Hypoglycemia

I am on a fact finding mission for my wife. She had a duodenal switch quite some time ago now, and about a year back had a revision. She is suffering from - what I think is` called - reactive hypoglycemia. She is saying it used to be triggered from sugar, but now she seems to get low blood sugar no matter what she eats. Does anybody know what might be causing this condition, and if there is any way to control it?

She has been close to passing out quite a few times. Very worrying.

Thank you,

Steve

Sorry she's experiencing this but I have a few questions.

What type of revision did she have? What do her doctors say (assuming she's seen a doctor about this)? Does she get her sugar checked regularly? Is her sugar normally low? That could be the issue.

Janet,

She had her common channel lengthened from 80cm to 280cm. That was the only change. Normally her sugar level is within normal range, but she said that recently it just plummets for no apparent reason.

Her surgeon said she might have to be referred to an endocrinologist

Steve

Hi Steve,

was your wife diabetic before her DS? I've heard of hypoglycemia being an issue more with people who had diabetes post DS. But your wife's situation seems different, as this didn't show up until the cc was lengthened.

Could I ask the reason for the common channel being lengthened?

With a longer common channel, generally A1C tends to rise due to the greater absorption of carbohydrates. However, i could also see a change from carbs absorbing in a much smaller part of the intestine to well over twice the area, with more carbs being absorbed than before causing BG to rise more rapidly, resulting in the pancreas producing more (too much in this case) insulin leading to lows. This is just a theory, from my t2 perspective. Veterans would know much better than me.

I'd suggest getting a meter and doing pre and post prandial testing to see what specifically triggers these episodes. A poster had hypoglycemia post DS, and they had a CGM to record BG. That was helpful in their case. It may help to eat smaller meals several times a day, high on protein and fat as DS eating goes and reduced carbs. That may help stabilize BG while you're waiting to see an endo.

I hope the endo is able to figure this out asap. I can imagine it being very stressful for her and you.

p.s. reactive hypoglycemia isn't just caused by sugars but high carb meals in general. so she will need to cut back on carbs overall not just sugar. as for protein and fats, the latter doesn't cause BG to rise and the former causes it to rise very slowly. so protein and fat heavy meals with low carbs are unlikely to cause hypos. in fact, they're generally what's recommended for people with reactive hypoglycemia.

Ankarew,

My wife was not diabetic before her original surgery. Her common channel was lengthened due to malabsorption. My wife checked her blood sugar this morning at 7am, her last meal was 10pm last night. The reading was 82 mg/dl. We have been thinking along the lines of concentrating on protein more and eating smaller meals more frequently, and maybe carrying something like glucose tablets in her bag for emergencies.

Thanks,

Steve

Hi Steve,

The fasting of 82 is great. But do check before and after meals (after 1, 2 and 3 hours). She'll need to discover her safe limit. She may, for example, be fine with 20 grams of carbs in a meal and 40 grams may cause a reactive low. Small high fat, high protein, low carb meals several times a day is a good rule of thumb.

The glucose tablets for emergencies is a good idea. I'd also suggest checking her BG when she feels a low coming on. Eat something with protein, like peanut butter crackers. That'll prevent another low a few hours later.

You're most welcome. Please keep us posted.

p.s. there's more info on this thread:

https://www.obesityhelp.com/forums/ds/4628761/Hypoglycemia-p ost-DS/

Steve - Clearly with the lengthening of her CC, everything has changed. You're getting some good information but your wife needs an endocrinologist to find out what's wrong. Hope you get some answers.

Sorry to hear your wife is having problems. Please go to "search this forum" at the top of the page. And type in reactive hypoglycemia, I did see others having the same issue. Good luck!

I am sorry your wife is dealing with that. I had RNY and I am the unfortunate person who is well aware about low BS. I wasn't diabetic before my WLS.

As I got very close to my goal weight, and stayed there my RH (Reactive Hypoglycemia) got much worse. Low body fat % meant low reserve my body could use for energy.

What buffled me most - was that I would get RH after almost any meal, and even after lean protein shakes. Someone mentioned the "food insuIin index". Google that and you and your wife may need to read as much as you can find.

In simple terms, my body release insuIin to process most foods like carbs and protein. And when my before meal BS was normal, and I ate very low carb protein meal, my body would release insuIin, driving my BS low. With no carbs in the meal, and low body fat %, low cholesterol, my system couldn't cope and my BS would drop significantly. I would crash after almost every meal.

I had to modify what and how much I was eating. Fast digestive and fast absorbed proteins, like proteins shakes, or eggs, would be the worst for me. I had to experiment with my food and see what works and what did make me crash. I now add some none starchy and starchy veggies to most my meals and I add fat. Things like avocado, nuts, nut butters are complex enough for my body to process. When I get just proteins - I get 1-2 hard candies I can pop into my mouth to get 4-8 great of simple slow sugar absorbtion from my mouth. Ideal - no, but it keeps me from crashing, and allow me to keep my goal, or even lose some regain. Crazy...I know , my friends are telling me I am the only person they know that can lose weight while eating hard candies.

I had a seizure from reactive hypoglycemia, starting about 4 years out from my duodenal switch. I was hospitalized and given the full evaluation, which identified an hour after every meal and 2 am as my most vulnerable times. A nutritionist gave me this advice and it has worked. Never eat carbohydrate without protein and never eat more carbohydrate than protein. Concentrate on at least 5 much smaller meals and eat every 2-3 hours. If you feel symptoms after a meal, eat a small amount of sugar, like a hard candy (believe it or not, candy was a prescription, but just one.) Alcohol causes it about an hour after taking a drink. I eat at 7am, 11 am, 1:30 pm, 4:30 pm, 7pm, with a small snack at bedtime, like cheese and a single cracker. A meal of pure protein doesn't cause hypoglycemia for me, but everyone is different. I wake up at 2 am and have half a peanut butter and jelly sandwich on whole grain bread. I haven't gained weight on this schedule but my meals are as much as a toddler would eat. I am not hungry. I always carry a KIND bar in my bag and have a few hard candies for emergencies. You can research postprandial hyperinsulinemic hypoglycemia. I was offered a drug, acarbose, but turned it down after I read about it. Pre-op I had one episode of pancreatitis, gallbladder surgery, and mild noninsulin dependent diabetes of about 4 years duration, treated with metformin. Good luck to her and you are right to be concerned. It is highly treatable in my case, with following the diet rules and I haven't had another seizure from it. My husband has learned that when I say "I have to eat" it doesn't just mean that I am hungry. When I HAVE to eat, I can feel the hypoglycemia coming on. Take care.