Management of severe post-bariatric hypoglycaemia with octreotide delivered via a Tandem t:slim insulin pump

A woman in her 40s presented with severe post-bariatric hypoglycaemia that persisted despite nutritional therapy and pharmacological therapy with acarbose and subcutaneous octreotide with meals. The nutritional limitations were difficult to sustain, and she developed adverse effects to the pharmacological therapy, and hence, doses could not be increased. She was subsequently treated with subcutaneous octreotide via an insulin pump, with a continuous basal rate and additional bolus doses with meals. This led to significant improvements in hypoglycaemia and less side effects, as well as the ability to titrate doses. This report describes the course of her treatment, illustrating continuous octreotide treatment via an insulin pump as a potential additional treatment option in post-bariatric hypoglycaemia.