low blood sugar??
hi father don,
yes this was shortly after eating dinner. i had ham, small amount of mashed potatoes, winter squash, green beans, little bit of sweet potato casserole, and a slice of cranberry sauce.
i did go see a diabetic doctor she said i had reactive hypoglycemic. she really didnt tell me much so i need help. maybe i should go see my gastric bypass doctor. anita
yes this was shortly after eating dinner. i had ham, small amount of mashed potatoes, winter squash, green beans, little bit of sweet potato casserole, and a slice of cranberry sauce.
i did go see a diabetic doctor she said i had reactive hypoglycemic. she really didnt tell me much so i need help. maybe i should go see my gastric bypass doctor. anita
I'm on this road too. I routinely crash. I am only 21 months out.
One of the things that helps me is to make sure that for every bite of carb based food, I take two of protein. Yeah it means I can't eat a lot of my favorite foods, but those are the things that make my sugar drop. My dietician said that for most of us with gastric bypass, our meals need to be 1/2 to 2/3 protein.
Hopefully this is of some help to you.
One of the things that helps me is to make sure that for every bite of carb based food, I take two of protein. Yeah it means I can't eat a lot of my favorite foods, but those are the things that make my sugar drop. My dietician said that for most of us with gastric bypass, our meals need to be 1/2 to 2/3 protein.
Hopefully this is of some help to you.
the possibility of a link between the islet hyperfunction and the bypass surgery
Uncertainty about the existence of an anatomical cause of post-gastric bypass hypoglycemia (if one can discount the islet cell tumors encountered in some patients with this condition) has given voice to the argument that post-gastric bypass hypoglycemia may represent a functional problem arising in part from excessive GLP-1 secretion after meal ingestion (without necessarily leading to islet hypertrophy).
Nesidioblastosis: The treatment was partial removal of the pancreas, some trials using stomaphyx or ROSE procedure if it is thought to be related to enlarged stoma that can dump the food into gut too quickly as well.
http://www.wlscenter.com/HypoglycemiaIntro.htm
http://www.news-medical.net/news/2005/10/12/13727.aspx
Severe hypoglycemia - complication of gastric bypass surgery
12. October 2005 18:59
Physicians monitoring patients who have undergone gastric bypass surgery should be on the alert for a new, potentially dangerous hypoglycemia (low blood glucose) complication that, while rare, may require quick treatment, according to a new study by collaborating researchers at Joslin Diabetes Center, Beth Israel Deaconess Medical Center (BIDMC), and Brigham and Women's Hospital (BWH) and published in the October issue of the journal Diabetologia.
The paper follows on the heels of a Mayo Clinic report on six similar case studies published in July in the New England Journal of Medicine. About 160,000 people undergo gastric bypass surgery every year.
The study details the history of three patients, who did not have diabetes, who suffered such severe hypoglycemia following meals that they became confused and sometimes blacked out, in two cases causing automobile collisions. The immediate cause of hypoglycemia was exceptionally high levels of insulin following meals. All three patients in the collaborative study failed to respond to medication, and ultimately required partial or complete removal of the pancreas, the major source of insulin, to prevent dangerous declines in blood glucose.
"Severe hypoglycemia is a complication of gastric bypass surgery, and should be considered if the patient has symptoms such as confusion, lightheadedness, rapid heart rate, shaking, sweating, excessive hunger, bad headaches in the morning or bad nightmares," says Mary-Elizabeth Patti, M.D., Investigator in Joslin's Research Section on Cellular and Molecular Physiology and Assistant Professor of Medicine at Harvard Medical School. "If these symptoms don't respond to simple changes in diet,
such as restricting intake of simple carbohydrates, patients should be evaluated hormonally, quickly,"
she adds. Dr. Patti and Allison B. Goldfine, M.D., also an Investigator at Joslin and Assistant Professor of Medicine at Harvard Medical School, were co-investigators of the study.
http://www.meltingmama.net/wls/2009/02/severe-recurrent-hypoglycemia-after-gastric-bypass-surgery.html
DUMPING SYNDROME DEFINED, EXPLAINED, AND AVOIDABLE!
http://www.sabariatric.com/effects.php
The weight loss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Rapid gastric emptying, or dumping syndrome, happens when the lower end of the small intestine (jejunum) fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, diarrhea, and shortness of breath. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. Stomach surgery is the main cause of dumping syndrome because surgery may damage the system that controls digestion. Treatment includes changes in eating habits and medication. People who have dumping syndrome need to eat several small meals a day that are low in carbohydrates and should drink liquids between meals, not with them. It is imperative to the Roux En Y or other procedural gastric bypass patient that they follow their diet plan to reduce the risk factor of Dumping Syndrome. Many people equate the term solely to be spasmodic fits of diarrhea, when that is merely one of the symptoms of a more intensified unpleasant experience. Dumping syndrome is usually divided into "early" and "late" phases - the two phases have separate physiologic causes and shall be described separately. In practical fact, a patient usually experiences a combination of these events and there is no clear-cut division between them. Early dumping is caused by the high osmolarity of simple carbohydrates in the bowel. The various types of sugar all have small molecules, so that a gram of (for example) sucrose has MANY more molecules than a gram of protein, creating a higher concentration (number of molecules per cc) from simple sugars than from other foods. This matters because, inside the body, fluid shifts will generally go toward the higher concentration of molecules. So, if a patient consumes a bite of milk chocolate (lots of sugar), when it gets to the Roux limb it will quickly "suck" a significant amount of fluid into the bowel. This rapid filling of the small bowel causes it to be stretched (which causes cramping pain). This also causes the activation of hormonal and nerve responses that cause the heart to race (palpitations) and cause the individual to become clammy and sweaty. Vomiting or diarrhea may follow as the intestine tries to quickly rid itself of this "irritant." Late dumping has to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid absorption of a relatively small amount of sugar can cause the glucose level in the blood to "spike" upward. The pancreas responds to this glucose challenge by "cranking up" its output of insulin. Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets going. These factors combine to produce hypoglycemia (low blood sugar), which causes the individual to feel weak, sleepy, and profoundly fatigued. Late dumping is the mechanism by which sugar intake can create low blood sugar, and it is also a way for gastric bypass patients to get into a vicious cycle of eating. If the patient takes in sugar or a food that is closely related to sugar (simple carbohydrates like rice, pasta, potatoes) they will experience some degree of hypoglycemia in the hour or two after eating. The hypoglycemia stimulates appetite, and it's easy to see where that is going...The reason that sugar does not cause dumping in non-operated people is that the stomach, pancreas, and liver work together to prepare nutrients (or sugar) before they reach the small intestine for absorption. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar that can occur after a Roux En Y. The released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid all the effects outlined above. Obviously, surgeons consider dumping syndrome to be a beneficial effect of gastric bypass - it seems to be important to provide quick and reliable negative feedback for intake of the "wrong" foods. In practice, most patients do NOT experience full-blown dumping more than once or twice. Most simply say that they have "lost their taste" for sweets. Of course, this is always a great topic to ask patients about directly, so you may want to ask about it at our support group in person, or in a support group online. It is an unpleasant side effect of this surgical procedure, experiencing it means one simple thing; you are not following your prescribed diet, and unless you do, dumping syndrome is going to become a major part of your life. Do yourself, and your body a favor and follow doctor's orders, to the letter.
Uncertainty about the existence of an anatomical cause of post-gastric bypass hypoglycemia (if one can discount the islet cell tumors encountered in some patients with this condition) has given voice to the argument that post-gastric bypass hypoglycemia may represent a functional problem arising in part from excessive GLP-1 secretion after meal ingestion (without necessarily leading to islet hypertrophy).
Nesidioblastosis: The treatment was partial removal of the pancreas, some trials using stomaphyx or ROSE procedure if it is thought to be related to enlarged stoma that can dump the food into gut too quickly as well.
http://www.wlscenter.com/HypoglycemiaIntro.htm
http://www.news-medical.net/news/2005/10/12/13727.aspx
Severe hypoglycemia - complication of gastric bypass surgery
12. October 2005 18:59
Physicians monitoring patients who have undergone gastric bypass surgery should be on the alert for a new, potentially dangerous hypoglycemia (low blood glucose) complication that, while rare, may require quick treatment, according to a new study by collaborating researchers at Joslin Diabetes Center, Beth Israel Deaconess Medical Center (BIDMC), and Brigham and Women's Hospital (BWH) and published in the October issue of the journal Diabetologia.
The paper follows on the heels of a Mayo Clinic report on six similar case studies published in July in the New England Journal of Medicine. About 160,000 people undergo gastric bypass surgery every year.
The study details the history of three patients, who did not have diabetes, who suffered such severe hypoglycemia following meals that they became confused and sometimes blacked out, in two cases causing automobile collisions. The immediate cause of hypoglycemia was exceptionally high levels of insulin following meals. All three patients in the collaborative study failed to respond to medication, and ultimately required partial or complete removal of the pancreas, the major source of insulin, to prevent dangerous declines in blood glucose.
"Severe hypoglycemia is a complication of gastric bypass surgery, and should be considered if the patient has symptoms such as confusion, lightheadedness, rapid heart rate, shaking, sweating, excessive hunger, bad headaches in the morning or bad nightmares," says Mary-Elizabeth Patti, M.D., Investigator in Joslin's Research Section on Cellular and Molecular Physiology and Assistant Professor of Medicine at Harvard Medical School. "If these symptoms don't respond to simple changes in diet,
such as restricting intake of simple carbohydrates, patients should be evaluated hormonally, quickly,"
she adds. Dr. Patti and Allison B. Goldfine, M.D., also an Investigator at Joslin and Assistant Professor of Medicine at Harvard Medical School, were co-investigators of the study.
http://www.meltingmama.net/wls/2009/02/severe-recurrent-hypoglycemia-after-gastric-bypass-surgery.html
DUMPING SYNDROME DEFINED, EXPLAINED, AND AVOIDABLE!
http://www.sabariatric.com/effects.php
The weight loss that is achieved through the RNY appears to be primarily dependent upon the removal of the pyloric valve, leaving the individual without a regulator of food movement into the small intestine. This results in the well-known phenomena called "dumping syndrome" which can cause an individual to feel sick or even faint. Rapid gastric emptying, or dumping syndrome, happens when the lower end of the small intestine (jejunum) fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, diarrhea, and shortness of breath. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types. Stomach surgery is the main cause of dumping syndrome because surgery may damage the system that controls digestion. Treatment includes changes in eating habits and medication. People who have dumping syndrome need to eat several small meals a day that are low in carbohydrates and should drink liquids between meals, not with them. It is imperative to the Roux En Y or other procedural gastric bypass patient that they follow their diet plan to reduce the risk factor of Dumping Syndrome. Many people equate the term solely to be spasmodic fits of diarrhea, when that is merely one of the symptoms of a more intensified unpleasant experience. Dumping syndrome is usually divided into "early" and "late" phases - the two phases have separate physiologic causes and shall be described separately. In practical fact, a patient usually experiences a combination of these events and there is no clear-cut division between them. Early dumping is caused by the high osmolarity of simple carbohydrates in the bowel. The various types of sugar all have small molecules, so that a gram of (for example) sucrose has MANY more molecules than a gram of protein, creating a higher concentration (number of molecules per cc) from simple sugars than from other foods. This matters because, inside the body, fluid shifts will generally go toward the higher concentration of molecules. So, if a patient consumes a bite of milk chocolate (lots of sugar), when it gets to the Roux limb it will quickly "suck" a significant amount of fluid into the bowel. This rapid filling of the small bowel causes it to be stretched (which causes cramping pain). This also causes the activation of hormonal and nerve responses that cause the heart to race (palpitations) and cause the individual to become clammy and sweaty. Vomiting or diarrhea may follow as the intestine tries to quickly rid itself of this "irritant." Late dumping has to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid absorption of a relatively small amount of sugar can cause the glucose level in the blood to "spike" upward. The pancreas responds to this glucose challenge by "cranking up" its output of insulin. Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets going. These factors combine to produce hypoglycemia (low blood sugar), which causes the individual to feel weak, sleepy, and profoundly fatigued. Late dumping is the mechanism by which sugar intake can create low blood sugar, and it is also a way for gastric bypass patients to get into a vicious cycle of eating. If the patient takes in sugar or a food that is closely related to sugar (simple carbohydrates like rice, pasta, potatoes) they will experience some degree of hypoglycemia in the hour or two after eating. The hypoglycemia stimulates appetite, and it's easy to see where that is going...The reason that sugar does not cause dumping in non-operated people is that the stomach, pancreas, and liver work together to prepare nutrients (or sugar) before they reach the small intestine for absorption. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar that can occur after a Roux En Y. The released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid all the effects outlined above. Obviously, surgeons consider dumping syndrome to be a beneficial effect of gastric bypass - it seems to be important to provide quick and reliable negative feedback for intake of the "wrong" foods. In practice, most patients do NOT experience full-blown dumping more than once or twice. Most simply say that they have "lost their taste" for sweets. Of course, this is always a great topic to ask patients about directly, so you may want to ask about it at our support group in person, or in a support group online. It is an unpleasant side effect of this surgical procedure, experiencing it means one simple thing; you are not following your prescribed diet, and unless you do, dumping syndrome is going to become a major part of your life. Do yourself, and your body a favor and follow doctor's orders, to the letter.
Take Care, 
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Clinical Nutritionist.Registered dietician familoiar with diabetes and RNY would be good start. It is all the carbs you ate that caused this (tatoes, squash, cranberry sauce, sweet potatoe casserole) evenham if had a coating of sugar or honey or such!
Anita if I recall you have been challenged with postop eating for many years, have you sought support in form of nutritionist? Therapist?> your surgeon? Support group?
Beyond reactive hypoglycemia this could be good old DUMPING! In rare cases Reactive hypoglycemia can lead to nesidioblastosis....that is why seekign proper medical care is of utmost importance for your wellbeing. Keep us posted.
Anita if I recall you have been challenged with postop eating for many years, have you sought support in form of nutritionist? Therapist?> your surgeon? Support group?
Beyond reactive hypoglycemia this could be good old DUMPING! In rare cases Reactive hypoglycemia can lead to nesidioblastosis....that is why seekign proper medical care is of utmost importance for your wellbeing. Keep us posted.
Take Care,
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Most Active
Recent Topics
