RNY reversal and revision to the Sleeve

Hi. I too suffer from reactive hypoglycemia (reactive to carbs), which is entirely different than dumping.  My normal blood sugar is around 80-90.  Anything in the low 70's and I would start to feel hypoglycemic symptoms.  It has gotten into the 40's/50's. 

I am 12 years post-op and the hypoglycemia started about 6-7 years after the surgery.  (I have read that that is typical.). It started slowly at first; my blood sugar would drop after eating something sweet.  But it progressed to where I couldn't eat a couple slices of an apple even with protein and fiber.

The only way I could keep my blood sugar stable was to cut out almost all carbohydrates.  I stopped eating grains, potatoes, sugar, and most fruit.  My diet became mostly protein, vegetables, nuts, and some berries.  I even stopped drinking milk and switched to almond milk.  I began to eat full-fat everything.  I lost 30 pounds too.  :)

I have done quite a bit of reading on the reactive hypoglycemia after the RNY.  Doctors have not been able to find a clear cause for this.  Those who have had a partial pancreactomy have not always "cured" their hypoglycemia.  I saw a recent study where doctors isolated a hormone in the gut as a likely cause.  They were able to address the hormone issue (don't remember how) and the people in the study stopped having hypoglycemia.  The pancreas, a gut hormone, and other things have all been discussed as potential causes.

My opinion is that since there is no certainty that your surgeries will fix it, that you should investigate as much as possible to decide if that is really what you want.  Have you tried giving up all carbs?  If not, try it. I initially looked for dietary guidance in the Wheat Belly book.  Can't think of the cardiologist's name who wrote it, but if you go to the book's website the author posted a letter I wrote to him about how it stopped my hypoglycemic attacks.

Certainly let me know if there are further questions about my experiences.  It is miserable to have low blood sugar. 

I am getting high blood sugar after eating carbs.  Is that dumping?  I bought a glucose monitor because I thought it was hypoglycemia but I've never gone low just feel super weird when it gets over 200. 

For me dumping is rapid heart beat, pain in the chest and arms, sometimes nausea, dizziness or diarrhea and blood sugar of over 200.

That is what I have except no diarrhea. Here I thought I wasn't experiencing dumping.

Actually I have had the same thing happen.  For a short period I was having reactive hypoglycemia episodes so I got to where I was monitoring my blood sugar throughout the day.

I found that it would go over 200 after I ate and then a while later it would be normal.

I brought this up to my doctor's office and was told it was normal for your blood sugar to get high after eating.  The problem is when it drops to a very low level afterwards.

If you aren't experiencing symptoms I wouldn't worry about it but see what your doctor says.

And Laura is right about this surgery. It is a complicated procedure and rarely done.  There is a good chance that you are going to be your surgeon's first. 

I don't get the sense that you really understand what the surgery is supposed to do.  I don't - because I thought that the RYN was better for curing diabetes than the sleeve was.  I have never heard of a RYN to sleeve procedure (although I could theorize that if someone had ulcers then cutting out that blind stomach could help).  Several people I know ended up with RYN rather than the sleeve because of complications during surgery.

You're in charge of your body.  Make sure you really understand what is happening.

I would be looking for a second opinion - probably from another endocrinologist (not a surgeon) who specializes with bariatric patients and can really tell if this surgery is best for you. (or the DS or just diet/meds)

There are 3 endocrinologists in NY that are listed here on the OH website.  Check out their reviews.  (Up at the top left where is says: Find a (click to see drop down menu with other types of doctors listed)

I dealt with hypoglycemia and reactice hypoglycemia post op RNY.  I mention both, because they are very different issues. 

I wrote -"  dealt" past tense because now I only deal with RH if I eat too many carbs, or carbs by itself... (very rarely)

I found a great endocrinologist that dignosed me with secondary adrenal insufficiency. SAI. Blood sugar is regulated by hormons - including cortisone. If the body does not make enough - side effect can be hypoglycemia.  We need cortisone to convert proteins and stored glycogen into blood sugar. 

If the body does not produce enough cortisol - not only BS will be affected, but also blood pressure, energy levels, allergies..etc etc... 

My body makes some cortisone but not enough... When the doc put me on a cortisone replacement dosage of steroids - now I can function and have semi normal life.  

We are not sure why my pituitary stoped working very well... But they did.  Now I take daily steroids to help my body. I have a chance to recover.  I take total of 20-25 mg Hydrocortisone (or equivalent) in 3-4 divided dosages per day. 

I do hope your endo verified it is not your issues...not enough cortisol.. Not many docs are really good to verify that.  

When I went to my doc - we wanted to find out if my low blood sugars were due to high insulin level or low cortisone level. 

I get RH - reactive hypoglycemia, when my body release way too much insulin as a response to carbs, but as long as I limit that -and follow a very good higher fat diet (moderate proteins, low carbs) I have no problem maintaining my BS. 

Only you and you doc know what tests were run and what were the results. 

My doc run ITT - insulin tolerance test to determine my body response to hypoglycemia. 

Before my diagnosis, and treatment - my BS could drop below 40's before I would even notice things are not OK... I had a few blackouts initially before I realized what was going on... Having BS in 30's was rather common for me... I had to keep glucose tablets and nut butter by me all the time.  What worse - during my very low BS episodes- I had to force myself to eat or drink anything... 

Make sure they know what they are doing and why... 

I feel like I could learn a lot from you.. Cause every time I search a problem you've already gone thru it.. 

My endo just did a full panel to figure out why my bs is dropping 30-60ish minutes after every meal and she told me my bs levels were normal and that I shouldn't be having problems according to blood test results but she did mention my cortisol was low but didn't mention anything further with it...

She said I just have very severe early and late dumping syndrome (since ANY and ALL carbs (including all grains, all  start chu veggies except raw carrots, and all fruits except strawberries and blueberries) send my bloodsugar thru the roof within 15 minutes, along with nausea/vomittinh, heart racing, then within another 15 minutes (30 minute mark) extremely low blood sugar, confusion, fogginess, muteness and sometimes I blackout.) the dr said there is no help for any of it because my blood tests are saying I'm fine. Just a modified diet..

did your body also adapt to dumping with certain foods after time even tho it was considered a safe food previously? That's super frustrating to me.. 

Well really all of my RNY health problems are super frustrating to me!! 

My body did not adapt overtime. I did. 

I avoid grains and starchty carbs. . no bread, paste, rice, beans, potatoes, etc etc. The only fruits I eat are berries. I don't eat banana, pinapples, grapes, pears, melons, etc. Etc.etc. I may have an apple once a while..(maybe every few months or so?) 

I eat non starchy veggies, (tomato is a fruit- BTW) . I eat mean and fish, eggs. I have allergy to Dailey so no milk, yogurts or cheese. I love cheese - so I may grab a slice or 2 (very seldom).

I eat higher fat nuts - like pecans, macadamia, coconut, some Brazil nuts, walnuts, lmonds..and some peanuts.. 

It is relatively restricted diet - but doable.