8299 A Case of Hypoglycemia in a Patient with Cirrhosis and Previous Bariatric Surgery

Abstract Disclosure: A. Risbud: None. G. Bao: None. K.M. Kirkeby: None. Background: Hypoglycemia is a known complication of both chronic liver and kidney disease as well as gastric bypass surgery. It can be challenging to treat in the setting of multiple medical conditions without definitive treatment, such as organ transplantation. Clinical case: A 47-year-old woman presented with symptomatic hypoglycemia. Her past medical history included obesity, for which she had undergone Roux-en-Y gastric bypass surgery 9 years prior; alcohol and metabolic dysfunction-associated cirrhosis complicated by hepatic encephalopathy and ascites, for which she was actively listed for liver transplantation; and stage 3 chronic kidney disease. Continuous glucose monitoring elucidated that hypoglycemic episodes (as low as 30 mg/dl) often followed periods of significant postprandial hyperglycemia (up to 300 mg/dl) without the use of exogenous insulin or insulin secretagogues. Hypoglycemia persisted despite smaller, more frequent meals with more complex and fewer simple carbohydrates, but was better managed with subcutaneous octreotide injections before meals for the next 11 months. Hypoglycemia eventually resolved after she underwent liver transplantation approximately 16 months after her initial presentation. Conclusion: Postprandial hyperinsulinemic hypoglycemia has been reported following gastric bypass surgery, sometimes occurring years after surgery. While nutrition intervention and somatostatin analogs such as octreotide may be helpful, hypoglycemia may be worsened by concurrent liver and/or kidney disease, wherein gluconeogenesis is impaired. Liver transplantation may be an effective strategy. References: Mala, T. (2014). Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment. Surgery for Obesity and Related Diseases, 10(6), 1220-1225.Pfortmueller, C.A., Wiemann, C., Funk, G.C., Leichtle, A.B., Fiedler, G.M., Exadaktylos, A.K., & Lindner, G. (2014). Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis. Journal of critical care, 29(2), 316-e7.Singh, E., & Vella, A. (2012). Hypoglycemia after gastric bypass surgery. Diabetes Spectrum, 25(4), 217-221. Presentation: 6/3/2024