Late Dumping

All,
Been a while since I've been on here!  Life is good and for those of you in the beginning stages of your WLS journey enjoy it!  
Thought I knew a lot of information about the RNY, but have been facing a rather new development:  Low Blood sugars, I've spent 6 hours in the hospital trying to stabilize my sugar and I have had readings as low as 22.
Well after meeting with an endocrinologist he has diagnosed me as having 'Late Dumping Syndrome' instead of Hypoglycemia.
Was wondering if anybody out there has dealt with this OR any offices that you might know of with information/treatment of this?  
Thanks!
--Sax

My numbers haven't gone that low yet, I think 45 is the lowest I recorded.  I had to stop eating shredded wheat wirh protein powder and almond milk on it because I regularly tanked on that

When I reported it as part of my four-year checkup, the registered dietician said there are many cases reported.  She didn't indicate that a reason had been found, just that the data was increasing.

I have seen it discussed on several boards and blogs as well.  The street wisdom seems to be small high-protein meals.  Many, but not all folks have mentioned a corollary between lots of artificial sweeteners and the big drops.  Except for Pure Protein bars, I avoid most sweet stuff most of the time, except for fresh fruit.  I haven't tanked for a few months now.

Keep me informed!

I am having the same problem.  No real rhyme or reason when it happens.  I do like the small high protein meals.  I am going to have to try that.  Thanks for that information.  My dietician said they have been noticing that also. 

 Endocrinologists like to call it "Late Dumping" because they aren't familiar with how serious and common true reactive hypoglcemia after RNY really is. There are lots of us here on OH who struggle with this regularly - I'm one of them. Most of us can figure out how to control the blood sugar crashes with the way we eat and react to what our body is doing. But there are times when I experience a crash for no good reason (like after a protein shake that has no carbs in it, for instance). 

I've written a really long post on my blog about reactive hypoglycemia and about my "marathon blood testing" week where I learned a ton about my body and what things trigger a crash. Each of us is different and we need to learn how our body works with different foods, stresses, exercises, etc. It's a huge game of experimentation at the beginning. 

Here's the article:
http://pamtremble.blogspot.com/2010/10/reactive-hypoglycemia -after-bariatric.html

I'm curious about your stay in the hospital when it took them 6 hours to bring up your sugar levels. Were they trying to correct the low counts with more glucose or with a balance of protein/carbs/fat? The typical medical response to low blood sugar counts in normal-gutted people is to pump them with sugar (juice, glucose tabs, etc.) and expect that to work for WLS people. It doesn't. IN fact, that's the worse thing we can do. We need to figure out what works for our bodies individually. For me, I need a small amount of simple carbs (like 3-4 crackers) and a combination of protein and fat (like milk or peanut butter). For instance, If I were to drink a glass of orange juice I'd spike my blood sugar levels and then get another crash in about 90 minutes. 

Good luck. And keep us posted. 

Pam

 Interesting read Pam!  As I'm sitting here trying to figure all this out I'm both really excited to know that getting back to basics will probably help me tons!  On the other hand, being as active as I am in endurance sports I'm wondering how I maintain my training/racing without Gatorade and other substances (or if having those during the session/races would really make any difference at all).

To answer your question about the ER trip [no need to flame as I explain, lol!]
My dinner was a poor choice (fish and chips).  Added in diet pop that I believe got switched to regular pop after my 2nd glass just set-up a night of pure misery.
I spent roughly 3 hours crashing to around 44, taking a couple of glucose tablets & eating some protein.  This has ALWAYS worked in the past, but that night I'd level off and then promptly crash again.  The last straw was when I tested my blood sugar and it was at 100, started feeling bad about 15 minutes later and it dropped to 70.  At that point I told my wife it was time to go to the ER.
When I got admitted they checked my sugar and it was at 180! That was after doing NOTHING since the reading of 70.  About 15 minutes after the 180 test I was down to 140.  They gave me glucogyn (or something to that affect) and my blood sugar dropped to 70.  They then started a glucose IV that got my sugar back up to 85 and suggested I get into my bariatric surgeon and an endocrinologist.  My bariatric surgeon just told me -- yep sounds like reactive hypoglycemia and there's not much we can do.  That inspired my trip to the endocrinologist.  From what I've read and piecing together the problems that I've had I am inclined to believe that I very well am most likely suffering from a 'late dumping' syndrome.  I'm going to start logging all that I eat and notating when I crash and right now I'm 99% positive I'll see that higher carb meals/snacks will cause (and has been the cause) of my crashes.  
I've gotten reenergized to get back to the basics and solve this annoying little problem.
Thanks for the info!  Great to see that you're still here.
--Sax

 No flaming from me! I think most of us figure out we have reactive hypoglycemia because we misbehave and wander back to the simple carbs we know we shouldn't have. I never would have discovered I had hypoglycemia if I hadn't been eating crap in the first place. I suspect a lot more people have it early after surgery -- but it's most commonly seen about 18 months post-op, which seems to conincide with the timeframe when people get a bit more lax with their eating and experiment with what it means to be in "maintenance."

Reactive hypoglycemia and late dumping are pretty much the same thing. It's just that reactive hypoglycemia will have more instances of crashing on foods that wouldn't normally cause dumping. And a late dumping episode might lead into a more severe reactive hypoglycemia episode. I can crash on coffee with no added sugar, so that would be reactive hypoglycemia. I can also crash on a Hershey's bar, so I guess that'd be more on the side of late dumping. 

I have "Reactive Hypoglycemia" on my medical alert bracelet because it is a medical term most recognized by the pros. Whereas calling it Late Dumping to someone who is not familiar with bariatric surgery would have no clue what that meant. So I tend to speak the language of the medical guys so they really understand what I'm dealing with.

 Curious:  Do you carry a Glucagon pen?  
Hoping I never need it, but I've been carrying it around lately. During an episode like I had that night I'm thinking the glucagon probably could've stabilized me earlier and better than then the tablets.

Nope. This is what I carry:

** Blood Glucose Monitor (Reli-On micro - small enough for my purse)
** Glucose Tablets ($1 at Walmart for a little tube. I've only used them once in an emergency)
** Granola bars (always one in my purse, plus a supply in the car)

I went out for a walk this afternoon with a friend. When I got back to the car I was feeling a bit off -- so I checked my blood sugar count and it was 73. Not dangerously low but I could tell that it was on the downward spiral and recognized how my body was feeling as a signal that I needed to check. So I ate a granola bar from my car's stash before I drove home.

We really really really do NOT want to rely on sugar to bring up a low count. If it drops down in the 20's like you had, then yes, sugar/glucose/glucogon would be the right answer. But then you'd need to follow that immediately with a good nutrient balance or else you'll just create a new cycle of spikes and crashes. Because we have a pouch that doesn't metabolize sugar like normal people and whatever we eat that's high sugar content gets absorbed directly in the intestinal walls.... we can't rely on the same remedies as normal people.

On a side note.... my PCP sent me to an endocrinologist to try and figure out why I wasn't able to lose any more weight and I had a conversation with him about my reactive hypoglycemia. I was amazed when he said there was no such thing. HA! Crazy how some doctors are clueless, huh?