Your help needed. Increased A1C and low blood sugar after RNY.

Has anyone had an increased A1C since having a RNY? Mine has increased in recent months to 5.8 which is not too high I think but on the border. I have to go back in to my PCP and have it checked in three months.  I've recently developed issues with low blood sugar--experiencing shaking and slight confusion at times. I was prediabetic before surgery, and I thought that the RNY would prevent my developing diabetes. I'm 20 months out and I weigh 127--so i'm below my goal weight and not gaining. I also dump, so I'm very careful about my sugar intake. I would appreciate hearing any of your ideas on what is happening here. I've been lucky--no other complications and the surgery was certainly a lifesaver for me!  I don't know what kinds of questions to ask my doctor regarding this issue though. Thanks!

As a previous diabetic, I often would drop low at night and found that a snack of string cheese at bedtime helped immensely. 

Truthfully, I would be concerned about a 5.8 A1c -- because it is borderline.  Do you have access to a blood glucose monitor?  I would want to take my fasting blood sugar (morning) to see if it was under 90 and then post prandial (2 hours after the start of meals) to make sure it was under 120.  It's hard to know what to do without knowing what is going on -- what does your doctor say?

Also, it may help if you post a typical day's diet?  A lot of people think they are being careful -- but they are eating fruits and more carbs than they realize that contribute to higher blood sugar readings.  

To give perspective, I was in insulin dependent diabetic before surgery (3 times a day + metformin!) and now my A1c hasn't been above 4.9.  My fasting numbers are between 75 and 85 and post prandial are rarely above 105.  

Hi Kat,

Thank you so much for your response. Good things to think about. I know nothing about diabetes. 

My fasting blood sugar is 74. I think that's on the low side. I am having trouble with this low blood sugar thing in the morning. My typical day's meals are: Breakfast: Siggi yogurt, snack: pear, lunch: ham and cheese rollup (no bread) with tomato, afternoon snack: crackers, olives, and cheese, dinner: chicken and broccoli or salad, snack: strawberries, cheese and nuts. I don't eat pasta or rice, but I do eat a little bread and crackers. I'm going to cut that out. I suppose the fruit has to go too. Once in a while I drink wine--maybe that has to go for a bit too until I figure this thing out.  I feel lucky though--still at a point where I can cut a food item and I have no craving--and feeling terrific due to the surgery. 

A fasting of 70 or above is not too low.  That's normal.  Seriously.  It's low only if you are a diabetic on medications.

Siggi yogurt (is so delicious!) and if it's the plain -- it's got great numbers.  Watch some of the fruit kinds -- they can get a bit high in the sugars -- but overall this should be good as the protein is usually around 13 to 14 and the carbs around 11. 

Pears are VERY high in sugar.  If you decide to eat fruit, try sticking to berries and adding a protein.  For example, 3 strawberry and a string cheese -- or some blueberries and ricotta.  It's important if you do eat fruit to eat a protein with it so that they sugar doesn't cause such a spike.

Lunch - great

Afternoon snack -- only gripe I have is the crackers but you already said you were going to cut it out.

Dinner -- great.

PM snack-- great... maybe add a protein close to bedtime to deal with the low feeling. 

Wine really caused me weird spikes -- 

Try adjusting those very little things and see if it helps you -- but I would definitely test your blood sugar for a few days if you can get a hold of a monitor.  That way you will know what you are really doing in terms of rises and falls.

I have been diagnosed with reactive hypoglycemia and what your are describing is identical to my symptoms. Mornings about an hour after breakfast no matter what I eat. Shaky, lightheaded, spacey feeling. My doc actually put me on Precose to aid in controlling it. I take one every morning and only in the morning as my symptoms do not appear any other time. Try a piece of hard candy, a star mint or butterscotch disc, as soon as you feel it coming on. If it helps stop it, chances are this could be what it is.

Burghblonde has a point, it could be reactive hypoglycemia. You know when you can feel the effects of low blood sugar -- the shakes, etc. But because your A1C is going up, that means you also have very high blood sugars  at other times.

Reactive hypoglycemia happens when you eat simple carbs, like bread, crackers, sugar, etc., and your blood sugar skyrockets. You release too much insulin, which causes your BS to plummet, and you feel the effects. Some people will use sugar or similar to get their BS back up, but it's a mistake. It just starts another spike, and then a  crash.

It's a harmful roller coaster. As Kat said, get a meter, and check your BS every hour while eating as you have. See what the peaks and valleys are like.

You can control RH easily with diet, but you have to stay on top of it.

Thanks everyone for your comments. I will definitely check in with my doctor and keep on top of this.