Topic: Post Bariatric Hypoglycaemia 

Speaker: Jonathan Hazlehurst 

Learning Objectives:

1. Define post-bariatric hypoglycaemia (PBH) using the pragmatic biochemical and symptomatic criteria and describe its proposed pathophysiological mechanisms
2. Identify patients at higher risk of PBH, including relevant pre-operative and surgical factors (e.g. lower pre-op HbA1c/BMI, procedure type — SG/RYGB vs LAGB), and recognise the diagnostic challenges around variable definitions, prevalence, and testing methods (OGTT, MMT, CGM).
3. Outline a pragmatic diagnostic approach to suspected PBH while avoiding over-investigation
4. Describe the tiered management approach to PBH — dietetic modification (low GI, carbohydrate portioning) as first-line, followed by pharmacological options (acarbose, octreotide, diazoxide) and their place in the pathway, plus emerging therapies under investigation (avexitide, GLP-1RAs).
5. Apply practical safety guidance for patients with PBH regarding hypoglycaemia self-management, driving regulations, and exercise precautions.
6. Recognise when to refer patients with PBH to a specialist centre, including treatment-refractory cases or those considering surgical reversal or alternative feeding approaches

Disclosure Statement: The faculty have indicated that they have no relationships which, in the context of their presentation, could be perceived as a potential conflict of interest.