Resolution of Post-Bariatric Hypoglycemia after GLP-1 Agonist (Liraglutide): A Case Report

Presentation Number: LB SUN 73
Date of Presentation: April 2nd, 2017

Aishah A Ekhzaimy1, Omayma Shaltoot2 and Maram AlSubaiee*3
1King Saud University,King Khalid Univesity Hospital, Riyadh, Saudi Arabia, 2King Khalid University Hospital, RIYADH, Saudi Arabia, 3National Guards Health Affairs, Alhasa, Saudi Arabia

Abstract

Resolution of post-bariatric hypoglycemia after GLP-1 agonist (Liraglutide): A Case Report

Authors: Aishah Ekhzaimy, Omayma Shaltoot , Maram AlSubaiee

INTRODUCTION:

Bariatric surgery is one of the successful option to manage obesity and its related metabolic complications. However, one of the long-term complications, which might occur post-bariatric surgery, is hypoglycemia that is sometimes difficult to manage and control. GLP-1 agonist is one of the agent that had been used in few reported cases with a very promising effect in controlling hypoglycemia post-bariatric surgery.

Case report: We present here a case of post-bariatric surgery hypoglycemia in a 37-years-old male known to have hypertension and arrhythmia, presented to our hospital with recurrent episodes of hypoglycemia for the last 2 years. He underwent sleeve gastrectomy 12 years ago for obesity management He had been complaining of recurrent episodes of hypoglycemia for the last 2 years. He was evaluated for insulin-mediated hypoglycemia by a supervised 72 hour fasting test, which turned out to be normal. Afterwards, he underwent a mixed meal study that showed hypoglycemia at 4 hours after the meal suggestive of dumping syndrome.

He was treated with different agents including diazoxide, alpha-glucosidase inhibitor in addition to the frequent scheduled low -carbohydrate meals but he didn’t respond to them. Somatostatin analogue was contraindicated in his case due to his arrhythmia and antiarrythmic drug interaction with the octreotide ( QT-prolongation). The decision was to start him on GLP-1 agonist (liraglutide). The dose was titrated up to 1.8 mg per day and his hypoglycemia resolved. He has been on it for the last 12 months and his hypoglycemia resolved and he maintained his weight. Conclusion, this is one of the few cases among the cases that have been published and GLP-1 agonist had been tried and controlled the hypoglycemia related to the bariatric surgeries. More cases and studies are needed to evaluate the effect and to understand the underlying mechanism of the GLP-1 agonist in managing the hypoglycemia related bariatric surgery, sleeve gastrecytomy in specific.

 

Nothing to Disclose: AAE, OS, MA