postprandial hypoglycemia

 https://store.joslin.org/docs/Dr_Patti_Joslin_affiliates_10-08.ppt

Here is a powerpoint that the Dr I am seeing has on the internet...very interesting. I have lows no matter what I eat. I can't go over 25 carbs without my sugar hitting over 200 and getting the side effects from high blood sugar. I get lows no matter what.. thank goodness my endo and obgyn knew I shouldn't do the glucose tolerance test. I don't even want to know what 70 grams of sugar would do to me. My current endo has no clue how to treat this. She actually had me email her the powerpoint above. She actually suggested I snack on glucose rescue tabs an hour after I eat...that should not be something I snack on to keep my blood sugar ok. I do use them often but I wouldn't make a habbit of eating three an hour after each meal...no way! I too did not know about this until I had it myself...before I had gastric bypass I did alot of research and never came across this as a possible side effect. I am very nervous in reading about it now though. Recently I just haven't felt myself. I always feel slightly impared. I told my MD that I don't feel comfortable working because I could have a diabetic emergency at any time and I would be putting my patients at risk. In reading it says hypoglycemia left ntreated can cause irreversable brain damage. I feel like I am in a cloud all the time. It very scary. I know I have had this for a long time and it went untreated. I'm glad to know there are people out there that understand, but hate that any of us are going through this...it is horrible. I was healthier at 330 lbs that I am now!!

I have read the power point, I am a nurse also and feel the same thing you do with "Brain fog" as I call it, my endo has refeared me to a neurologist in which ordered a battery of tests MRI,neuro eye exam and also will be taking a neuro-phych test in which last more then 8 hours but maybe able to determine which part of my brain has been effected by all the lows and causing my feeling out of it at all time.. I to dont feel safe around my patients or driving but at this time I have no option and simply cant quit work ,,,my dr's act like they at times dont know what to do with me as this is so new...please keep me updated with any new meds or tests that work for you!!

 The only reason I can stay out of work is due to disability through my employer. My eyes have gotten really bad. I work for a lrge eye department and my eyes have been being checked by an optomotrist for glasses and a retina specialist which is the specialty I work for. My eyes went from 20/30 and no glasses RX last year to left eye 20/400 and right 20/50...and corrected with new glasses I am 20/30 again...but that is a huge difference in one your. My left eye is -2.75+1.75 which is a strong RX for not having one last year. I am going to speak to the specalist in Boston about the brain fog and see if she recommends a neuro eval. I am so forgetful now. Its making me depressed. I will keep you posted!! And you please do the same!

I posted here a few weeks ago. As I said, I can only eat 4 grams of carbs without a spike, sometimes it is now 3, as I am losing more weight (99 yesterday). I too have read Dr. Patti's powerpoint. I contacted her office and her assistent was most kind and thought she would want to see me as a patient. Scanned my records and emailed them but got no reply.
With a new endocrinologist, I took the glucose tolerance test with ensure under a controlled medical setting and dropped to 27. A terrible experience as I normally would not injest that many carbs. I am anxious to hear the results of the test. I believe that if it indicates hyperinsulinimic hypoglysemia without nesidioblastosis, a takedown will help because the food will not enter the small intestine so quickly. However, if there is nesidioblastosis, a takedown won't help. Has your doctor talked to you about a takedown?

I wish I didn't have to work. It is so hard to keep from accidently eating over 4 carbs at a setting and then, of course, I am useless afterwards. Also, very fatigued. Looking forward to trying acarbose, but I don't think it will be a total answer. Can't take Byetta as I get awful side effects from it.

I see you are in pacific time. There was an interesting study done at Stanford feeding patients with our symptoms with a G-tube through the remnant stomach. Five of the six in the study did not develop symptoms with feeding through the remnant stomach. This makes me wonder if restoring the original pathway of digestion would be helpful in alleviating our symptoms.

 Im here on the east coast and saw Dr Patti 2 weeks ago. I started acarbose. Things have slightly improved with my blood sugar only going into the 30's once, but they generally still go into the 60's on a regular basis. I have a very bad case from what she saw on my meter. My endocrinologist from my area that I really thought was using me like a guinea pig surprised me by being at Joslin, the day I went, shadowing Dr Patti to learn how to treat patients like me. I also saw the nutrisionist out there and gained some useful tips. I was starving my brain of carbs due to being so scared of a cra**** will be a long road and they are not sure if my brain fog will ever go away! My goal is to keep my blood sugar above 90 at all times and let me tell you it is next to impossible! I see her again in4 weeks to see if I need added meds or dosage increase. Worst part of acarbose is the gas...I get it so bad it wakes me up at night from being so painful! If you want to see Dr Patti you have to get a referal fromyour PCP or endocrinologist. Most endo Dr's do not know how to properly treat this type of diabetes so seeing someone who does is key. This is a life threatning problem and very scary for me. I know have to carry a glucagon emergency kit and wear a med alert bracelet....I'm doing what I need to do to get better, I have way too much to live for!

I am glad you saw Dr. Patti. A number of endocrinologists around the country seem very intrigued by our illness. How much Acarbose are you taking? I just started it on Monday at 25mg per meal, to increase to 50 mg per meal in a week and 75 mg per meal the third week. That is to mitigate gastrointestinal distress. I hope it works. I have been starving myself of carbs too. I hope your brain fog gets better; my endo says the nerves in the brain can repair themselves overtime. At least that's how I interpret what she told me. Did she mention a takedown? My plan is to see how well meds work before attempting surgery. I don't like the idea of being on meds at each meal for the rest of my life because I am afraid of what would happen if I didn't have health insurance and couldn't afford my medicine. On the other hand, what new problems might come up with a takedown. I am not to afraid of weight regain as I have learned so much discipline following this low, low carb diet. I bet you have to be hyper disciplined too. Is it hard for you?

 I started at 25mg 15 minutes before each meal for three days and I am currently on 50mg each meal. I am having gastro issues but rather that than the crashing blood sugars. Hopefully I will adjust soon. It wakes me up at night. Surgery will only be talked about if medications don't work and that is the only way insurance will cover surgery. What is a takedown? I've heard of Dr Patti sectioning the pancreas. This cuts down on hyperactivity of insulin production. She has found that people who have had gastric bypass tend to have small cyst like sectios that produce extra insulin. I was actually on insulin injections for 4 months. My origional endo Dr said it would replace my pancreas from even kicking in thus reducing the over reaction. It worked during my pregnancy but after I had her in July it didn't work the same. The only reason I was diagnosed was because I was having what they thought were low blood sugars. A1C was 5.2 and fasting blood sugar was 72. I knew something wasn't right so I borrowed my mom's meter for a week. As soon as I showed it to my OBGYN she sent me to endo. My vision is horrible in my left eye due to corneal edema cause from rapid sugar flucuation. I'm lucky I work for eye Dr.s that will see me even though I am not working right now due to all these issues! Good thing about the acarbose is it isn't horribably expensive. $83.99 out of pocket per month....I don't want to regain weight as that can cause even more health problems!

Lauren, a takedown is the surgeon's term for a "reversal", since they can't actually reverse the RNY. Somehow the surgeon connects the pouch back to the old stomach and your digestive route goes back to using the pylorix and the previously bypasses portion of the small intestine. My surgeon said she would make the stomach an hourglass shape so I could have the sensation of fullness. I am thinkg that with the improved eating habits and all the discipline people like you and I have to practice with regard to what we eat, that we could avoid very much wait regain. But, I am afraid of regain too. I have read about the pancreatectomy, but very much hope meds work, rather than have any surgery. Glad to hear acarbose is $83.99; not as bad as some drugs that cost hundreds without insurance. I am afraid of being without insurance someday and not being able to buy the medicine I need!

How many carbs per meal can you eat now? Is it scary for you to up your carb intake? I am afraid to do it. I wore a glucose monitor all week last week and my doctor encouraged me to eat more complex carbs combined with protein and I did that for a number of meals throughout the week. It will be interesting to see the results from the monitor.

I can be obsessive about counting carbs and use a scale and Spark People website to put in recipes and see what the carb count is. I also have an app on my phone for counting carbs. I was surprixed that with a very dry meal I could eat maybe 15 carbs. I found that a spinach casserole made with cottage cheese, swiss, eggs and spinach and 1/3 slice of sprouted whole grain toast didn't provoke a swing. I was shocked. I tested myself with finger *****s before and 15 mins, 30 mins, 1hour and 2 hours after meals like that to see what my sugar did. However, this week I find myself afraid again to push the carbs and plan on waiting until I am on the full dose of Acarbose before going up as high as 15 carbs again. What are you eating?

Sorry about those gastro issues. It seems like the remedy for one thing causes a problem for something else.

 I eat about 15 carbs and still get a spike of about 180. I want it to get to as close to 120 as possible. I was able to do that on insulin. With a spike of 180 I get a low in the 60's and any spike higher than that can send me into the 30's and 20's. Lowest I have gone is 10 which usually results in coma, seizure or death. I now carry a glucagon emergency kit and ordered a medical alert bracelet. Before acarbose I would spkine ovr 200 with about anythng I ate. So it is working. I tend to eat alot of homemade hummus (I don't like the bitter flavor of store bought, and I can add alot of olive oil for the fat)...high fat proteins that slow down the uptake of carbs. Peanut butter and whole grain crackers. I find Arnold Deli thins are ok as long as I eat a good dose of protein with it, it doesn't spike too high. Tuna and Egg salad are good for me. They told me to stay away from Low Fat products. We need the fat to slow things down. Hummus and carrots is one of my favorite snacks. They suggested I eat berries because they don't spike BS's as much. As well as an apple with peanut butter. Their are these extend bars that are sold at Walgreens. They are kinda sweet for my taste and not that good, but they get me through the night without crashing. I think I might have had a seizure in my sleep a few nights before starting the acarbose. I woke up in the am with huge gashes I bit into my cheeks on both sides. There is a bread they mentioned to me that I wasnt to find ...its made out of bean sprouts. They suggested real unmilled cooked oats with almonds...but I'm a maple syrup or brown sugar on Oats fan. I can't do plain...I tried. Butternut squash fares ok with me. I check the glycemic index for low value veggies. Carbs I stick to whole grains...Oh and DREAMFIELDs pasta has been a gret trick...it works for me but doesn't for everybody. I make a pasta with sauteed spinach chicken and roasted garlic that is delishous. I use alot of roasted grlic. it is very healthy and can reduce blood sugar levels. I buy the huge container of peeled garlic cloves at Sams Club and use a 13 x 9 pan to roast it in olive oil for 1 1/2 hours on 300 degrees. I blend it into a paste and freeze it in ice cube trays...when its frozen you can take it out and put it in ziplock bags. I obsess with carbs and checking my blood sugars.