Post-bariatric hypoglycaemia: an under-recognized complication of weight loss surgery - a case series.

Post-bariatric hypoglycaemia (PBH) has emerged as a significant, under-recognized complication following Roux-en-Y gastric bypass (RYGB) and other weight loss surgeries. The purpose of this study was to characterize the timing, clinical presentation, diagnosis and management outcomes of PBH in a diverse case series from a multi-speciality centre in Southern India owing to a 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 in Southern India from May 2017 to April 2024. Time to onset of PBH, nadir plasma glucose levels, management approach (diet, medication and surgery), complication rates and patient follow-up duration were evaluated. Nine adults (mean age: 41.5 years; both sexes) were diagnosed and managed for PBH following RYGB. PBH onset ranged from 1 month to 5 years following RYGB (mean: 17 months). Nadir glucose levels ranged from 16 to 67 mg/dL. Hyperinsulinaemia and nesidioblastosis were diagnosed in select cases. Patients received individualized medical nutrition therapy, medication (voglibose, octreotide and diazoxide) and, in severe/refractory cases, surgical procedures such as reversal of RYGB or subtotal pancreatectomy, as was required in two patients. Frequent and severe PBH episodes were more common in patients with higher initial BMI and persistent carbohydrate-heavy diet intake. 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 patients' quality of life.