SUN-622 Utility of Continuous Glucose Monitoring in the Management of Severe Post-Bariatric Hypoglycemia

Abstract Disclosure: L.A. Ertuglu: None. A.L. Morvant: None. S. Bao: None. Introduction: Postprandial hyperinsulinemic hypoglycemia is a debilitating complication of bariatric surgery, affecting over half of patients. It can cause seizure and coma in severe cases and increase the risk of death. Management can be challenging with limited options including dietary modification and medications such as acarbose, diazoxide and octreotide. Continuous glucose monitoring (CGM) has become increasingly valuable in managing these patients. This case highlights a severe case of post-bariatric hypoglycemia complicated by hypoglycemic seizures successfully managed using CGM. Case presentation: A 52-year-old female with prior class 3 obesity treated with Roux-en-Y gastric bypass 21 years ago presented with hypoglycemic seizure. She began experiencing severe postprandial hypoglycemia 10 years after her bariatric surgery, complicated by several episodes of hypoglycemic seizures requiring hospitalization, despite diazoxide and acarbose treatments. Work up during hospitalization revealed severe hypoglycemia (blood glucose 35 mg/dL), with concomitant inappropriately high c-peptide 5.0 ng/mL and insulin 4.2 mcunit/mL. HbA1c was 4%. Cosyntropin stimulation test was normal. Prolonged fasting study, CT abdomen and PET-CT with dotatate were negative for insulinoma. Postprandial hyperinsulinemic hypoglycemia was diagnosed clinically. Diazoxide and acarbose were stopped. Dietary modification with frequent small meals consisting of high protein, fiber and complex carbohydrates was recommended. CGM with Dexcom G7 was started for close glucose monitoring and preventing severe hypoglycemia. A review of her CGM data during follow up visit showed very low incidence of severe hypoglycemia. She did well over time with continued use of CGM without requiring pharmacotherapy, experiencing no further episodes of hypoglycemic seizures. Discussion: Postprandial hypoglycemia is a common but serious complication of bariatric surgery. In a study of 1138 patients, 44% had ≥1episode of post-bariatric hypoglycemia within 25 months, 11% of which had severe hypoglycemia1. Treatment options remain limited, and dietary modification for prevention is the primary management. This case highlights the value of CGM for patients to allow real-time monitoring and alerts to prevent severe hypoglycemia. CGM is also invaluable for clinicians to guide individualized treatment plans based on glucose profile. However, CGM use is currently not part of official guidelines for hypoglycemia management in non-diabetic patients, which hinders access to CGM for many patients. Wide use of CGM in patients with post-bariatric hypoglycemia may improve clinical outcomes and should be advocated. Reference: 1.Bienvenot R et al. Symptomatic Hypoglycemia After Gastric Bypass: Incidence and Predictive Factors in a Cohort of 1,138 Consecutive Patients. Obesity (Silver Spring) 2021;29(4):681-688 Presentation: Sunday, July 13, 2025