What's on your Tuesday Menu, RNYers?

Hello Menu Gang! Doing ok, still exhausted. I forgot how tired I feel recovering from surgery. You would think I would be a pro at this by now. Oh well... I made it work again and am getting through. Last night I fell into bed as soon as I got home so that is my plan tonight as well.

I ate an unplanned snack last night of peanut butter and fruit jam on toast because I had a nasty blood sugar crash. My Guy is diabetic and so when I felt 'super weird, shaky, heart racing and sweaty' I got him to check my blood sugar...sure enough it was 52. I've never been diabetic or had an blood sugar issues before so I am definitely going to be talking to my doctor when I see him next week. This is the second episode I've had like this where my blood sugar was very low. The first time I went to the ER thinking I was having a heart attack and they tested my blood sugar and found it was 47. This time I was able to figure out that it was the BS and eat something. It was better within 20 minutes or so.

The first time I hadn't eaten anything special, just typical protein first type dinner. This time, I had eaten a home made sugar free pudding about 30 hour before that which has about 12g of sugar, 26 carbs. I wouldn't think that was enough sugar to set off a Reactive Hypoglycemia (RH) episode. Do carbs trigger RH in some folks? I have been making these sugar free pudding things for a few weeks now and having them in the evening sometimes and haven't had any reaction previously. Trying to figure out what is tipping that scale for me seems to be stumping me. Suggestions? Man, the literature on RH is sparse and the doctors all seem to think it isn't a real thing. Even at the ER when I suggested that might be what was causing the low blood sugar the doctor looked at me like I was nuts and waved that off.

QOTD: This morning my son talked me into stopping at the brand new Chik-fil-A that just opened in our little town. He had 2 coupons for free breakfast sandwiches. Oh man...how I wanted one!!!!! I resisted though and made it through without even a bite.

Menu: Greek yogurt with granola and strawberries; L: Instant Pot Chicken tortellini soup; D: Shrimp with ****tail sauce and pico de gallo; S: No sugar added vanilla ice cream; ES: 2 ozs cheese and celery

Accountability: Feel good. No smoking.

I have RH now and can feel when my blood sugar drops too low. It is 100% a real thing. Unfortunately, it doesn't only happen for me when I eat off plan (high carb/sugar) so it's hard to plan. However, the SF pudding you had would do it for me. Maybe have a bit more protein with it to be more in balance??? I know when I have RH, it hits about 1-1.5 hours after I eat. I start to feel fuzzy, my hands shake and I get hot from the inside right before I start to sweat rivers. When I start to feel like that, I know I have to eat something, stat! Last time it happened, I was driving and luckily my mother was in the car AND I had food with me. It would have been incredibly scary if it happened when I was driving by myself. We were meeting friends for dinner and I had to stop and buy a new shirt because it was soaked through.

I agree that this time it must have been that SF pudding. I'm taking that off my list. The frustrating part is that it isn't consistent and sometimes it is something weird I eat while other times it seems to come out of the blue. I am going to carry a notebook and jot down every time I feel weird and make notes about what happened right before, what I ate, the whole thing to see if I can find any patterns. I can't stand the idea of using my Guy's testing supplies up because he needs them so I am going to ask my doctor if he will write me a prescription for testing supplies. If I can chart the blood sugars with the intake and activities maybe I can get somewhere. Why is it that the doctors seem to think this is bunk? Did you get your doctor to help you? If so, what was the thing that helped get the doctor to really listen?

~E

It's not consistent at all, which is the most frustrating part. Ok, so I dump right? I went to a basketball game with a friend of mine, and she bought a package of redvines. We sat and watched the game and I ate LICORICE (WTF???) That should have pushed me over the edge, right? Nothing. No reaction whatsoever. That's what makes it maddening.

I'm very fortunate that I have Doctors who listen to me and never brush me off. When I first complained about my dumping/RH my surgeon did the following:

1. Made me meet with his dietitian who gave me ideas regarding food pairings to try and minimize my symptoms
2. Made me keep a food log where I had to log my food, my heart rate before eating, and again after eating beginning at 20 minutes post, every 10 minutes to 60 minutes post. He also made me check my blood sugar before a meal and then 20 minutes post and every 20 minutes for 2 hours. This was done with a high protein meal and a meal higher in carbs than I normally would eat
3. Once that test was done, he referred me to an endocrinologist (who happens to specialize in dumping syndrome/RH) She had me fitted with a continuous glucose monitor that sampled my blood every 5 minutes and charted my highs and lows. I had to keep a food log and also test after eating a carb heavy meal (pasta) both with exercise and without exercise. She asked me to test my blood whenever I felt symptomatic (either with dumping or RH) and that test conclusively proved the existence of RH. I had many lows that were down in the 40-50 range. When I'm symptomatic, I eat something that has a mixture of carbs and protein. Cheese and cracker, a kind bar, etc. and I can feel myself getting better. My symptoms tend to resolve in 20-30 minutes.

The thing to me that is scary, is since my reactions don't always correlate to food, it's hard to know when its going to happen. The continuous glucose monitoring showed that I was having lows when I was sleeping, which is not good, since you're unaware that it's happening. I now have to eat a snack before bed to keep my blood sugars steady while I sleep

I'm so sorry that your doctors are brushing you off. It is a very real thing and miserable. Not really serious, but want to come to LA and see my Doctors??? At least they'd listen to you!

Thank you for the info. I am going to meet with my doctor next week and now feel like I have a fair amount of info and questions based on your experiences. I will let you know how it goes!

Everything Stacy said! When I talked to my surgeon about it he recommended that (after avoiding it by not eating things that cause it for me-which are simple carbs****ep something like Ritz crackers and peanut butter on hand (or those little cheese and cracker packs) and eat a few together. In his opinion it's a good balance of carb/protein/sugar to bring things back into balance. He said if I have juice or tablets like diabetics are recommended to do it could end up being a vicious cycle of high/low sugar.

I feel exactly the way Stacy describes when RH hits. I get hotter than the inside of a sauna.

Lots of things can cause it. Liquid sugar, like ice cream, is a killer. I can't touch the stuff anymore.

Sugar and simple carbs are next. Basically, anything a diabetic should avoid. When I was diabetic, bread would spike my bloodsugar more than candy. So bread, pasta, crackers, bananas, etc are bad.

Stacy gets RH from just protein, but that's pretty rare.

Reactive hyploglycemia is different from regular hypoglycemia. With regular hypoglycemia, it's usually because you haven't eaten in a long while, and your blood sugar crashes. With RH you HAVE eaten, which causes blood sugar to briefly spike. Your body produces too much insulin, and your blood sugar drops like a rock.

For hypoglycemia, you eat sugar to raise your blood sugar. Candy, orange juice, etc. DO NOT do that with RH low blood sugar. If you do, your blood sugar will spike. You will then produce too much insulin, and your blood sugar will plummet. More RH. You will be on that roller coaster all day.

Simple carbs raise blood sugar and insulin. Lean protein only will not raise blood sugar, but will increase insulin response. Not usually enough to cause a blood sugar crash, but in people like Stacy, it can. Fats raise neither blood sugar or insulin, and shouldn't give you RH.

A mix of protein and fats will usually keep RH away for the vast majority of us. If you have an episode, a mix of carb, protein and fats will get you back on track without causing another episode.

A note about our A1C after WLS. A1C measures our average blood sugar over about the last 90 days. It uses red cells to do this, and red cells have a life span of about 90 days. So taking your blood sugar right now tells you the reading this moment, while A1C is a 90 day average.

An A1C of 5 is an average of 97. Very good number. One person can have an A1C of 5, and their blood sugar might have spiked at 120 after eating, and drop to 70 by sunrise. So an average of 97. Really good.

Another person getting RH a lot also has an A1C of 5. Good, right? But their blood sugar shoots up to 190 for a while after eating simple carbs, then plummets to 45 when RH hits. They do this roller coaster a lot. But their 90 day average still turns out to be an identical 97.

Obviously, person 1 has a healthier blood sugar, will have fewer health issues, and much less chance of diabetes rearing it's head down the line. So beware of a good A1C number if you are having other issues.

Thank you Grim! Will try more fats, less carbs. I hear you knocking on my no sugar added ice cream evening snack... damn I knew it wouldn't go unnoticed! LOL I can't tolerate any kind of real ice cream but this stuff is almost not terrible. :) I will cut it and see if that helps. Well...let's be honest...I will cut it once the container is gone. I think the best snack is always going to be meat...bacon strips or roast beef or something. I just get so tired of it. I do hate feeling sweaty miserable shaky though so I gotta do something different like it or no.

~E

And on the bright side, I now know what it will feel like when I have hot flashes!!

You and me both, sister.