Question:
What's the difference between dumping or hypoglacemic?

Does anyone know the difference between a really really bad dumping session (sweating, weak, chills, can not think, you feel like your going to pass out) or hypoglocemic. Im over two years out and had one last night. Im not sure which one it was. It was pretty scary. I had some sugar maybe an hour earlier, but I have had the same amount of sugar and that never happened. I ate an apple, and 15 minutes later I felt normal again. I guess my question is what is the difference between dumping and hypoglacemic. Thanks so much for your time.    — Geralyn (posted on October 8, 2004)

October 8, 2004
Funny you asked that. I am a little over two years post op and I was just diagnosed with Hypoglycemia. I too always wondered about this. What I read on the internet is that hypoglycemia can be induced by food entering your intestines too quickly. Well that is what happens when we dump, the food enters our intestines and is digested there, when we eat sugary foods it calls on our bodies insulin to digest it. This can cause a drop in blood sugar. I am going to see a dietician soon. It will be interesting to see what they say. Either way it is not pleasant. I was having episodes not related to sugar or high fat foods and this is what took me to the doctor. I actually was fainting for no apparent reason.
   — tulagirl

October 8, 2004
For me, it is the violence of the attack. Dumping is more subtle, sleepy, then the heart palps, etc. I can usually identify the culprit, too. The reactive hypoglycemia hits me like a truck, weak knees, no brains, etc. Sugar can fix it right then, but I am sure to have a reaction that THAT and do it again. Usually peanut butter on a cheap carb (saltine, white bread) is the fastest way to stabilize it for me and many other post-ops. Unfortunately, it is fairly common.
   — vitalady

October 8, 2004
I found this explanation on the web, and it made me finally understand the issue of dumping and the relationship to hypoglycemia. This has happened to me a couple times, and I was so hypoglycemic I could hardly think straight to get something to eat. For this reason I now usually always have protein bars handy to get my blood sugar up but not cause another rebound. Unfortunately I learned the hard way that sugar to bring it up brings on another cycle of hypoglycemia. I do not think the bouncing around levels are good for me or anybody. This can happen on foods I have tolerated just fine previously and all of a sudden it will hit out of no where. It is improving with a lot of vigilance on my part on what I ingest. ****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. This page was last updated on:
   — **willow**