MON-700 A Case of Post Bariatric Surgery Hypoglycemia 20 Years Later

Abstract Disclosure: J. Nannar: None. T. Tornberg: None. H. Haque: None. S. Dukkipati: None. R. Alhaddadin: None. V. Variar: None. Introduction: Bariatric surgery is a treatment option for morbid obesity refractory to other treatments. Associated with reversal of type 2 diabetes mellitus and non-alcoholic fatty liver disease. Post-bariatric hypoglycemia (PBH) is a complication. Incidence of PBH can be 13% five years following surgery. There are no guidelines to diagnose PBH. Clinical Case: 65-year-old female presented for an elective knee replacement. She tolerated the surgery without complications. Post-operatively noted to have episodes of dizziness, flushing and diaphoresis associated with hypoglycemia. Episodes have been on-going for the past 5 years, occur usually prior to meals and resolve after eating. Past surgical history was significant for Roux-en-Y gastric bypass (RYGB) in 1996. She was not on any hypoglycemic drugs. During hospitalization, when blood glucose was less than 55 mg/dl, C-peptide was inappropriately high at 7 ng/ml (ref 0.5-2.0 ng/ml) and insulin at 41.4 uIU/ml (ref 5-15 uIU/ml). Sulfonylurea screen was negative. Cortisol was unremarkable. CT abdomen/pelvis without contrast did not show any pancreatic mass. This workup was consistent with endogenous hyperinsulinemia and she was diagnosed with post prandial hypoglycemia due to prior RYGB surgery. Dietary modification was advised and she will be following up outpatient with Endocrinology clinic. Clinical Lessons: Hypoglycemia is a complication following bariatric surgery. Risk factors include female sex, longer duration since surgery, no history of diabetes and RYGB. Onset of PBH is usually more than 1 year after the surgery. Patients usually present with lightheadedness, palpitations and fatigue, which can overlap with those of dumping syndrome, complicating diagnosis. This results in limited data available on the frequency and incidence of PBH as the diagnosis is based on physician and patient awareness. RYGB is associated with a higher incidence of severe hypoglycemic episodes and PBH than sleeve gastrectomy. Treatment options include lifestyle changes (low glycemic carbohydrates, frequent snacks), with additional pharmacological and surgical interventions. Conclusion: We present this case in which a patient started developing hypoglycemic episodes 24 years after RYGB. It is essential to complete a thorough medical history and have high suspicion for PBH, as these symptoms can ultimately impact a patient’s quality of life. Further cases need to be reported to support literature and establish guidelines. Presentation: Monday, July 14, 2025