Post-Bariatric Hypoglycemia: Diagnosis, Mechanisms and Management-A Case Report-Based Review

Background: Post-bariatric hypoglycemia (PBH) is a clinically significant complication of bariatric surgery, characterized by inappropriate postprandial hyperinsulinemia and recurrent hypoglycemia. Episodes are often frequent, severe, and medically refractory, substantially impacting quality of life and potentially causing compensatory carbohydrate intake that leads to weight regain. Methods: A 50-year-old male underwent Roux-en-Y gastric bypass (RYGB) in 2009. Symptomatic postprandial hypoglycemia emerged in the second postoperative year and progressively worsened to multiple severe daily episodes. The patient developed compensatory carbohydrate intake with subsequent weight regain. Following the failure of dietary interventions and pharmacologic therapy, he underwent conversion to single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) in September 2022. Results: Following surgical conversion, the patient reported no clinically significant hypoglycemia during the follow-up period. Weight and obesity-related comorbidities improved. Gastrointestinal symptoms remained manageable, and micronutrient status was closely monitored. Conclusions: In selected patients with severe, medically refractory PBH following RYGB, conversion to an ileal-based procedure may be considered a viable therapeutic strategy. Prospective studies are needed to better define this hypothesis.