In most cases, apart from homozygous lipoprotein lipase or apolipoprotein CII deficiency, use of a fibrate in combination with a low fat and carbohydrate diet and improvement in blood sugar control is highly efficacious in reducing severe HTG to more moderate levels, as seen in our cohort. This evidence concerns the gene APOC2 and hyperinsulinemic hypoglycemia, familial, 4.