Post bariatric surgery care within the NHS is currently for 2 years. Post bariatric surgery hypoglycaemia (PBSH) can occur many years following surgery. The true prevalence of symptomatic PBSH is difficult to establish given variable recording and high median time to first event following surgery. Screening post-operative patients reveals high rates of asymptomatic hypoglycaemia of uncertain significance. The numbers of symptomatic patients fulfilling Whipples triad is still comparatively high. Diagnostic methods are varied and include provocation testing such as mixed meals as well as blinded continuous glucose monitoring with a symptom and food diary. Alternative pathologies including adrenal insufficiency and insulinoma have been reported as causes of hypoglycaemia in the post-operative period and should not be missed. The characteristic timing in PBSH is of post-prandial hypoglycaemia occurring several hours following a carbohydrate containing meal. The mainstay of treatment is of dietary adjustment both in terms of meal and snack content, frequency and timing. The pharmacological management of PBSH is extremely heterogeneous with a lack of a step-wise considered approach. Pharmacotherapy in the literature includes metformin, acarbose, diazoxide, incretin-based treatment, calcium channel antagonists, somatostatin analogues as well as newer treatments in ongoing trials. In patients who remain symptomatic despite dietary adjustment and a trial of pharmacotherapy other reported treatments include surgical reversal, endoscopic treatment, partial pancreatectomy or the use of jejunal feeding tubes. Given the heterogeneity of diagnosis and management approaches to PBSH we have conducted a large scoping review to inform a simplified guideline aimed at the non-specialist endocrinologist, GP with specialist interest and colleagues within Tier 3. The guideline is currently underway and this presentation will report on the situation so far and allow a platform for consultation as the guidelines develops further prior to its publication later in the year.
30 Jun 2021 - 01 Jul 2021