PT  - JOURNAL ARTICLE
AU  - Chen, Xin
AU  - Kimura, Brad
AU  - Nagelberg, Jodi
AU  - McCowen, Karen C
TI  - Fasting hypoglycaemia secondary to carnitine deficiency: a late consequence of gastric bypass
AID  - 10.1136/bcr-2021-241703
DP  - 2021 Jul 01
TA  - BMJ Case Reports
PG  - e241703
VI  - 14
IP  - 7
4099  - http://casereports.bmj.com/content/14/7/e241703.short
4100  - http://casereports.bmj.com/content/14/7/e241703.full
SO  - BMJ Case Reports2021 Jul 01; 14
AB  - Twelve years following gastric bypass surgery, a cachectic 69-year-old woman presented with both fasting and postprandial hypoglycaemia. Postprandial symptoms were relieved by dietary modification and acarbose, as is common in such cases. During a supervised fast, symptomatic hypoglycaemia occurred. Concurrent laboratory testing showed suppression of plasma insulin, c-peptide, proinsulin and insulin-like growth factor II. However, beta-hydroxybutyrate was also low, surprising given insulin deficiency. Elevated plasma free fatty acid (FFA) concentrations suggested that lipolysis was not impaired, making cachexia/malnutrition a less likely cause of hypoglycaemia. The apparent diagnosis was failure to counter-regulate—subsequent plasma carnitine measurements showed carnitine deficiency which presumably prevented FFA transport across mitochondrial membranes for ketogenesis. Repletion with high-dose oral carnitine supplements effected resolution of fasting hypoglycaemia.