Question:
Anyone Else Having Problems with HypoGlycemia (low blood sugar)?
About a yr ago I posted a question on this web site seeking help regarding symptoms of low blood sugar and was accused of whinning because I could no longer have sugar. After suffering a year with low blood sugar symptoms, I sought help from a endocrinologist who diagnosed me as having Alimentery Hypoglycemia, this is what I learned and want to share with others. What Are the Symptoms? The symptoms of hypoglycemia (low blood sugar) are different for ea person, but tend to be the same for any one person. They include: sweating, feeling warm, difficulty speaking, dizziness, inability to concentrate, hunger, drowsiness, anxiety, confusion, nausea, trembling and headaches. ALIMENTARY HYPOGLYCEMIA Occurs from a mismatch of insulin and carbohydrate and insulin which is usually due to having an abnormality of the stomach. Ordinarily, a meal sits in your stomach and is slowly released, so the carbohydrate absorption occurs over a prolonged period. For people who have stomach surgery to remove part of the stomach or who dumps most of the meal into the small intestine immediately, there is a very rapid absorption of the carbohydrate. This rapid carbohydrate absorption can be followed by a very brisk insulin release. The big insulin release can drive the glucose level very low. Of all the causes of reactive hypoglycemia, this can be the most dangerous, it has been reported to cause coma and seizures. Characteristically alimentary hypoglycemia occurs 1 - 2 hours after eating. It usually does not occur without a history of partial or total gastrectomy (stomach surgery). How you can help your Alimentary Hypoglycemia Delete simple carbs and most complex carbs from your diet, due to the carbs causing great fatigue and symptoms of hypoglycemia. Eat mainly protein foods, green veggies, and minimal fruit 4-6 x's per day to keep glucose from dropping. I was so relieved to know that this was not a question of lack of sugar or a psyco problem, but an actual (side effect) from having the RNY. My hypoglycemia is under control now and I pray this helps anyone else out there suffering from LOW BLOOD SUGAR. — Barbara M. (posted on November 23, 2003)
November 22, 2003
I think a large percentage of us suffer early on with this, since it
describes typical dumping. It helps train us to eat right. My surgeon says
duming although unpleasant isnt dangerous. I have NEVER heard of anyone
here siezing or getting into a coma. Our bodies are wonderfully adaptable
and thats why most of us dont dump after awhile.
— bob-haller
November 22, 2003
I understand Alimentary Hypoglycemia (low blood sugar) can mimic dumping
syndrome, but there is a certain percentage of non-RNY and RNY people who
do suffer from Reactive/Fasting or Alimentary Hypoglycemia whether it's
from eating simple or complex carbs please don't confuse the 2 we're
talking about different issues here, I can attest to that as my mother has
reactive/fasting hypoglycemia due to hyperfunction of the islets of
Langerhans and she's never had any type of gastric surgery and is not
diabetic. I rest my case.
— Barbara M.
November 22, 2003
Thank you for your very accurate and informative alert....and it is
imperative that readers do NOT confuse "dumping" with alimentary
or reactive hypoglycemia. As a new post-op (nearly 4 years ago), I
experienced my share of "learning experiences" with dumping
syndrome, and consequently fine-tuned my new eating habits to avoid it
completely. Although it is true that some of the symptoms of
"dumping" and reactive hypoglycemia closely mimic each other in
the first few minutes of the experience...profuse perspiration, rapid heart
rate, weakness, trembling or shakiness...the end results are critically
different. The symptoms of dumping will go away on their own within 15-30
minutes usually, and the patient will feel completely fine...in fact, even
better...and the LAST thing that you want to do when dumping is to eat
anything else! In reactive hypoglycemia, the symptoms will not go away and
will only become worse unless the patient immediately eats
something...preferably a high-protein substance since sweets or
concentrated carbohydrates only "jerk around" insulin production
even more. I had been a Type II diabetic for over 5 years before my
WLS....the last thing I ever expected was to experience LOW blood sugar! I
did not experience my first hypoglycemic episode until I was almost two
years post-op. There are now five RNY post-ops in my family...I, and my
two daughters, are the only ones who experience reactive hypoglycemia (and
they were not diabetic pre-op)...a diagnosis confirmed by our bariatric
surgeon, our PCP, and an endocrinologist. As the previous writer stated,
these episodes occur at least an hour after eating, and sometimes up to 3-4
hours after a meal (dumping usually occurs within 15-30 minutes of the
"offending" meal). I can now tell when this is beginning to
happen to me by a sudden feeling of weakness, extreme shakiness, and
profuse sweating...by the time the sweating starts, I am hardly able to
form complete sentences to my family, and am almost too shaky to get to the
kitchen....a glass of skim milk with a packet of No Sugar Added Carnation
Instant Breakfast turns these episodes completely around for me within 10
minutes. My younger daughter can feel an episode coming on when her lips
and face start to become numb....she keeps cubed Cheddar cheese in her
refrigerator at home and work, and that works for her. Fortunately, for
the two of us, we only experience these episodes a few times a year...not
even once a month....but we can certainly tell what is happening to us when
it starts! My older daughter, who is one year post-op, just had her first
experience this month, and it is felt by her family that she actually
experienced a seizure at that time. A neurological exam and brain MRI were
negative, and she has now been diagnosed with "alimentary
hypoglycemia". She has been given a prescription of Glucagon, an
injection to rapidly increase blood sugar, and instructed to have it with
her at all times. The other two members of my family who do not experience
this at all are between 2 and 3 1/2 years post-op. This is not a common
side-effect of WLS, but certainly one which needs to be medically
differentiated by a physician to be simple dumping syndrome or reactive
hypoglycemia. A simple blood sugar check is diagnostic....any blood sugar
less than 60, and that causes symptoms, should raise questions...a blood
sugar less than 50 requires immediate protein intake...a blood sugar less
than 40 can be critical, and can indeed result in seizures and coma for a
very small segment of people. Like the writer who submitted this alert, I
searched this site for months wondering if this was happening frequently
for other patients or was this "just me". The very fact that so
little information is present here, is evidence to me that this is not an
overwhelming or frequent problem for most WLS patients. However, our
bariatric surgeon (with over 1500 WLS patients) confirmed that reactive
hypoglycemia happens in a small percentage of patients, usually becomes
evident within the first year or two after surgery, and
"generally" is no longer a problem after 3-4 years post-op as the
body completes its adjustment to the surgery and patients are able to
resume a more varied and "normal" diet. He stressed that the key
is to "forever stick to the rules"...protein FIRST, veggies and
fruits next, and NO junk foods or simple carbohydrates. The patients that
stick to the cardinal rules that they were given in the beginning, seem to
rarely have problems with reactive hypoglycemia. The patients who
"stray" and begin to graze and snack on
"empty-calorie-carbohydrates" or concentrated sweets are most
likely to experience this medically-challenging condition which requires
immediate attention. Thanks again, and best wishes!
— Diana T.
November 22, 2003
Thank you Thank you Thank you. I used to have episodes like this every few
months prior to bypass surgery, usually when I hadn't eaten much all day
and then went to the movies and had some movie food or candy. About six
months after surgery I started to have them every day and it was VERY VERY
scary. I knew it was somehow connected to food and I find that I have them
when I don't eat at all (if I haven't eaten by 11 am, I can count on one
like clockwork) or if I start my day with a muffin or something like that
instead of a protein drink. However, I have had them on days when I had a
protein drink and nothing else for 4 or 5 hours. My solution has been to
eat very small balanced meals every 2-3 hours. If I depart from that plan,
I have an episode and it is exactly as described...somewhat nightmarish.
I'm fine with carbs so long as they are balanced with protein but if the
carb is way more than protein or there is no protein or I haven't eaten in
3 or 4 hours, I'm in big trouble with this. Low blood sugar does NOT mean
you want sugar, it means your glucose levels in your body are out of whack.
I'm so glad you posted this...thank you so much. I feel much less crazy.
— susanje
November 23, 2003
Barbara,
Thank you so much for posting this extremely important information! I have
had contact with quite a few RNY post-ops lately who are suffering from
this very thing - I think it must be MUCH more common than is acknowledged,
or understood.
One lady I know has had several seizures now and is essentially housebound
because of it! Thank you again - I've passed this on to several people!
Blessings,
dina
— Dina McBride
November 23, 2003
If you pop over to the Grad list, you'll find about 90% of us have symptoms
of this, periodically. Doesn't matter how "good" we are or not.
When I have issues with it, it's almost like it gets out of rhythm and I'll
have several in a row, for several days. I try not to correct with a dose
of sugar (which sends the BS way up to be followed by another crash), but
PB on cheap carb. That seems to be the fastest, most stable option, and the
general concnesus amoung us who live with it. Then I'll go months without
any incidents. There does not seem to be any rhyme nor reason to it. But I
know when it hits, I am just "done" with whatever I'm doing and
am lucky if I can GET the PB on a hunk of bread. It becomes VERY
complicated to get the knife, get the PB and the bread, then to unscrew the
lid, undo the twistie on the bread? Monumental. The spreading of PB is a
super human effort while I brace rubber legs against the counter. This is
kinda like dumping, yes, but much faster & more violent. It appears to
be part of our basic disease (insulin resistance) more than something to do
with the actual WLS.
— vitalady
November 23, 2003
Michelle, I keep a box of Melba Toast and a jar of PB in my office for the
same reason. I don't know why, but it does cure it very fast.
— susanje
November 24, 2003
So, what exactly then is the difference between 'dumping' and reactive
hypoglycemia then? According to this article, it usually occurs 1-2 hours
after eating. Well, I experience the exact same symptoms just usually
about 15-20 minutes after I eat. As a matter of fact I just had this
happen while eating part of a sourdough roll in a restraunt the other day
and was thankful that my hubby was there to get me to the car, because I
wouldn't have made it anywhere but to the floor otherwise! Also, is there
anything you can do once it does start to make it pass more quickly or not
be so severe? Right now, it seems all I can do is get myself to the couch,
or bed, and 'sleep it off' for 45-60 minutes...if you can call it
that...it's more like your sleeping and can hear things around you but
can't come out of it to respond.
— eaamc
November 24, 2003
So, what exactly then is the difference between 'dumping' and reactive
hypoglycemia then? According to this article, it usually occurs 1-2 hours
after eating. Well, I experience the exact same symptoms just usually
about 15-20 minutes after I eat. As a matter of fact I just had this
happen while eating part of a sourdough roll in a restraunt the other day
and was thankful that my hubby was there to get me to the car, because I
wouldn't have made it anywhere but to the floor otherwise! Also, is there
anything you can do once it does start to make it pass more quickly or not
be so severe? Right now, it seems all I can do is get myself to the couch,
or bed, and 'sleep it off' for 45-60 minutes...if you can call it
that...it's more like I'm sleeping and can hear things going on around me,
but can't come out of it to respond.
— eaamc
November 28, 2003
Thank you so much for posting this!!! As a medical person, I have had some
questions about this too, and couldn't find anything. The reactions are so
VIOLENT!! I was never diabetic prior to wls either, but have had some
issues with this since. It is NOT the same as dumping! I have always
known to tx with protein, as more sugar causes worsening of the condition,
but didn't know what it was called! I am looking forward to controlling
this better now that I am better informed. Diane, that was a great
response also. As always, I learn something every day. karen (open rny,
9/6/01, 297/146)
— Karen M.
November 28, 2003
~Barbara~ Thank you so much for this posting. I too have reactive
hypoglycemia (sp?) and have questions about it. This puts things together
for me. I keep crackers and PB close at hand and eat some fruit every day
to keep my BS up or it has been known to drop as low as 20. To me the side
effects of LBS is worse than dumping. ~Sidney~ Open RNY 10-23-02 down 130+
— Siddy I.
November 29, 2003
I am five months post op and have just started having problems with LBS. I
did have problems with this prior to surgery as well. I had labs done, and
have been seeing my dietician. She has me carry Glucose Tabs with me at ALL
times. I have found that if I don't drink the Protein Drinks, I don't have
as many Episodes. At first we thought I was dumping from the Protein
drinks, but that has been discarded. What the dietician said was happening
is, with the protein drink you are getting protein, and not many carbs, if
any. This will cause Reactive Hypoglycemia. So, I am getting my protein in
other forms and am doing much much better. I also, keep the Glucose Tabs on
me at all times. I was worried about sugar in the Glucose tabs, but it is
Glucose and did not make me dump. I also, am eating every 2 hours in order
to keep things at an even keel. Good Luck to all. God Bless!
— PammieC
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