Reactive Hypoglycemia

I had my one year check up yesterday.  I talked to my doctor and my dietitian about the hypoglycemia I have been dealing with.  Usually it doesn't start until 18 months in, but I developed it early.  When it got bad, I went to my regular doctor.  She told me 6 small meals with complex carbohydrate in each.  She actually used the words, "Peanut butter crackers."  I stopped losing weight, but I didn't gain.

Yesterday, my surgeon and dietitian gave me very different advice.  Four or 5 small meals, preferably four.  Yes, complex carbs, but in the form of non-starchy veggies and no more than 2 small fruit servings a day.  I had added in whole grains and sweet potatoes, which they told me was making the problem worse.

I'm writing this to say:  If you start having hypoglycemia, go see your bariatric team.  They know what will work for YOUR body post surgery.

I'm thankful I haven't gained.  And my surgeon said my surgery is successful because I've lost more than 50% of excess weight.  But he wants another 25-30 pounds off.  (And so do I).  Hopefully I'm now going to be able to control the blood sugars and get back to losing.

I know a lot of you have NEVER added back any carbs other than a bit of fruit and veggies.  I wish I hadn't either.  I got so much conflicting advice I wasn't sure what to do.  And let's face it, when your doctor says, "Eat more carbs," that's advice you WANT to follow.  So anyway, back to basics for me.  I hope when someone else has hypoglycemia, this post can help.

There is a difference between hypoglycemia (H) and reactive hypoglycemia (RH).   I have both. 

You get reactive hypoglycemia app 1-2 hr after eating either carbs or lean proteins...  It was a huge surprise to me to get RH after eating lean protein only meal - i.e. 2 HB eggs,  or water based protein shake.. 

as I found out - the body releases insulin when we eat proteins. So if our body reserves of sugars are low - or we make too much insulin in response to any foods - our BS will drop... 

Hypoglycemia can be a result of either too high fasting insulin or .. adrenal issues.. - body needs cortisol to bring BS up - so if you don't make enough - you may crash. 

Since i deal with both...(yeay me !!!- sarcastic). I learned to manage that... To prevent RH - I eat moderate proteins and fats with some carbs at almost every meal. (non starchy carbs). To avoid middle of teh night hypoglycemia - I eat just before bed... typically high nuts like almonds, brazil, walnuts.. Not a lot - but a good serving. 

I Keep NSA (no sugar added) nut butter  by my bed, in my purse,and I used it often (no crackers) to bring my BS up. Sometimes as little as 2 tsp of PB will be enough to prevent low BS. 

I buy individually packed almond or PB (check health food store for Justin brand) That not only does not spoil - but it is really portable...

Nuts have a lot of calories... so make sure you use them as needed... but not too much...

Any alcohol make my BS issue really icky... I have to make sure I monitor taht very well. Alcohl block some enzymes - and even a small glass of wine may make me crash...  

Hi Hala,

It has been a few days since this OP and your response, but if you see this, I would appreciate more information on the RH.  Can you direct me to some good links that have helped you understand and manage it?  I was really happy to read your post, and to see that RH can be from lean protein as well as carbs.  I keep having what I would call mini crashes after eating even my protein meals.  I feel great when I don't eat, energy wise.  Then I eat, and even after lean proteins, I will sometimes feel overcome with sleepiness and fatigue, often about an hour or two after eating. I have noticed this a lot more in the past month or two (I am 11.5 months mos post-RNY).  I have chalked it up to lack of sleep, but it really seems more timed to my eating.

I was also at my doctor's office for a UTI the other day.  When they did the urine test, they said I had dumped a lot of glucose in the urine.  (Sorry if TMI words, but we are friends let friends say urine, right?)  I have never had diabetes or pre-diabetes, even pre-op.  They did a finger ***** test, and that was all normal.  But I was left wondering, why was my body dumping sugars in my urine, and what did that mean?  The doctor just said that some people do that, which I accepted at face value.  But then I started wondering.

xoxo

I would be happy to help you. It took me a while to understand what is going on.. that's why I try to stay on here to help others... I know how frustrated I was when I tried to be doing all the right things and still ended up with low blood sugars...

When we do low carbs - we deplete glycogen stores - in muscles and in the liver.  So when we try to eat just lean proteins - the body process that - and some proteins will cause more or less insulin release... if a meal does not have any carbs - i.e. lean water based whey protein shake, or egg whites, or scrambled eggs, etc - he body will use the proteins and the insulin will cause the BS to drop. 

now - there was tudy that show that post op RNY we could dump a lot of insulin - as much as 20x or a normal person in response to food - not even carbs only... that would make a person extra sleepy.. as far as I know the insulin storm , not just the carbs makes a person tired/sleepy after a meal.  And if your body does not have enough glycogen (stored sugar) the low blood sugar would follow... in a way -" darn you do - darn you don't... " very low carb diet.. 

Also - consuming too many proteins in any given time - without adding fat or carbs may cause imbalances. Our body learn to turn proteins into glucose... (a person can have high blood sugar on a very low carb diet - if the diet is very high in proteins. 

to balance that- a lot of people turn into keto style diet when they balance proteins with fat...Fat - doesn't cause insulin response...

i.e. ideal meal would be no more than 10-20 gr of proteins, with 20 + gr of fat and no more than 5-10 gr of carbs mostly from non starchy sources.. ( low sugar) 4 melas - 300 cal each... 15gr of protein average..per meal.. 

15 gr of proteins= 60 cal

5 gr of carbs= 20 cal

300-80=240 cal = 25 gr of fat.. 

4 meals =1200 cal.. 

if the past I tried to get more proteins and felt worse... now I add more fat and more "real food" (no more shakes unless I have a really bad day_)  But doing that improved my blood protein levels.. from 6.2 to over 7.. and my blood sugar is much better... adding some fat (i.e. 2 tsp of coconut ioil to my lean chicken) makes things better... 

protein insulin response

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&e spv=2&ie=UTF-8#q=protein+insulin+response

http://thepaleodiet.com/whey-protein-and-its-effect-on-insul in/#.VnRUKflVhBc

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&e spv=2&ie=UTF-8#q=whey+protein+insulin+study

http://thepaleodiet.com/paleo-diet-q-a-whey-protein/#.VnRUx_lVhBc

http://ajcn.nutrition.org/content/82/1/69.full

http://www.nutrientdataconf.org/pastconf/ndbc35/4-2_sampson. pdf

http://ses.library.usyd.edu.au/bitstream/2123/11945/2/Bell_K J_thesis_2.pdf

https://www.google.com/webhp?sourceid=chrome-instant&ion=1&e spv=2&ie=UTF-8#q=food%20insulin%20index%20database

I can give you more... lol.. 

Thank you for continuing to share.

I having severe symptoms and this stuff is gold.