Harshni Kalimuthu, Gayathma Seekkuge, Sona Joseph
Reactive hypoglycaemia is characterised by symptomatic hypoglycaemia occurring several hours after food intake and can significantly impair quality of life. Management is often challenging, particularly in patients who fail dietary modification or cannot tolerate conventional pharmacological therapies. We present the case of a 50-year-old woman with longstanding, debilitating reactive hypoglycaemia who experienced marked symptomatic and biochemical improvement following treatment with semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. The patient presented with recurrent episodes of dizziness, profound fatigue, tremulousness, and syncope despite adherence to dietary recommendations. Previous treatment with acarbose was discontinued because of gastrointestinal intolerance, and metformin failed to improve symptoms. Continuous glucose monitoring and an oral glucose tolerance test confirmed reactive hypoglycaemia. Following initiation of semaglutide, the patient experienced a substantial reduction in hypoglycaemic episodes with corresponding improvement in glucose profiles and quality of life. This case highlights the potential role of semaglutide as a novel therapeutic option in patients with refractory reactive hypoglycaemia and contributes to the emerging evidence supporting the use of GLP-1 receptor agonists in this condition.