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Hyperinsulinism is characterised by dysregulated insulin secretion and is typically associated with reduced fasting tolerance. Long-term hyperinsulinism management includes nutrition and medication to normalize plasma glucose levels. 1 A new generation of commercial Food Based Enteral Formulas (FBF) consists of rehydrated real food.2 Aim was to review the tolerance of a food-based enteral formula for the nutritional management of children with hyperinsulinismMethods A single-centre retrospective case series to explore the dietetic practice of prescribing a commercially available FBF (Compleat® pediatric, Nestlé Health Science) in children with congenital hyperinsulinism (CHI). Data were collected on demographics, gastrointestinal symptoms, anthropometrics, percentage glucose management indicators (GMI%) and hypo/hyperglycaemic episodes.Results Data were collected on eight children, six were diagnosed with CHI and two children had PPH. The mean age was 1.4 years old (0.4SD). All children had a gastrostomy for enteral nutrition. Six of the eight children were prescribed proton pump inhibitors or stool softeners to manage gastroesophageal reflux and/or constipation symptoms. Within one month of children being prescribed FBF dietitians documented an 80% improvement in gastrointestinal symptoms. Dexcom glucose data was available for six children. One month after FBF was prescribed, Dexcon Inc. data reported that five children had an improvement or stable GMI% and all six children had a reduction in hyperglycaemic episodes (chi-square =5.3, p-value 0.02). Children prescribed FBF were less likely to require a glucose polymer (Chi-square = 4.9, p-value = 0.02). 3 Conclusion Our retrospective case series suggests that FBF is well tolerated in children with hyperinsulinism and may mitigate gut motility issues associated with hyperinsulinism, especially in relation to gastro-oesophageal reflux and constipation symptoms. Furthermore, FBF may help reduce the dependency on glucose polymers and reduce the likelihood of a hyperglycaemic episode. A larger sample size and longer follow-up study are necessary.References Aynsley-Green A, Hussain K, Hall J, Saudubray JM, Nihoul-Fékété C, De Lonlay-Debeney P, Brunelle F, Otonkoski T, Thornton P, Lindley KJ. Practical management of hyperinsulinism in infancy. Arch Dis Child Fetal Neonatal Ed 2000;82(2):F98–F107.Banerjee I, Salomon-Estebanez M, Shah P, Nicholson J, Cosgrove KE, Dunne MJ. Therapies and outcomes of congenital hyperinsulinism-induced hypoglycemia. Diabet Med 2019;36(1):9–21.O’Connor G, Watson M, Van Der Linde M, Bonner RS, Hopkins J, Saduera S. Monitor gastrointestinal tolerance in children who have switched to an ‘enteral formula with food-derived ingredients’: a national, multicenter retrospective chart review (RICIMIX study). Nutr Clin Pract 2022;37(4):929–934.