26 months post op and suffering severe hypoglycemia----

Maggie, the bariatric community is finding more and more post-ops dealing with the reactive hypoglycemia. It is similar to dumping but happens usually a couple of hours after eating vs. 10 or so minutes that normal dumping shows up. Eating more smaller meals per day does help. What are you eating? I find to many carbs cause me the problem and only a couple of foods being the real culprit, of all things oatmeal causes me lots of problems. I always keep a pack of peanut butter crackers with me. When it hits, I grab 2-3 crackers and it levels my sugar out pretty quick. I've heard others say they drink orange juice. Eating chocolate or something real high in sugar will bring the bloods sugars up quickly but will only cause an additional crash soon. Eating protein with a carb is the best route. Sorry you are having such extreme hypoglycemia episodes, hope you can get a handle on it soon. Dana

The Physiology of Dumping Syndrome Dumping syndrome is usually divided into "early" and "late" phases - the two phases have separate physiologic causes and will 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.

All of this information has been very very helpful. I have found that zone oerfect bars eaten between my regular meals have been a godsend. I have also been working with different combinations of food that seem to be working fairly well. I have found that peanut butter, banana, drizzle of honey and some cinnamon wrapped in a small flour tortillia keeps me on a pretty even level as well. I will be contacting my doctors and sending them all of the info I have gotten on these boards. You are all angels and I appreciate everything you have all said. Like I have said before I do not want any one else to suffer but I am glad I am not alone. I was feeling so very frustrated. I have even broke down into tears in my docs office. I have seen my Endocronologist about this (I am a thyroid cancer survivor so I already had one) He seems to be a bit more helpful, however I don't agree with his course of treatment. So I will continue to play with food combinations and watch the boards for more helpful information. You all have no idea how helpful you have been. I AM NOT GOING NUTSO!!!!! I AM NOT ALONE!!!!! I would hug each and every one of you in person if I could. hugs, Maggie

Thank you, Willow, for your very detailed replay. I have Type 2 diabetes, but the answer applies to this also. Marilyn

I find it alarming that your gastric bypass surgeon is not aware of or has never heard of a very common after effect of gastric bypass surgery. http://www.emedicine.com/med/topic589.htm http://www.ajcn.org/cgi/reprint/32/10/2104 if you are having reactive hypoglycemia you are in fact dumping whether you realize it or not.

Actually becoming hypoglycemic after wls is rather common. Most doctors suggest eating small quantities 6 times a day to control the problem. I've only had a couple of episodes, but for me it comes in the form of being light headed as though I might be going to pass out. A couple of bites of almost anything will make me feel fine within minutes. In the old days they suggested coke, candy, etc. Now days the medical profession tends to recommend a couple of cheese crackers, peanut butter crackers, an apple, etc. These things don't raise the blood suger as fast, but neither do they lead to a drastic drop of blood sugar which will lead to another episode. Eating small quantities six times a day resolved my problems. A snack for me might be 12 almonds or a small apple. Doesn't add a lot of calories but keeps the blood sugar level. Best of luck in getting this under control. It seems each person has to figure out what works best for them.

Do a google search for hypoglycemia & gastric bypass surgery. There's a ton of info out there. Not to scare you, but you need to be very careful about this. There can be a problem with the cells in the pancreas that can cause this after WLS. You need to see an endocrinologist. I thought I was having hypoglycemic attacks also so I bought a meter. Wouldn't you know I haven't had one since?