FRI666 Postbariatric Hypoglycemia: The Brody School Of Medicine Institutional Experience
Authors: Jiang Zhaozhi , Raihan Azad Mohammad , Seagrove-Guffey Maighan , Javaid Maria , Jerkins Drake Almond , Saeed Dar Moahad 
Published: October 2023

Abstract
Disclosure: Z. Jiang: None. M.R. Azad: None. M. Seagrove-Guffey: None. M. Javaid: None. A.J. Drake: None. M.S. Dar: None.
Background and objectives: Post-bariatric hypoglycemia (PBH) is a complication of bariatric surgery and occurs most often after meals but can be nocturnal. PBH tends to occur most often after Roux-en-Y gastric bypass (RYGB). Hypoglycemia severity ranges from mild symptoms to severe lows that require assistance and can be life threatening. The management of PBH is challenging due to its variable presentation and incompletely understood pathophysiology. Medical nutrition therapy is tried initially followed by medical therapy if patients do not respond. Reversal of RYGB is reserved for the most refractory cases. Here we present our institutional experience treating PBH patients (pts) between 2007-2014. Methods: This is a retrospective cohort study of PBH pts seen between 2007-2014 at our institution. Thirty RYGB pts with PBH were included in the study. PBH was confirmed when symptoms of sweating, shakiness, tachycardia, and confusion that were correlated with a fingerstick blood sugars (FSBS) &lt;70 mg/dl which improved after FSBS &gt;70 mg/dl. Mixed meal testing was not done. Pts were referred for medical nutrition therapy. If there was no improvement in hypoglycemia frequency/severity in 3-6 months, Acarbose or Creon were tried at the discretion of the physician with Diazoxide reserved for patients who were refractory to these medicines. Results: Most of the pts were Caucasian females (26/30) without diabetes (25/30) and mean age was 54 +/- 9 years. BMI decreased after RYGB (47.8 +/- 9.2 to 26.4 +/- 4.9) and the weight loss nadir occurred at 26 months for most patients. The average time to first episode of hypoglycemia for all PBH pts was 28 months but only 11 months for PBH pts with pre-diabetes. About 47% of PBH pts (14/30) reported some improvement in the severity and frequency of hypoglycemia after either dietary interventions (8/30) or pharmacological interventions. With regards to pharmacological interventions, Acarbose (3/10 pts), Creon (3/8) and Diazoxide (1/4) all led to some improvement in hypoglycemia frequency and severity. We found that 3 pts with PBH had died. We had access to charts of 2/3 pts and reviewed them to determine cause of death. Both pts had severe PBH with hypoglycemia and loss of consciousness. Pt #1 had a history of atrial fibrillation and developed PBH 8 years after RYGB. He was referred to medical nutrition therapy and lost follow up. Pt # 2 experienced PBH 1 year post-RYGB, treated with Acarbose which did not help. He was then tried on Creon with improvement in the frequency and severity of hypoglycemia and was later lost follow up. Conclusions: PBH is a challenging complication of RYGB and appears to occur more often than previously reported. Medical nutrition and pharmacologic therapy showed modest improvement in PBH severity and frequency but more rigorous controlled trials are needed. PBH may increase the mortality but more research is needed.
Presentation: Friday, June 16, 2023