Endocrine Abstracts

Flash glucose monitoring has increased dramatically in patients with diabetes since the introduction of the FreeStyle libre 2 (FSL) incorporating hypoglycaemia predictive features and an alarm system. A 31-year-old lady, gravida 2, para 1 presented at 26 weeks’ gestation following a car accident where she fractured clavicle and navicular. She reported blurred vision and subsequent collapse whilst driving (with her daughter as a passenger) prior to the accident. Paramedics at the accident scene documented severe hypoglycaemia with a blood glucose of 1.6 mmol/l which was appropriately treated. Five years previously she underwent Roux-en-Y gastric bypass surgery with a consequent drop in BMI from 47.7 kg/m² to 29.9 kg/m². Whilst she reported minor post prandial hypoglycaemic symptoms pre pregnancy these had not required medical advice, but she had noticed these more frequently in preceding weeks. A 2-hour glucose of 2 mmol/l was noted from a 24-week OGTT to exclude gestational diabetes. Despite intensive dietary advice she continued to suffer severe hypoglycaemic episodes for the next 2 weeks with glucose values below 2 mmol/l. She had severe hypoglycaemia during her OGTT done at 24 weeks gestation. A FSL-2 with hypoglycaemia alarm was inserted to reduce the risk of further seizures and maternal harm. The frequency and severity of hypoglycaemia was reduced but not completely eradicated following the FSL-2. Within 24 hours of delivery the severe hypoglycaemic episodes were eradicated but the patient continues to flash monitor for 4 weeks for reassurance and to obtain evidence to restart driving. Severe hypoglycaemia during pregnancy should be recognised as a complication following Roux-en-Y bypass surgery. Such patients with low 2-hour glucose values at OGTT should receive further dietary advice. In non-diabetic patients with severe hypoglycaemia e.g., dumping and insulinoma flash monitoring can be invaluable in reducing harm from hypoglycaemia.