Reactive Hypoglycemia - my trial, error & research...

Tarsha, please keep us posted on your findings, you're in my thoughts and prayers!  I too knew nothing about RHG before surgery, but do know I was so desperate to lose weight that it wouldn't have changed my mind in surgery so now its learning how to live with the new found diagnosis.   I did read a post about someone having their entire pancreas removed on the main board.  That seems so serious.  Please research options before going to such a severe treatment and maybe seek a second opinion? 

after reading todays article, I'm wondering if my weekend (bagel for bfast which is an insoluble fiber) is helping me crash as during the week breakfast is oatmeal (insoluble fiber, important for RHG) I dont crash as much...  something I'll have to watch!

Purpose Hypoglycemia is the term for a blood glucose level that is lower than normal. When foods are digested in the body, they are broken down into many nutrients. These nutrients are absorbed into the bloodstream to be used in performing various body functions. One of these nutrients is glucose, a sugar that provides fuel to the body. The process that regulates the amount of sugar in the blood is complex. Adrenaline is a part of this complicated process. Everyone has experienced a rush of adrenaline at some time -- that "love-at-first-sight" feeling, or the pounding heart after narrowly escaping an accident. Adrenaline is produced by the adrenal glands located on top of the kidneys. The sudden release of adrenaline is what causes the symptoms of hypoglycemia -- apprehension, hunger, sweating, rapid heartbeat, and faintness.

Hypoglycemia can occur from certain illnesses, such as liver disease and some types of tumors. These conditions cause a type of hypoglycemia called organic hypoglycemia. They usually require specific medical treatment or surgery. There is another type of hypoglycemia. In some people, the body simply responds differently to the digestion of foods. Some foods are digested and absorbed rapidly, resulting in a burst of glucose entering the bloodstream. In most people the body adjusts smoothly. It would be like two children trying to balance a see-saw. There may be a slight teetering or swinging up and down as the children shift their weight to achieve the balance. In some people, however, the response is like an actively rocking see-saw swinging up and down. The body over-reacts and sets the process in motion to reduce blood glucose. The result is a glucose level that is too low. Then the body releases adrenaline, increasing glucose in the bloodstream. This is called Reactive Hypoglycemia -- the body is simply over-reacting. It is not easy to diagnose. However, it usually occurs consistently from one to three hours after a meal and returns to normal on its own. When no known medical causes are found, the diagnosis of reactive hypoglycemia is made. The best way to manage reactive hypoglycemia is have glucose enter the bloodstream at a steady, even pace. This can be done with changes in eating habits.

Nutrition Facts Following a hypoglycemia diet gives the body all the calories, protein, minerals, and vitamins necessary to meet the Recommended Dietary Allowance (RDA) for healthy adults.

Special Considerations

Simple carbohydrates and concentrated sweets: All carbohydrates can be broken down into glucose in the body. Some carbohydrates have a simple structure that easily breaks down into glucose. These are simple carbohydrates, commonly known as sugars. Table sugar, corn syrup, and honey are simple carbohydrates. Simple carbohydrates also occur naturally in fruits, milk, and other foods. They are digested rapidly, and this allows glucose to be absorbed into the bloodstream quickly. Therefore, meals that are high in simple carbohydrates can contribute to reactive hypoglycemia. Concentrated sweets such as candy, table sugar, soft drinks, cookies, cakes, and ice cream are mainly simple carbohydrates. Avoid these foods unless they are made with sugar substitutes. Read package labels to avoid foods containing sugars. Look for terms such as sugar, corn syrup, corn sweetener, or high fructose corn syrup. Complex carbohydrates and proteins are important in the diet. They are a basic source of energy. Complex carbohydrates are many molecules of simple sugars linked together like beads on a string. They take longer to break down in the intestine, and this helps to keep blood glucose levels more consistent. Pasta, grains, and potatoes are complex carbohydrates. Proteins are made of amino acids that the body needs for growth and good health. Foods from animal sources contain protein, but so do legumes, nuts and seeds. Most food protein can be converted into glucose by the body, but since this process takes some time, the glucose gets into the bloodstream at a slower, more consistent pace. That is why people with reactive hypoglycemia should eat complex carbohydrates and protein for their energy needs, instead of simple carbohydrates. Choose high fiber foods. Fiber is the indigestible part of plants. Insoluble fiber, such as wheat bran, does not dissolve in water. It adds bulk to the stool and causes it to pass through the intestine more quickly. Soluble fiber does dissolve in water, forming a sticky gel. It is found in the fibrous coatings of foods such as legumes, oat products, and pectin found in fruit. Soluble fiber delays stomach emptying, digestion, and absorption of glucose. Therefore, it helps to prevent hypoglycemia symptoms between meals. When making fruit choices, choose whole fresh fruits or those canned without added sugar instead of fruit juice. The added fiber helps to slow down the absorption of sugar. Size and frequency of meals is very important for managing hypoglycemia. The body really can't tell the difference between the glucose in a candy bar and the glucose in a whole grain roll. The object is to manage the diet so glucose is released into the bloodstream slowly and evenly. Many people skip meals, and this is certainly not good for people with reactive hypoglycemia. Start out with three well-balanced meals. Include a small mid-morning, afternoon, and evening snack. If symptoms are not relieved, it may be necessary to divide the daily food intake into five or six smaller, well-balanced meals evenly spaced throughout the day. Include an evening snack. Choose more complex carbohydrates over concentrated sweets, and try to include some insoluble fiber and protein with each meal. Fats like those in whole milk, cheese, and meats should be limited. A low-fat diet has been shown to help in treating hypoglycemia. When selecting dairy products and meats for protein; choose lean meat, skim milk products, and eggs in moderation. Use oils sparingly. Sweeteners such as sorbitol, saccharin, and aspartame (Equal® and Nutrasweet®) do not contain sugar or calories and may be used in a hypoglycemia diet. If you have questions about them, consult your physician or a registered dietitian. Alcohol is high in calories and can cause hypoglycemia all by itself. Therefore, people with reactive hypoglycemia should avoid or limit alcohol. Caffeine should be avoided. Caffeine stimulates the production of adrenaline. So does reactive hypoglycemia. Therefore, caffeine in the diet can make symptoms worse because the production of adrenaline is increased. Body Weight: Excess weight has been shown to interfere with the body functions that regulate glucose. So if you are overweight, reducing to the proper body weight could help to control reactive hypoglycemia.

Food Groups
Group	Recommend	Avoid
Meat and Meat Alternatives	all lean meat and poultry, seafood, peanut butter, nuts and seeds, limit eggs to four per week including those used in cooking	fatty and heavily marbled meats, hot dogs, salt pork, cold cuts, sausage, bacon, fried meats, or those prepared with sweetened sauces
Breads, Grains, & Potatoes*	enriched or whole grain bread and rolls; English muffins; unsweetened cereals; potatoes; rice; pasta and noodles; crackers; pretzels; popcorn; plain cakes and cookies made with allowed oils, low fat milk, and sugar substitute	presweetened cereals; sweet rolls; pastries; donuts with sugar topping, glaze, and fillings; frosted cakes; pies; cookies
Milk and Milk products	skim milk, 1% fat milk, nonfat dry milk, evaporated skim milk, plain or artificially sweetened now-fat yogurt, buttermilk, cocoa with sugar substitute, puddings made with allowed milk and sugar substitute, low-fat skim milk cheeses	whole or 2% milk, cream, chocolate mil**** cream and ice cream products, flavored or fruited yogurt, milkshakes, sundaes, malted milk, sweetened pudding and custard, cocoa mixes, processed cheeses, cheese spreads
Vegetables*	dark green or yellow vegetables (eaten daily), all otehr raw or cooked vegetables, legumes (beans, peas, and lentils)	any glazed or sweetened
Fruits*	citrus fruit (eaten daily), raw fruit or fruit canned in natural juice or water, dried fruit	any canned in heavy syrups, candied fruit
Beverages	decaffeinated coffee, tea, and herbal teas, water; diet decaffeinated sodas; unsweetened fruit juice	sweetened fruit juice, ades and punches; alcohol; regular and caffeinated sodas
Fats and Oils	unsaturated vegetable oils such as corn, safflower, sesame, soybean, sunflower, peanut, canola, or olive oil; salad dressings and mayonnaise made with these oils	visible fat, poultry skin, fried foods, high-fat sauces and gravies, butter, shortening, hydrogenated oils, coconut oil
Miscellaneous	jelly, jam, or gelatin with sugar substitute or unsweetened; herbs; spices; seasonings; vinegar; lemon juice; broth; unsweetened pickles; sugar substitutes; homemade soups with low-fat broth	sugar, jam, jelly, honey, syrup, molasses, candy, sweetened gelatin, dietetic chocolate candy, sherbet, fruit ice, popsicles, creamed soups
*=Complete Carbohydrates (Breads, grains, and potatoes are good sources, but some fruits and vegetables also contain them.)

Some Food Sources of Fiber
Insoluble Fiter	Soluble Fiber
Whole grains; including wheat, rye, brown rice, bran, and cereals Cabbage, Brussels sprouts, broccoli, and cauliflower Root vegetables Dried peas and beans Apples	Citrus Strawberries Oatmeal Strawberries Dried beans and other legumes Apples

ok another day of home testing...

so far the testing I've done on myself (to see what makes me crash or how the pattern has developed) is:   - high glycemic index foods (simple carbs like crackers, shredded wheat, white rice, white toast), checked blood sugar during crashes to see how low my sugar would go after each food, ate protein during crash, timed and retested when blood sugar was normal again.  Finding: most times my blood sugar would drop so low my boyfriend said I sounded drunk.  After eating pretzels I actually passed out twice.  Kashi shredded wheat (glycemic index 75; high) was just as bad as the pretzels.. never having that again!!   - not eating on a normal schedule (every 3 hours) to see if even after having protein rich foods my blood sugar wouldn't drop or if it would.  Finding:  if I don't eat every 3 hours, no matter how the rest of my day goes, I usually crash at some point.  Its like my blood sugar is a see-saw, its either up or down, never in the middle on these days that I miss breakfast (usually weekend schedule is off.  Very on schedule during the week 6:30 shake, 9a breakfast, 12:30 lunch, 4p snack, 730p dinner, 11p snack) - day of carbs with protein (cheese with whole wheat crackers, shrimp with whole wheat pasta, peanut butter with whole grain bagel) Finding:  if I had more protein than carb I was ok (ie. more cheese than cracker), if I had more carb than protein I began to crash (ie. more whole wheat pasta than shrimp) - having 1/2 cup of orange juice at the start of a "crash" and chasing it with protein like cheese, greek yogurt, peanut butter.  Finding:  I used Tropicana lite and healthy OJ which is sweetened with splenda so it isn't as high in sugar.  During a serious crash (blood sugar below 50) my sugar level would come up faster (as it does for treatment with hypoglycemics), but with the protein chaser it kept my blood sugar even instead of going back down once the OJ wore off...  Sunday 11.25.07 Yesterday I crashed probably because I didn't eat every 3 hours.  A few days ago I was wondering... I wonder what would happen if I had protein all day and no carbs... Does a person with RHG need a combination of protein and carbs to keep consistant normal blood sugar? so today I set my alarm, starting around the time I normally have my morning shake during the work week and continued to have protein shakes every 3 hours... Finding:  I feel great.  Maybe because my body isn't processing "food" just injesting protein shakes?  I haven't felt my blood sugar rise and fall all day.  I've had a shake at 7, 10:30, 2, 5:30 and will have another one at 9 and 12:30.  Blood sugar hasn't crashed, haven't been shakey, feel alert and good.  Apparently the carbs dont help keep my blood sugar level.   I think one of the importance of not crashing for people with RHG is eating EVERY 3 hours.  Skipping a meal or snack could be all it takes to throw your day into an uncontrolable cycle of crashes.  Its important to figure out what your crash consists of.  The onset of my crash is an itchy stomach (maybe the stomach insulin?) and shortly after I get jittery and then finally the shakes start and get worse (a few times I've passed out because of WAY too many simple carbs).  Now that I know what my first stage of a crash is, thats why I start immediately eating protein (usually a tablespoon of peanut butter, followed by another tablespoon of peanut butter) to stop the crash as quick as possible.  When your blood sugar drops, it means the insilun being produced has slowed down and not enough of it is getting to your brain.  Why wait until you pass out or come back from a crash to level out your blood sugar?  To put that extra strain on your brain, pancreas, to feel awful for a period of time when you can control it?  Help yourself stay healthy even if your doctor and/or nutritionist doesn't have answers on how to fix it, you can journal and find out what works best for you!! 

I will. Thanks for your support.:)

Just adding a link to a you tube video I found today.  The woman isn't from the US but explains what hypoglycemia is as she was finally diagnosed with it http://www.youtube.com/watch?v=tKXT1Osk90A  Theres a DVD out there called Sweet Fire: Understanding Sugar's Role in Your Health

it has some great reviews on how explanitory it is re: sugar levels within diabetics and hypoglycemics.  I ordered it this morning and will post my thoughts after watching it :) heres the link if you're interested (5 reviews, all giving it 5 stars).. http://www.amazon.com/Sweet-Fire-Understanding-Sugars-Health /dp/B000J20CU2/ref=cm_pdp_review_teaser_product 

I know I was having the Reactive Hypoglycemia at about 6 months out and it lasted for almost a year. It seems to have stopped for the most part but I am left with constant headaches. Day and night it just never seems to stop. Anyone else having the headaches there seems to be no way to control them.

I've never heard of it stopping before, I can only hope the same happens for me! :)  Headaches haven't been a symptom for me unless I dont have that morning cup of coffee then forget it!!

Oh my Goodness....this is so helpful.  After having blackouts and dumping over "nothing", this makes so much sense.  The PCP did an HbGA1 C that was 90, so she blew me off. Thanks you guys!

Try some protein when you start getting the symptoms when it happens again.  Reactive hypoglycemia is a little different than regular hypoglycemia.  Sugar or orange juice will spike your blood sugar momentarilly but you'll crash again if you don't stabolize it with some protein, anything you have handy will work (peanut butter is my vice, its in my house, work, bedroom, car, bag, everywhere incase I crash). Not only did my primary blow me off when this started happening, but my wls doctor did too.  My nutritionist said she only knows 1 other post-op in our clinic with RHG which is why they didn't think I was having the same symptoms.  Its frustrating when you're going through something and don't know what the problem is, but stay on them so you can correct the problem!   take care :)

Oh My Gosh....All of this sounds so familiar.....Down to the point of my daughter being able to talk to me on the phone and she will ask, Mom, are you having a spell? My speech slurs, and I get foggy..I go to sleep and sometimes will be out for several hours, totally not hearing a single thing. My husband will wake me just to make sure he can get me to talk to him.  I have even woke up craving a peanut butter sandwich....I keep glucose tablets with me at all times.....The nurse has told me to chew as many as 5 or 6 if it happens and this does help. i can always tell when one is about to happen as my heart starts feeling funny, I get a funny chill in my chest and a pain in y upper right side, as if I had a gall bladder which I don't any more. I am sluggish for a day or so after an episode. I work in an automotive plant and told my supervisor if I ever just disappear for any length of time have someone look for me at my desk, it usually will mean I felt a spell coming on and thought I had better sit for a while...at the same time I will be taking the glucose and calling my hubby in case I have to go home. I live about 8 miles from work and know if I did not wait too long I could make it home. I call him and tell him I am taking this route home, will be there in 20, if not I will pull over and come look for me.  I think the scariest was when I was in grocery store and it hit me, I did the best I could and grabbed a pieceof candy and went straight to my truck and called my hubby to come get me, I knew I would have made it home that day, I almost didn't make it to my truck...SO embarassing.... THANKS SO MUCH FOR LISTENING, I KNOW THIS WAS LONG, BUT, IT NICE TO KNOW YOU ARE NOT ALONE.... My hubby tries, but, I know it scares the bejeezers out of him when it happens... [email protected]