Abstract #1413680: Post-Bariatric Hypoglycemia (PBH) Refractory to Conventional Therapies: The Combined Effect of Very High Doses of Glucagon-Like Receptor Agonist (GLP1-RA) and a Low Dose of Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i)

As the number of bariatric surgeries in United States plateaus at nearly 200,000, prevalence post-bariatric hypoglycemia (PBH) is escalating. Since pathophysiology driving PBH not fully understood, treatment for can be challenging clinical practice. Most recently, use GLP1-RA or SGLT2i have been reported as monotherapy options PBH. We are presenting case a patient without diabetes who failed conventional therapy her persistent and dumping syndrome but was successfully treated with very high doses liraglutide low dose empagliflozin. A 50-year-old Hispanic woman referred to endocrinology an 8-year history recurrent syncope due hypoglycemia. She diagnosed non-insulinoma pancreatogenic complicated by syndrome. had Roux-en-Y gastric bypass 10 years prior. Initially, she attempted diet modification, eating less than 20 grams carbohydrates per meal, no improvement. Next, trialed acarbose, which resulted ongoing hypoglycemic events gastrointestinal side effects. Intermittent-scanning Continuous Glucose Monitor (CGM) revealed 4% Target Below Range (TBR, <70 mg/dL) off acarbose despite every 2 hours avoid Her were confirmed glucometer. started on Octreotide 50 mcg sq twice daily (BID), improved TBR 1% relentless constipation. To regulate bowels, adjusted 25 AM PM, increased 3%. With addition Liraglutide 0.6 mg BID, constipation unbearable, 2%. remained BID up-titrated 1.2 (TBR 4%) then 1.8mg 4%). discontinued. On 2.4mg alone, continued nocturnal noted improvement both effects post-prandial 3%). The maximized 3 daily. CGM changed real-time CGM, 2.4%. Empagliflozin added daily, instantly, completely resolved sustained 0%. Very combined empagliflozin corrected 0% symptoms. This combination should considered patients responding anti-hypoglycemic monotherapies.