to achieve TG < 11.3 mmol/L, days

IV insulin + fasting (n=5)

105.1 ± 30.1 13.6 ± 4.1 9.1 ± 4.4 5.6 ± 3.4 87 ± 4 2.6 ± 1.8

IV insulin (n=4)

94.3 ± 18.9 57.6 ± 16.2 35.4 ± 17.3 7.5 ± 4.1 40 ± 8.4 5.7 ± 1.5

SC insulin (n=1)

102 78 46.6 11 23.5 8

p-Value*

p=0.55 p=0.002 p=0.03 p=0.46 p=0.0003 p=0.027

*Comparing IV insulin 1 fasting vs IV insulin alone

Adverse Events

Common Adverse Events: Not disclosed.

Serious Adverse Events: Not disclosed.

Percentage that Discontinued due to Adverse Events: Not disclosed.

Study Author Conclusions

Extreme HTG is commonly associated with poorly controlled type 2 diabetes. The combination of IV insulin and fasting appears to be a very effective, simple, and safe treatment strategy for the immediate management of extreme HTG.

InpharmD Researcher Critique

This retrospective review of a small number of cases specifically focused on a cohort of HTG (in which 50% had developed pancreatitis on presentation) acutely managed with IV/SC insulin. The specific dosing regimen for IV/SC insulin was not provided, and this analysis only serves as a basis for larger prospective studies. 



References:

Thuzar M, Shenoy VV, Malabu UH, et al. Extreme hypertriglyceridemia managed with insulin. J Clin Lipidol. 2014;8(6):630-634. doi: 10.1016/j.jacl.2014.09.004.

 

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis

Design

Retrospective chart review/case series

N= 12

Objective

To present 12 cases of acute pancreatitis (AP) successfully treated with insulin administration

Inclusion Criteria

Patients with hypertriglyceridemia-induced (HT-induced) acute pancreatitis diagnosed by computed tomography

Exclusion Criteria

N/A

Methods

Following discontinuation of oral nutrition, patients were initiated on intravenous regular insulin infusion in 5% dextrose with a goal blood glucose level of < 200 mg/dL. Insulin infusions were discontinued after patients showed clinical improvement and triglyceride levels were < 300 mg/dL. Patients received lipid-lowering agents following discharge.

Duration

2005 to 2012

Outcome Measures

Triglyceride levels

Baseline Characteristics

  Patients (N= 12)

Age, years

46 ± 9.75

Female

4 (33.3%)

Severe pancreatitis (Ranson Severity score > 3)

6 (50%)

Primary hypertriglyceridemia

4 (33.3%)

Diabetes

8 (66.7%)

Time to diagnosis, days

2.25 ± 0.75

Laboratory parameters

Plasma glucose, mg/dL

Total leukocyte count, cells/mm3

AST, units/L

ALT, units/L

ALP, units/L

Serum amylase, units/L

Serum lipase, units/L

Serum calcium, mg/dL

Serum albumin, mg/dL

 

117.92 ± 21.87

10,750 ± 2,589.31

36.42 ± 10.64

30.25 ± 17.19

102.33 ± 29.32

390 ± 211.72

226.83 ± 109.05

8.27 ± 0.77

3.44 ± 0.29

AST: aspartate aminotransaminase, ALT: alanine aminotransferase, ALP: alkaline phosphatase

Results

Endpoint

Patients (N= 12)

Serum triglycerides, mg/dL

Day 1

Day 2

Day 3

Day 4

Day 5



1,140.75 ± 74.74

718 ± 79.37

492.92 ± 54.51

378.83 ± 62.93

305.33 ± 49.81

The authors reported amylase and lipase levels returned to normal after 3 to 4 days, and patients' abdominal pain was resolved. Additionally, the average hospitalization period was 6 days.

Study Author Conclusions

These results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. 

InpharmD Researcher Critique

This was a small retrospective study, which introduces a large risk for bias and human error. Insulin appeared to lower triglyceride levels in this study; however, the insulin dosing protocol or concomitant AP treatments were not mentioned by the authors, making it difficult to determine insulin's role in treating HT-induced AP.



References:

Coskun A, Erkan N, Yakan S, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. Prz Gastroenterol. 2015;10(1):18-22. doi:10.5114/pg.2014.454