Endocrine Abstracts

Introduction: With the increasing incidence of obesity worldwide, there is growing demand for bariatric surgery which carries its own risks. Post Bariatric hyperinsulinemic hypoglycaemia is rare but yet challenging condition to manage.

Case Presentation: In this paper we are describing the case of a 54 years old female who presented with severe hypoglycaemia symptoms 10 months post her RYGB surgery. She underwent an oral glucose tolerance test through which she developed hypoglycaemia symptoms and was found to have a blood sugar of 1.7 mmol/l after 150 minutes of the glucose load with an insulin level of 28.7 mIU/l (2.0–25.0) and a C-Peptide level of 3.15 nmol/l (0.34–1.8) confirming a diagnosis of hyperinsulinemic hypoglycaemia. Different non-operative approaches were tried to help controlling her hypoglycaemic episodes with good response achieved by the combination of proper patient education, dietary modifications, Acarbose and Octreotide injections. As a reflection of this case, we have conducted a retrospective case series review for 422 patients who underwent a bariatric operation in James Cook Hospital–Middlesbrough from 2012 to 2016. 18 patients were confirmed to have hyperinsulinemic hypoglycaemia where different treatment options were tried to control the symptoms.

Conclusion: The incidence of sever hypoglycaemia occurring post bariatric surgery might be commoner that appreciated. Early recognition and patient involvement in the management are crucial to prevent life threatening consequences.