• Dr. Patti and Dr. Suarez, who are adult endocrinologists (hormone/metabolism specialist physician).
• Endocrinology fellows (physicians in training for advanced expertise in hormone disorders) who work with Dr. Patti
• A registered dietitian and certified diabetes educator with expertise in hypoglycemia.
• Registered nurses and certified diabetes educators.

How do I make an appointment?

• Get a referral from a doctor.
  You must be referred by a physician (not yourself) so we can work with a medical provider involved in your care.
• Send all medical records before scheduling
  We need your records ahead of time so our team can fully understand your health history.
• Include endocrinology records if you have seen an endocrinologist before.
  This helps us see past testing and avoid repeating work.
• Please call 617 732-2400 and ask for a hypoglycemia intake.
• Try to be patient as we review records before scheduling an appointment.
  We review everything first to decide what tests or labs you may need.

• Be prepared to see different providers at your first visit
  You may meet with Dr. Patti, Dr. Suarez, and/or a physician in training so you get a full team evaluation.  You may also see a dietician with expertise in hypoglycemia, as nutrition is a key part of the treatment plan.

   

• Expect a wait due to high demand.  We are sorry about  this!
  We have many referrals, so appointments may take time.
• Most serious cases are scheduled first.
  This ensures patients with urgent needs are seen quickly.
• Consider seeing a local endocrinologist while you wait.
  This allows you to start care sooner instead of delaying treatment.

• You may return to your local doctor after evaluation.
  We often work together with your doctor for ongoing care.

   

• We ask you to do some "homework" before your visit.  This will really help us to understand patterns which may contribute to the symptoms you are experiencing.
• Track your symptoms and blood sugar levels
  Write down when symptoms happen (date and exact time) and check your blood sugar at that time so we can see patterns.  Try to write down what you were doing for 2-3 hours before the symptoms developed.  Were you active, eating, or fasting?
• Use a fingerstick glucose meter (not a sensor/CGM)
  Fingerstick readings are more accurate for this condition.

• Ask your doctor for a glucose meter and strips.
  You may need a prescription, and low-cost options are available if insurance does not cover it.  Your local pharmacist may be able to help you find a lower cost meter and strips.

   

• Plan for follow-up visits after your first appointment.
  Ongoing care helps us adjust your treatment as needed.
• Meet with a dietitian.
  Nutrition is a key part of treatment, and you will learn helpful new strategies.

Resources

• Handout for physicians and other clinicians who may be seeing patients in an urgent care or emergency setting, describing strategies for managing acute aspects of hypoglycemia
• For additional information about results of ongoing research in this condition, please refer to PubMed search:  Patti ME - Search Results - PubMed (nih.gov)

Other thoughts about hypoglycemia that may be useful to you (November 2025):

HYPOGLYCEMIA IN GENERAL

Hypoglycemia is not your fault!

We recognize that hypoglycemia is challenging on so many levels.  

EVALUATION

The first step of evaluation is to verify that hypoglycemia is the cause of your symptoms.  Hypoglycemia causes a wide variety of symptoms - but these symptoms are not unique to hypoglycemia.  The symptoms can feel exactly the same as those with low blood pressure, rapid heart beat due to irregular heart rhythms, anxiety, or even symptoms related to how the stomach empties (sometimes called dumping syndrome) and others.

This is why it is essential that the evaluation done by your doctor is aimed at making sure that your symptoms are linked to low glucose at the time of the symptoms!

Continuous glucose monitors (CGM) are very helpful but are not accurate enough for making the diagnosis of hypoglycemia.  They are less accurate at low values.  In addition, they can give you falsely low readings.  For example, if you lay on the sensor during sleep, it can result in a falsely low glucose value.  The monitors are also less accurate in the first 24 hours after insertion of the sensor.  It is important to rely on a fingerstick glucose reading at these times to ensure accuracy.

CGM were designed for use in people with diabetes.  You may see that 70 is the lower limit of the CGM goal range.  Remember that this was designed for people with diabetes, many of whom are on insulin therapy. Keeping the glucose above 70 is helpful for safety in this situation.  However, people without diabetes often have glucose levels below 70 on CGM.  A sensor glucose value under 70 does not mean hypoglycemia.  Most healthy individuals do not have sensor glucose readings under 54 mg/dl. Furthermore, CGM do not measure blood glucose - it is not the same as a blood sample from a vein or even a fingerstick (capillary) glucose level.  CGM are much less accurate and low ranges and should not be used for diagnosis. 

Once we verify that hypoglycemia is the cause of symptoms, additional evaluation may be done.  This is aimed at making sure you don't have medical conditions which would require different treatment plans  (e.g. insulin producing tumor, adrenal problem, others).  

We often do fasting testing to be sure your body can turn off insulin production when you fast.  Sometimes this could be an overnight fast or sometimes over several days in the hospital. We check other hormones such as adrenal hormones, to be sure these are not contributing.  

If the blood testing is normal this is a good thing!   It doesn't mean you don't have hypoglycemia.  It just means you don't have the other conditions which would be treated differently.  

GETTING CARE FOR HYPOGLYCEMIA

If you are able to travel outside of your local area for your care, we recommend looking into endocrinologists based at clinics and academic hospital centers close to your home, as it is important to have a local physician.

If you do not have endocrinologists in your area who are experienced in hypoglycemia, you may wish to inquire at these centers with expertise in caring for individuals with hypoglycemia. This is not a complete list!  There are many excellent endocrinologists around the country who may be able to assist you, and we just don’t have personal experience with them. For the centers below, ask for the endocrinology division and ask for a physician with expertise in hypoglycemia. 

• Stanford (Palo Alto, CA)
• University of Colorado (Denver, CO)
• University of Wisconsin (Madison WI)
• Mayo Clinic (Rochester MN)
• University of Texas at San Antonio (San Antonio TX)

If you are looking to get an appointment with Dr. Patti at the Hypoglycemia Clinic in Boston, there is a waiting list. To be scheduled, please call 617 309 2400 and ask for a hypoglycemia clinic intake.  We will ask you to send all records for review.

INFORMATION ABOUT HYPOGLYCEMIA AFTER GASTROINTESTINAL SURGERY

Hypoglycemia can be a complication of upper gastrointestinal surgery, such as  gastric bypass, sleeve gastrectomy, gastrectomy, esophagectomy, or fundoplication.  After these surgeries, food enters the intestine quickly, and this causes the release of hormones and other signals which increase insulin production and then can cause hypoglycemia.  This is a well-recognized complication and not your fault!

INFORMATION ABOUT REACTIVE HYPOGLYCEMIA

Sometimes low blood gluoses can occur after eating, after activity, or at other times of the day.  Sometimes this is related to how your stomach and intestine moves (motility).  We do not fully understand all the causes but we and other research teams are working hard on this.  The evaluation is aimed at excluding  those causes of hypoglycemia which would be treated differently  (e.g. insulin producing tumor).  We often do fasting testing to be sure your body can turn off insulin production when you fast.  We check other hormones such as adrenal hormones, to be sure these are not contributing.  The first step of treatment focuses on changing nutrition to reduce the effect of food to stimulate insulin production and then lower glucose.  Sometimes we need to use medication in addition to medical nutrition therapy, if hypoglycemia is severe.

INFORMATION ABOUT POSTPRANDIAL SYNDROME

Sometimes people have symptoms similar to hypoglycemia after eating, but glucose levels remain normal.  It is thought that the symptoms relate to hormones and other signals released from the intestine after eating, which can cause symptoms.  The treatment is similar to hypoglycemia, and largely focuses on changing nutrition to lessen these symptoms.  It is a good thing if the glucose levels are normal!  We understand that you still have symptoms, but they just are not due to hypoglycemia. Other causes of similar symptoms can include rapid heart rate, low blood pressure, anxiety, and others.

TREATMENT

The first step of treatment focuses on changing nutrition to reduce the effect of food to stimulate insulin production and then lower glucose.  Sometimes we need to use medication in addition to medical nutrition therapy, if hypoglycemia is severe.  If you don't respond enough to changing food patterns, it is not your fault - everyone is different.  

We have a number of medications which we can choose from based on your specific condition and pattern.  If one medication does not work for you, we may need to use another medication or  combinations of medications.  Sometimes side effects can be present which cannot be predicted.

Continuous glucose monitoring can be helpful, especially for those persons who cannot always sense low glucose levels.  Suggestions for maximizing the benefits of CGM:

1.     When the sensor glucose is low:

• If you feel fine, check to be sure you are not laying on the sensor as this can cause a false low.  This is especially important during the first 12-24 hours after insertion of a new sensor, as this can cause a falsely low reading. When this happens, you need to check your glucose by fingerstick and meter to verify the reading.
• If you are having symptoms, try to test.  If you cannot, or have verified that the glucose is low, go ahead and treat.
  • Start with 2-3 glucose tablets (4 grams each) or 1/2 of glucose gel pack or gel pack mini size (e.g. Transcend).
  • Repeat after 15 minutes. Retreat if needed.
  • Follow the treatment with a snack containing protein and complex carbs (see handout).

2.  Be sure to discuss the alarms during your visit with your clinician.  Which ones are the ones you really need or pay attention to?

3.  The rapid fall alarm (3 mg/dl/min) can help you to PREVENT a low.  If you see this alarm, and the glucose is under 100, this is a signal to eat a small amount of food (e.g. piece of cheese, some nuts, natural sugar-free peanut butter)  to PREVENT subsequent hypoglycemia.  Don't wait for it to go low.

4.  Do not calibrate when sensor glucose is low, or when the arrow next to the circle with the glucose in the middle is either pointing up or down.  Just check the glucose by fingerstick but don't enter the # as a calibration.

Lack of coverage for glucose monitors:  I know many people are frustrated with lack of coverage for supplies for monitoring glucose, whether capillary glucose monitors and strips or continuous glucose monitors (CGM).  Please be aware there are ongoing advocacy efforts to change the law (Medicare guidelines are dictated by law, yes!).  Please see a recent publication written by myself and a number of physicians who feel strongly about coverage for all forms of hypoglycemia - this article is being used as a focus to change these laws. This is at Pubmed (PMID 41271215):  The Importance of Expanding Medicare Continuous Glucose Monitoring Coverage for High-Risk Hypoglycemia - PubMed

What should I do in the meantime? 

1. First, remember that CGM are not helpful for diagnosis of hypoglycemia due to inaccuracies at low levels and the fact that these measure glucose concentrations under the skin, which can be influenced by other factors beyond glucose.  Once you have received a diagnosis based on blood sample (either blood test (best) or capillary glucose), then CGM can be helpful to alert you to impending lows so you can treat before it becomes severe. If you can afford CGM (either Dexcom or Libre), you are lucky.  Be sure to check around to find the lowest prices at pharmacy, big box discount stores etc.  Stelo and Lingo are non-prescription versions, but be aware that these do not have direct alarms and may not provide the info you are hoping for.  For strips, suggest starting with the least expensive strips/meter available online or in your retail pharmacy.

Selected research publications on hypoglycemia authored by the staff of the hypoglycemia clinic - more in progress! 

Suggest going to PubMed (https://pubmed.ncbi.nlm.nih.gov) and then enter the PMID indicated to pull up the paper.

Thanks to our volunteers and funding from the NIH for making this progress possible!  Research funding is absolutely  essential to make progress in prevention, diagnosis, and treatment.

• 2026:  Identification of GDF15 as a hormone which rises during hypoglycemia and may contribute to symptoms (PMID:  41806840)
• 2025:  Summary of data supporting need to expand Medicare coverage for high-risk hypoglycemia (PMID: 41271215)
• 2025:  Dr Patti and team reported that alterations in bile acid metabolism and transport were different in individuals with post-bariatric hypoglycemia, potentially paving the way for new approaches to treatment.  This was published in Nature Metabolism (PMID 40186075).
• 2024:  The Patti Lab team (working with both clinical and basic science team members) showed that serotonin and several aspects of glucose metabolism differ in individuals who develop hypoglycemia, as compared with those who do not develop hypoglycemia after gastrointestinal surgery.  This was published in Journal of Clinical Investigation (PMID:  39264731).
• 2024: The Patti Lab team reported on characteristics of individuals with hypoglycemia as compared with those without hypoglycemia. Key findings were high rates of irritable bowel, dumping syndrome, orthostatic hypotension, preoperative symptoms of hypoglycemia, and family history of hypoglycemia. This was published in Clinical Endocrinology (PMID: 39604085).
• 2024:  The Patti Lab reported on hypoglycemia associated with Ehlers-Danlos Syndrome.  This was published in JCEM Case Reports (PMID 39498469).
• 2023:  Dr. Patti reported results of treatment in a patient with  severe tumor-associated hypoglycemia, using an investigational antibody against the insulin receptor to block the effects of insulin.  This was published in the New England Journal of Medicine (PMID 37611129).
• 2023:  Dr. Patti and the hypoglycemia research team published results of the use of continuous glucose monitoring, which successfully reduced hypoglycemia and reduced glycemic variability.  This was published in Diabetes, Obesity, and Metabolism (Cummings C et al, PMID 37046360).
• 2023:  Scientific review of glucose metabolism after bariatric surgery:  implications for type 2 diabetes remission and hypoglycemia (Sandoval DA and Patti ME, Nature Reviews Endocrinology 2023, PMID 36289368).
• 2022:  Medical nutrition therapy and other approaches to management of post-bariatric hypoglycemia:  a team based approach (Patience N et al, Current Obesity Reports 2022, PMID 36074258).
• 2022:  Results of a study using pramlintide for post-bariatric hypoglycemia. Sheehan A et al, Diabetes Obesity and Metabolism 2022, PMID 35137513.
• 2022:  Review of hypoglycemia and dysautonomia (disorder of the autonomic nervous system) after bariatric surgery.  Addison P et al, Obesity Surgery 2022, PMID 35133603.
• 2021:  Identification of mediators of post-surgical diabetes control.  Dreyfuss JM et al, Nature Communications 2021, PMID 34845204.
• 2021:  Postbariatric hypoglycemia:  symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study.  Fischer LE et al, Surgery for Obesity and Related Disorders (SOARD) 2021, PMID 34294589.
• 2020:  Review of post-bariatric hypoglycemia.  Sheehan A et al. Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment, published in Diabetes, Metabolic Syndrome, and Obesity 2020, PMID 33239898.
• 2018: review of  "Hypoglycemia after Gastric Bypass Surgery" .  Salehi M et al.  Journal of Clinical Endocrinology and Metabolism 2018, PMID 30101281.
• 2017:  Our expert dietitian, Emmy Suhl RD, MS, summarizes the critical nutritional approaches to managing this condition. Suhl et al.  SOARD 2017, PMID 28392017.
• Article from our hypoglycemia team which describes first steps to developing a glucagon delivery system to prevent hypoglycemia in this setting, information now guiding current ongoing research. Laguna Sanz AJ et al.  Diabetes Technol Ther 2018, PMID 39355439.
• Article from our hypoglycemia team about further development and testing of a novel glucagon delivery system to prevent hypoglycemia in patients with post-bariatric hypoglycemia.  This study is now guiding further development of a pump system.  Mulla CM et al.  Journal of Clinical Endocrinology and Metabolism 2020, PMID 31714583