Post-Bariatric Hypoglycaemia: An under recognized Complication of Weight Loss Surgery - A Case Series

Post-bariatric hypoglycaemia (PBH) has emerged as a significant, underrecognized complication following Roux-en-Y gastric bypass (RYGB) and other weight loss surgeries. The purpose of the study was to characterize the timing, clinical presentation, diagnosis, and management outcomes of PBH in a diverse case series from a multi-specialty center in southern India owing to predominantly high-carbohydrate diet and distinct bariatric phenotype. This was a retrospective observational case series analysis from a multidisciplinary bariatric clinic at a tertiary teaching hospital and in southern India from May 2017 to April 2024. Time to onset of PBH post-surgery, nadir plasma glucose levels, management approach (diet, medication, surgery), complication rates, and patient follow-up duration were evaluated. Nine adults (mean age 41.5 years; both sexes) diagnosed and managed for PBH following RYGB. PBH onset ranged from 1 month to 5 years post-RYGB (mean 17 months). Nadir glucose levels ranged from 16 to 67 mg/dL. Hyperinsulinemia and nesidioblastosis were diagnosed in select cases. Patients received individualized medical nutrition therapy, medication (voglibose, octreotide, diazoxide), and in severe/refractory cases, surgical procedures such as reversal of RYGB or subtotal pancreatectomy was required in 2 patients. Frequent and severe PBH episodes were more common in patients with higher initial BMI and persistent carbohydrate-heavy diets. PBH after bariatric surgery presents with variable onset, severity, and duration, emphasizing the need for long-term multidisciplinary follow-up and individualized management, especially for high-risk populations. Early recognition and tailored intervention can improve clinical outcomes and patient quality of life.