Endocrine Abstracts

Background: Approximately 3 million people living in the UK are affected by severe obesity. Post bariatric reactive hypoglycaemia (PBH) is an increasingly recognised complication. PBH is estimated to occur in 10–30% of patients following Roux-en-Y gastric bypass (RYGB) surgery. We have compiled a few challenging patients with PBH managed with various pharmacotherapeutic agents at our centre.

Results: Case 1: 69F had RYGB (2014) presented with PBH (1.9 -2.5 mmol/l). A trial of Acarbose was discontinued following gastrointestinal intolerance. Hypoglycaemia significantly improved with Octreotide 50 mg twice daily. Case 2: 56F had single anastomotic gastric bypass SAGB (2014) converted to RYGB (January 2019), developed worsening hypoglycaemia (November-2019, 2.9mmol/l) confirmed on prolonged oral glucose tolerance test (OGTT). There was minimal response to dietary changes and acarbose. Hypoglycaemia improved with liraglutide 1.2 mg daily (2025). Case 3: 45F SAGB (2022), converted to RYGB (2022) finally had a partial gastrectomy-2023, presented with hypoglycaemia (March-2023) improved with diet and reversal of surgical procedure in parallel. Case 4: 34F developed severe hypoglycaemia refractory to dietary changes (1.8mmol/l) following gastric bypass (2019). Mixed meal test MMT was diagnostic. She developed gastrointestinal intolerance with acarbose and Octreotide injections; improved on Diazoxide transiently. Treatment was escalated to Liraglutide. Case 5: 27F had RYGB (2020), presented with hypoglycaemia confirmed on MMT; had gastrointestinal side effects with acarbose; injections site issues with Octreotide later improved with Liraglutide 1.2 mg daily. Case 6: 43M, had gastric bypass (2022), developed PBH diagnosed with MMT, commenced on combination of dietary modification and acarbose, experienced improvement of hypoglycaemia.

Conclusion: There are no medications that have a specific license for management of PBH. A standardised national guideline outlining a stepwise approach to medical management would be highly beneficial. Continuous glucose monitoring systems are valuable for patients with hypoglycaemic unawareness and in monitoring treatment response.