Wednesday, October 20, 2010

Reactive Hypoglycemia after Bariatric Surgery

Reactive hypoglycemia is becoming more and more commonly diagnosed after Roux-en-Y gastric bypass surgery. Doctors and research clinics are recognizing this trend and are studying the phenomonom. But if you research online, you'll find that the published information is going to discuss extreme cases of "severe hypoglycemia" in patients being studied at the Mayo Clinic and elsewhere.

Most of us post-op folks don't have the "serious" kind of reactive hypoglycemia that requires removal of parts of our pancreas or study in a clinic. Most of us have a form of reactive hypoglycemia that is easily managed through diet changes and close monitoring of our condition, symptoms and habits. It seems that this type of reactive hypoglycemia is showing up around 12-24 months post-op in many people I've talked to on the forums. I was officially diagnosed with reactive hypoglycemia about 15 months after my RNY.

Reactive hypoglycemia is scary. It sucks big time and it's definitely no fun to have. Waking up in the middle of the night with a blood sugar crash is pretty horrifying. It's happened to me a couple times and I have since taken steps to make sure it doesn't happen again. But it takes some work to figure out how to control the crashes and some planning and discipline to make sure the plan works. You CAN live with it and it can be managaed through some diligent lifestyle adjustments and careful attention the detailed signals your body gives you.
This article is going to be a long one... so grab a cup of tea and prepare for an educational session.

What is Reactive Hypoglcemia?
Reactive hypoglycemia or Postprandial hypoglycemia (low blood glucose after meals), is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2–4 hours after a high carbohydrate meal (or oral glucose load). Symptoms vary according to individuals' hydration level and sensitivity to the rate and/or magnitude of decline of their blood glucose concentration. Some of the food induced hypoglycemia symptoms include:


Mild Hypoglycemia
  • Increased or sudden hunger
  • Feeling shaky, dizzy or nervous
  • Pounding heartbeat
  • Drowsiness, feeling tired
  • Sweating (cold and clammy)
  • Numbness or tingling around the mouth
  • Headache or stomachache

Moderate Hypoglycemia
  • Any of the above mild symptoms, plus:
  • Headache
  • Personality change
  • Irritability
  • Confusion and/or difficulty concentrating
  • Headache or stomachache
  • Slurred or slow speech
  • Poor coordination

Severe Hypoglycemia
  • Any of the above mild or moderate symptoms, plus:
  • Loss of consciousness
  • Seizures and/or convulsions
  • Death

 
Do I Have Reactive Hypoglycemia?
Many doctors will want to do a "Glucose Tolerance Test" on you to find out if you officially have reactive hypoglycemia or not. This is a very bad idea! It has been determined by the science people that a glucose tolerance test on post-gastric bypass patients will not give an accurate test result. Even for those who don't experience dumping syndrome (or who have a high threshold for sugar before dumping is induced) the glucose tolerance test is too excessive an amount of sugar for RNY folks. The test gives you an 8oz glass of pure glucose to drink before the test and contains about 70-100g of sugar. Yikes!

Landsberger, et al., suggested using modified glucose testing. They recommend obtaining a fasting blood glucose level and a two-hour postprandial level after consuming the most carbohydrate-loaded breakfast the patient can tolerate. source
 
So if your symptoms match all or some of those listed above and you suspect that you have reactive hypoglycemia, definitely see your doctor. And discuss alternative methods for testing your condition for an official diagnosis.

Marathon Blood Testing Week
When I suspected I had reactive hypoglycemia I did a whole week of marathon blood testing so I could learn what my body was doing with various types of food or meals. Here's the deal. You need to understand what's going on with your body. You need to learn what foods or activities trigger a crash and what makes you feel good and sustains your blood sugars. It's different for everyone so you'll have to do the work to figure it out for yourself.

Here's how the blood testing marathon went for me...

My brother has had Type I diabetes since he was 10 years old. So I borrowed one of his blood glucose monitors and bought a container of test stripes for it. I later bought my own glucose monitor. When you're shopping for one, look at the price of test strips and supplies, not the monitor itself. Most insurance companies won't cover these supplies for hypoglycemia, so this will likely be an out-of-pocket cost, so shop wisely. I bought the ReliOn brand from Walmart.

I tested my blood sugar several times a day. An hour before a meal, a few minutes after eating, an hour afterward, two hours after, etc. Then after seeing what my blood sugar did with good, healthy, balanced meals.... I did a bit of naughty experimenting. What would happen to my blood sugar if I ate chocolate? ice cream? pancakes? pasta or crackers? What happens after coffee? milk? fruit juice? How does the number change over time.... 5 minutes, 20 minutes, 60 minutes, 90 minutes after eating.

Guess what I found out about chocolate? Starting from a normal blood sugar reading of about 100, my glucose level will spike to about 215 within 20 minutes of eating some chocolate (about half a Hershey's bar). Wow! And I'm a non-dumper, remember... so I was never even aware that my glucose spiked that much, I felt no symptoms of a high blood sugar count or dumping at all. But within 90 minutes of eating that chocolate my blood sugar crashes down to a level of 50. Same thing happens with ice cream, except the crash comes faster.

I also tested whenever I FELT different which helped me recognize what my signals were for a low blood sugar count. For me it's an overheated feeling, lightheadedness, shakiness -- those are my primary signs of low sugar. But I can also get the signal of a strange feeling on my tongue -- like my tongue is fuzzy or swollen or something or my lips tingle. I also can get a super cold nose while the rest of my body is overheating. Each person is different, so you need to test based on what you think is an off feeling for you and see if that "feeling" is really connected to blood sugar or if it's something else (like mere head hunger or a craving or whatever).

Make notes of your discoveries. Keep a food log and keep track of your blood glucose readings at all the various times before and after meals. Also track your symptoms (or off-feelings) and what your glucose reading is for those symptoms. Over time you'll be able to spot trends and understand how your body  is working a bit better.

I found that if I eat a balanced meal of protein, complex carbs and good fats that my blood sugar remained stable for hours and hours. I could go 6 hours without eating and never have a low blood sugar count if I eat a healthy meal. It was only after a meal or snack that was based in simple carbs and not enough protein that I saw my crashes. And sometimes with meals out of balance with too much protein and not enough carb or fat to balance it out.  I also found that coffee is a trigger for me and if I'm going to drink my morning coffee (which I still do), then I need to make sure I have a snack or meal planned within an hour after drinking it.

I also experimented with which foods would raise my blood sugar out of a crash and keep it stable without causing another crash in an hour. So often you hear of diabetics eating candy to bring their blood sugar up quickly -- that doesn't work well in our situation, that will just cause a new cycle of crashes and spikes. We need a BALANCE of nutrients, not sugar! For me it's peanut butter crackers - or - a handful of grapes and a slice of deli turkey or cheese. Basically a bit of simple carbs to bring the crash up quickly, then a balance of protein and fat to keep the numbers up.

So you'll need to play around with foods and figure out what YOUR triggers are, and what foods work best to bring you back from a crash. You'll also need to figure out which foods should be with you at all times (I carry a granola bar in my purse for emergencies and have an extra stash in the glovebox of my car).

It's a process and it takes patience and experimenting -- and you'll go through a whole jar of test strips. But it's worth the effort and you'll learn to recognize a low blood sugar count well before it becomes an emergency. I can now catch a dropping count when I'm in the 60's or low 70's. It's rare for me to hit the 40's or 50's anymore.

Reactive Hypoglycemia IS Manageable!
Make sure you are eating according to the RNY Laws - protein first, moderate complex carbs and healthy fats. Figure out an eating schedule and stick to it. You'll want to make sure you have a planned meal or snack every 3 to 4 hours. You'll also want to keep a food log including the times you eat and also keep track of any blood sugar highs or lows on that same log so you can spot any patterns that might develop. Pay attention to what your body is telling you and adjust your new schedule accordingly.

~Pam

88 comments:

  1. Terrific post, Pam. I am 18 months out and have not been diagnosed with reactive hypo, but I have noticed some minor symptoms every now and again that could turn into more down the road. If I ever decide to get tested for it, I'm going to print this post and bring it to the doc with me. Thanks!

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  2. What a detailed experimenter you are! I have to eat protein every 3 hours to keep it at bay. If I eat a snack that is just carbs I will crash. I get a panicky and shakey feeling. I can have carbs or fats if I eat them with the protein.
    I keep protein bars in the car and at work. I'll eat peanut butter in single serving packets as well.
    Mine started about 18 months post op.
    Deb T.

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  3. Mine started at 23 months post-op and it was discovered because I started having seizures. Once they did testing, it was determined blood sugar crashes were causing the seizures. My blood sugar drops within 2-3 hours after a meal, no matter what combination of foods I eat. Simple carbs DO make the drop more severe. I saw a Bariatric Nutritionist who specializes in Hypoglycemia and was advised to add 1 oz of protein 1 hour after a meal. This seems to have solved the problem, and glucose levels are now steadier.

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    Replies
    1. Jenstock1970- what testing did you have done to confirm your diagnosis?

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  4. I have it. I have not been tested by a doc, by I know I have it. Stress, coffee and alcohol will trigger than for me big time. I identified foods that trigger that and I avoid them. For me there are starchy carbs. My body does not care if is complex - if they are from starches, and more than 20 gr. (net) I would pay the price. I balance my RH with fat. I add cream or half and half to my coffee, eat nut butter and cheese. Not much - but enough to give my body something to work with. i.e. I will have a tsp of nut butter before my coffee. I do not use skim milk – to the carbs to protein-fat ratio is totally wrong for me. I also noticed that once I get an episode of RH – my body would be supper sensitive to any carbs for a few days. During those days – even eating noramly “save” foods with carbs may trigger RH. I have to avoid most carbs (except green – non starchy veggies) for a few days. But once my system is back to “normal” – I can eat fruits, even occasional wraps, some crackers, etc.
    IMO – finding what works specifically for you is more important that to follow RH guidelines.

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  5. I am 2 years out from RNY and I have had one true hypoglycemic episode. I ate a mini cupcake with frosting about 4 hours after dinner one night. About an hour later I started sweating, got heart palpitations, and became very lightheaded and sleepy. I grabbed my husband's glucose meter and the first reading was 45. I ate some peanut butter on some whole grain crackers. 20 minutes later it was 54, and then 70. I rarely eat simple sugars, and if I do it's a bite or two after having a regular meal, with protein, fat, and some complex carbs, and the RH doesn't happen then. The cupcake thing scared me- I always have some cheese, greek yogurt, or a protein shake in the evening now.

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  6. I was just diagnosed last week and am still working on figuring the whole thing out. This was a great blog and full of information. I tend to wake up with it, so I have been trying to eat some cheese before I go to bed. That has helped some, I also try to be sure and eat at least every four hours when I am awake.

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  7. This helps so much - I am 8 years post RNY (I lost 25 BMI points - from a BMI of 50 to a BMI of 25) and its just been the past few years that I get the sweats, shakes, confusion, dizziness, total confusion, can't talk, I forget everything, even how to breathe, and if I don't get a protein shake in when the symptoms start then I end up flat out on the floor in a pool of sweat and can't do a thing for myself for hours - I'm a raving scared person trapped in a body and brain that can't work. Terrifying. Anyhow, enough drama, this post helped me feel like I'm not alone - I didn't know other post RNY people had this and this gives me very practical tips on how to avoid it - thank you!!

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    1. That sounds EXACTLY how I feel!

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    2. I am almost 10 years post surgery... I lost 150 pounds but have put back about 50 pounds the past few years. Shortly after surgery I experienced dumping after eating something high in processed sugar (cake, candy, ice cream, etc.) So I learned to stay away from those things. I now seem to get hypoglycemic episodes after eating a high carb breakfast of no sugar oatmeal, 1/4 cup grape nuts, a few raisins and 1/2 banana. I become very shakey, very cold, weak, and clammy. I usually try to load up on protein when the symptoms present.... however, I am totally exhausted with a headache for hours afterward.... it's almost as bad as dumping... (I started doing the high fiber breakfast to help prevent heart burn - and it seems to help. I have thought about adding some protein, to breakfast, but I'm not sure how much would solve the issue... and I am trying to cut down to try and lose some of the weight I gained. Any comments?

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    3. Even though the things you are eating don't contain sugar they are very high in carbs. I am 10 years out from the RNY. A few years after the surgery I noticed I reacted to sugary items. I figured out that I could still eat a little tiny bit if I are it after eating a healthy meal so that the sugar isn't absorbed so easily. Over the years the symptoms intensified so that I didn't even have to eat sugar, but plain old carbs - even complex carbs cause t

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  8. @mwsmommy -- I'm so glad you found this information. Congratulations on your success with weight loss since surgery, you've done great! I'm sorry to hear you're dealing with Reactive Hypoglycemia like so many of us are. One thing to keep in mind is that AS SOON AS you sense that your blood sugar is dropping you need to EAT something right away. Preferably a healthy combination of carbs and protein with some good fats mixed in. It doesn't need to be a protein shake. I usually use a granola or protein bar or crackers/peanut butter. But the key to the whole thing is immediate action. You can't wait until you're at the point of lying on the floor unable to help yourself, you'll end up dead that way. The only way to fix a low blood sugar crash is to eat some food right away.

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  9. Thank you - I didn't realize other foods besides protein shakes could help - I'm going to try those and do it right away as you suggested. I appreciate your caring :-)

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  10. Mine come on so quickly that once I realize they are coming I am forced to use glucose tablets and then once my blood sugar rises some I can then eat some protein. I was told that each time drop occurs that it causes stress on the pancreas.

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  11. I also have an issue if I go long lengths of time between meals. If I do this then it doesn't matter what I have for a meal it will usually hit me around the two hour mark after a meal. The lowest my glucose level has gotten was 38 and I was on the verge of passing out.Glucose tablets are the only thing that brings it back up.

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  12. I had what I believe to be a hypoglycemic episode last night. I am just about 17 months out. I am a dumper, and dumped last night too, before episode. I always can figure out what made me dump but last night i could not. I remain fairly anal about what i eat too. Wondered if there was a connection. I will have a heightened awareness. Thanks for your information!

    Jen

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  13. I had RNY surgery 6 years ago and developed hypoglycemia 3 years later after having my gall bladder removed. I spend almost 2 years trying to figure out what went wrong and how to bring it under control. I worked with a nutritionist, who related that it was not about my diet and referred me to a doctor who had experience working with hypoglycemia and RNY patients. I am now on medication as of a year ago and doing pretty well, as long as I eat, as you state, protein first, no more than 15-20 grams of complex carbs, high fiber and moderate fat intake. My issue now is trying to add back in an exercise routine. Any exertion causes my blood sugar to drop. I am now working with a personal trainer. But my question is: is there anyone (doctors or groups) working with patients with severe insulin sensitivies after RNY. I need to find out what my next step is to be able to safely add in exercise to my daily routine without having to deal with weight gain and insulin issues, www.milestogoblog.com

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    1. Hi Julia,

      as a diabetic who used to be on insulin, the best thing to do is test your blood before any exercise, if it is in your normal range, start with a graded exercise routine - walking or jogging but only for a few minutes then test your blood again and see what has happened, leave it an hour and test gain, if it has dropped then eat! If it is low before you start it will only get lower, so eat and check that your blood glucose is at least normal. Graded exercise is starting with a few minutes and extending them by a couple of minutes at a time. Think about what exercise you have done that day - walking, ironing, gardening etc is all exercise, so you have to think about what glucose your body has already burning.
      Exercise means that you burn calories/energy after you have finished and it can last for a couple of days so you may not hypo on the day but your blood glucose may be just holding on, so test your blood before bad and when you get up the next morning.

      I wish you well and hope that my advice on exercise and the advice on food helps. Remember a little exercise is good, but check with your doctor first.
      Marilyn

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  14. NOTE: Sorry Johanna, I accidentally deleted your comment when I was trying to approve it. Here's the message. Thanks for your comments and I wish you the best of luck in regulating your reactive hypoglycemia.

    ---


    Hi Pam! I was searching on Google for reactive hypoglycemia since I've had it for some months now. I am currently 14 months post-op (in Sweden) and I'm having horrible problems with this. Just stopped drinking coffee yesterday and am focusing on protein now.

    This was very helpful, I'm checking my sugar too and have dropped to under 20 after a high carb-meal. It's awful. The doctors and nurses do not know so much about it here but I take that its more common in the states where these operations have been going on longer and more patients have been going through surgery.

    I also hope that you understand my English, it's not the best :-)

    Best regards, Johanna

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  15. had roux en y 4 years ago and am currently unable to work due to severe post priandal hypoglycemia. has anyone heard of any type of lawsuits or other form of help while Im unable to work.
    thanks,
    Jeff Pete jzk230@aol.com

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  16. Hi Jeff. I'm sorry you're having such a hard time with reactive hypoglycemia. I'm not sure why you'd want to know about lawsuits. What's there to sue over? You knew there would be any number of risks associated with having bariatric surgery and this is one of them that many of us have to live with as a result of our decision. I wish you the best of luck as you try to get your hypoglycemia under control and manage it so you can live a normal life. It takes a lot of practice and patience to find the right balance to control this condition, but it IS controllable if you find that balance. I wish you good luck. ~Pam

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  17. I'm more than 10 years out. I also have this reactive hypoglycemia problem. My doctor wants me to see a endocrinology. I'm pretty sure that I need to correct my diet - I've been a hot mess since I got married (7 years ago LOL) We found there was an issue because I passed out on the floor. Fortunately I had called my husband at work first. He couldn't understand one word I said, and when I did not answer after I dropped the phone - he drove home. That was a bad place to be. Bad place to be. If you think this is a problem for yourself or someone you know, you should get it checked out.

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  18. Jeff apply for social security disability. I am one of the worst cases out there and got disability first try with no lawyer. Such a relief to at least have an income.

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  19. Those of you able to contain this with food are lucky. I however can not. I have a machine stuck inside me now that transmits my blood reading to a monitor and sends alerted. After a while you don't feel it anymore. It gets worse and happens to fast to do anything about it. It even happens in the middle of the night while sleeping without food. If it wasn't for my husband waking up to my seizures and putting honey in my mouth I would be dead so my endocronologist says. I should have fief several times but he keeps me alive. My surgery was 9 years ago before they knew about this. This is no way to live.

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  20. Anonymous is correct.... I had my GBS over 10 years ago and the only risk at that time where only anemia..... Not Reactive Hypoglycemia...I also have a nice machine inside of me that monitors my levels.Wait until after 10 years post-op and we will see what other issues there are with this surgery.

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  21. I'm so sorry for the people suffering the severe levels of RH and really amazed at how much worse off I could be. I am two years post-op and diagnosed with RH almost a year ago after a couple of what I thought were bad episodes (feeling sort of drunk and unable to talk sensibly or figure out how to use a menu in a restaurant). I feel blessed to have been able to manage it most of the time by eating more frequently and being more mindful of limiting sugar and other carb loaded foods. I do concentrate on protein first and use greek yogurt and high protein meal replacements (from Bariatric Advantage) as staples in my diet. Lately, I've been trying to get bread and crackers out of my routine because I had gotten to where I was eating a lot of both (with meat and cheese so as to avoid crashes). Because of this attempt at reducing carbs further, my blood sugar fluctuations have changed. I've been surprised to find glucose at 60 or 70 when I'm feeling pretty much okay. What is the healthy range, anyway? Is it okay to go to bed at night when glucose seems low? I tend to have a snack even if I'm not hungry but would like to skip that if I don't really need it.
    Thanks so much for this blog. I'm glad to be reading of other people's experiences.

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  22. Hi, my name is Pat, I am 11 years post op of RNY. Believe it or not I have had the same surgery twice. 5 years apart. I never had any symptoms from the first surgery and yes, as others have stated back in 2001 there was no worries except anemia. I always took my vitamins and b12 liquid and had perfect blood work for the first 5 years. Some initial dumping but that too subsided. Unfortunately, as many probably experienced you can regain the weight. I lost 100 lbs with the first surgery and regained 50 some 5 years later. As not experiencing all which I have just read I persued my doctor and had it repeated RNY. I lost 60 lbs this time. I did not experience any reactive hypoglycemic tendencys until almost 2 years after. I crashed as many have stated. One difference I am not hearing from others is I also experience severe pain of "10", the pain never goes away until I find myself in the emergency room and beg for morphine. Morphine clears the episode and my head clears. I am able to work, but as I travel monday through thursday it has been very hard to find a doctor. For 3 years I went to general practitioners and then finally have gone to endocrinologist. He is working up now and have undergone traditional testing. He wants an abdominal scan to rule out tumors (which can be present) before I get a lecture on my diet. I have in the recent years been able to manage my diet and have bouts about every 8 months. When I have a reoccurrance it appears to be a combination of exercise and volume of food together that brings it on. As others have stated you have to know your own body. My weakness is wine. Traveling every week makes you reach out for an escape until you get home once again.
    I wish everyone the best, I just wish I knew about this 11 years ago. I am paying for a private life insurance policy, the cost is 3 times of my husband's. Never knew. Unfortunately, I believe physicians are not sharing the consequences we all are experiencing to perform this surgery on others. Who would guess years after a procedure something would pop up? Who would of thought?

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  23. Hello! I just found this blog by googling hypoglycemia. I am post op by 6 years. My first episode was 2 years after surgery. It took me over a year to figure out what it was because I had them so seldom. I figured out that it probably had something to do with my surgery. But wasn't sure what. I just assumed it was a dumping episode. While I am getting better over time at catching it early, I am still finding foods that cause it. Another thing I have found is that some foods may cause it one day and then later, not cause it. I have come to the conclusion that certain foods on their own will not cause a problem but when combined with others, will. For me the biggest culprit is milk. Not sure what there is about it but I can't drink it on its on anymore and usually find it difficult to tolerate in protein shakes too.
    I also wanted to ask you, do you were a medical alert bracelet for your RNY and reactive hypoglycemia?
    thanks,
    Pamela

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  24. @Pamela
    I'm so glad you found this post. I hope it helps you better control your reactive hypoglycemia. Some doctors actually think of RH as a form of "late dumping" - and in some cases, it's easily mistaken for this. What you're describing about certain foods being triggers on some days but not others or in various combinations with other foods -- that is completely normal! It's all a matter of learning your own body and adjusting your daily routine to accommodate what it wants/needs to keep a steady blood sugar level.

    A couple questions you asked can be answered with other blog posts here.

    Medical Alert Bracelet - yes, I wear one and one of the lines says "Reactive Hypoglycemia" - you can see a picture of it here (it's the dangling medallion): http://www.flickr.com/photos/pwsammy/3145555202/in/set-72157605380269874

    Milk -- it is VERY common to become lactose intolerant after RNY gastric bypass. The specific enzymes we need to process lactose are produced in the part of the intestinal tract that is bypassed, so many of us have problems. Read more about it here: http://pamtremble.blogspot.com/2010/03/lactose-intolerance-after-gastric.html

    ~Pam

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  25. Had RNY 8 years ago have had RH for the past 5 years..I have gained 40 of 125lbs lost. I seem to have this on a regular basis unless my diet is just protein. I am concerned about the weight gain and am terrified. What can a endocrinologist do for my condition I don't understand.

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  26. @Anonymous - I know some RH folks have to carefully plan their meals to contain primarily protein. I suggest looking for the types of non-protein foods that do not effect blood sugar levels, such as green vegetables and low-sugar berries. An endocrinologist who understands Reactive Hypoglycemia after WLS (not many do) would be able to confirm the diagnosis of RH. But you'd have a lot more success in finding a life balance by working with a nutritionist who understand the situation and can help with meal planning and crash solutions.

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  27. I had RNY surgery in 2005 @ 65 yrs.old. I had my first attack after eating a small piece of fig cake. It happened so fast & I just had to go to sleep. I woke & went back out for a long time. I had sweat dipping from my hair! I was completely wet & couldn't talk or hardly walk. I finally made it to the kitchen & started eating peanut butter as fast as i could. In a few minutes I started to feel better. This was about 2 yrs. post op.My husband fuses every time I eat too much carbs or a bite of real sugar dessert. I have had a few bouts since, but am careful most of the time. I know when I need to eat & always eat some protein.I also eat a small piece of cheese before going to bed. I cook desserts w/splenda & use it in my coffee@ times. I try to not use too much. I have 1 or 2 sugar free dark chocolate candies now & then. My Dr. said p/butter was the best , as it is a combination of protein & natural sugar & raises you to a normal level & stays there. You have to give up the white stuff, and do i love bread & potatoes.!!!!!!!!!!!!!

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  28. This site has been a great help. I am glad to know I am not alone.

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  29. Hi Pam! I had my surgery in April this year and have been having symptoms since about my 4th month. I guess I'm an early bird. In March I weighed 213 and was 196 the day of my surgery. I have lost all my weight and have a BMI of 22 and weigh 129. I worked really hard to get healthy and exercised a lot like MD wanted. I truly respect my MD and I wouldn't be where I am now without his guidance. However he is very strict with what he advises meal wise and I know he will not be happy when I see him next in Jan. and I am eating like I have started to. I was diabetic but that's gone now a1c 5.3.
    I didn't associate the way I was feeling with RH because my tsh has been up and down and thought it was that. All my labs are fine. At the time though I was pretty much only having shakes and a protein meal 75 - 100 gms protein a day. (MD's plan.) I told my doctor when I saw him in Aug. and Oct that I just didn't feel as good now as I did before and felt hungry a lot even in the night. I didn't eat but it was really hard not to. He didn't feel it was anything other than my thyroid.
    I also have noticed my color isn't as good and i don't look as healthy I did recognize that I sometimes felt like I used to when my blood sugar would drop on diabetic meds. I had seen others post about it on sites so decided to check when I felt symptoms. I have had a couple of readings in the 50's at night or early am and a number in the 60's nothing as dramatic as others have. Usually my readings were in the 70's then up to low 100's after shakes. My first symptom is blurry vision and then being shakey and foggy. However a lot of times my BS is normal' it is weird. Ran the symptoms by my endo when MD didn't feel it was noteworthy because I was only eating 3 times a day and he disapproves of snacking and I figured I might be hypoglycemic even if sugars were ok and I was feeling so badly. She said that she had seen it with a number of her pts after GBS and that they would have to alter my diet to try to prevent the symptoms.
    Dietician at MDs office didn't seem surprised but did mention my doctor doesn't like it but that she advised 3 snacks and 3 meals a day. She is sending me info but until then I am doing what she said and putting together a protein and carb. I still feel I need to have 2 shakes in milk alternatives to help get the right amount of protein but I wonder if I am eating correctly the rest of the time. For snacks I have a protein portion(usually 1/4 cup Greek yogurt with 1/8 cup of low sugar cereal (Kashi), 2 oz of cottage cheese with 2 oz fruit(no sugar), or a string cheese.I had 1/2 of a bagel thin last night with a string cheese and 2 hours after my BS was 151 I didn't think that was good. I don't want diabetes again!
    I start having symptoms within 1 hour or so. I don't know what might work better. I do feel better and generally my vision is much clearer now after a couple of days of this change and only if I can't eat when I feel the dip do I get as bad as before this new plan. Monday I have to begin teaching an all day class so it will be hard to eat as frequently. I am a nurse and have to think clearly so any ideas would be appreciated. I am so glad this was here. On the message board I frequent I couldn't get it to bring this up(probably me and poor computer skills) Thank you so much

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  30. Thank you for the detailed blog. I too have this condition - I'm 3 years out and pregnant. I was diagnosed in my first trimester after having severe sugars in the teens. I hope to God my baby will be ok. I'm 7 months now. Wish I knew about it earlier.

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  31. I am now almost 3 and 1/2 years out. I reached goal at 140# and then went down to about 110# when I moved to Israel. I had my first ever clonic-tonic seizure last December and another in April. My endocrinologist and PCP are sure it's blood sugar related but haven't come up with a way to stop it or stop the horrible feelings that come with it. If I get a real low ike 58 or lower while at work, I am done for the day. I feel sick, irritable, out of body and massively tired and sleepy. Sometimes I can't talk. This is a horrible way to live. I live with my 19 yo son with Aspergers who is a big help to me when I get night time lows (they are NASTY - I have fallen asleep eating a PB sandwich!). I also feel that my issues may be related to dehydration as well. But you're right, protein, fat and good carbs help. Ice cream kills me, I can handle chocolate but then I dump which is the opposite of RA in that my sugar goes way UP not down and I feel icky and sleepy.

    My endo did a fasting test where she took blood every 30 minutes for about 2 hours. I dropped to the 50s or what I call "seizure zone". They increased the activity and the blood draws and sticks to every 15 minutes...my BS went back to 74. Is that weird or what?

    I am supposed to see her next Wednesday. The lows are still very debilitating and I have to say I live in fear of a seizure. I carry glucose tabs with me and pepperoni sticks sometimes but other times nothing helps if it's too far gone...then I will get it to high and crash later.

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  32. Hello all,

    I have lost too much weight, i have been told i look malnurished but all my tests have come back normal bar a little anemia...fab, however i have been getting these episodes and they are really bad, i stopped eating for 7 days as i was scared of another "attack" my surgeon is convinced its blood crashes but the blood monitors so nope to much sugar which is unfair being a single slice of toast!!! unfair but ho hum, i never knew this was a side affect of the surgery and feel it should be on the risk list of side effects. anyway my question is this can you have a heart attack because of this? My heart beats so fast and so strong it makes me feel ill and i'm worried about the amount of "attacks" i'm having taking its toll on my heart? i really am convinced that this can not be good for my heart, its all too much surely? hope someone can give advice on this. caz

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  33. @caz - I'm so sorry you're going through such a rough time. It seems you have several issues to look at from your comment. 1) have you "really" lost too much weight or are people just reacting to the dramatic change? Check your BMI to make sure you're still within a healthy "normal" range and not in the "underweight" category. If your doctor says you're OK, then tell your concerned friends to mind their own business. 2) you can't stop eating because of fear of the blood sugar issues. Are you able to test your blood glucose levels and keep track of them after certain types of food (like I describe in the post above)? Take these logs to your doctor and discuss a treatment plan and figure out what's best for your body to control the dramatic blood sugar swings. Knowing your body and how it reacts to different foods is the best defense you can have. 3) heart problems can actually be revealed by dumping syndrome, so take this seriously. I know of one patient who felt the same way you do about your heart beating too fast, she talked to her doctor about it, he put her on a 24-hour monitor to test her heart activity and they discovered she has a heart defect that she's had all her life and that by eating sugar and causing dumping, it was making the defect worse. So talk to your doctor about this to make sure you're OK.

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  34. Hiya, thank you for your response...it means alot,
    I am offically underweight and my surgeon it very concerned, they have put my on protine shakes and are offering a feeding tube but i cant do that as it would be soul destroying for me as i had anorexia when in my teens, then delt with it then obese in my 20's now underweight again in my 30's driving me nutts, i have been testing my blood but it never showed as low blood sugar, i'm sure it was a faulty machine. i am seeing an endocrinologist on the 14th of december to try and get too the bottom of this problem, people have spoken about the "crash cycle" and i am one of them that has difficulty getting out of it, takes weeks to give me a few days respite and then back to crashing, I really think this condition should be getting the right exposure as it is nasty. i signed up for the dumping if i ate crap i signed up for the forever careful with food choices but i didn;t sign up for not being able to live properly and having to have people helping me to look after my children if i eat!!!! its unreal and i feel bitter towards the bypass no as it was ment to change my life for the better :O( xx Caz

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  35. Hello, I am 12 years out from RNY and believe I have moderate RH. My goal this year is to figure out how to manage it with foods, not sugar. The panicked hunger drives me to eat something sugary and I don't want to keep band aiding the issue. thanks for all the good info and the responses from everyone have helped. I'll also be blogging about my process of figuring out this RH see www.mytinytank.net there are a bunch of us out here with this issue. I didn't know it was RH until just recently. I know I have been experiencing it for some time now. I'll be back to continue to read the responses. thanks, Tracy aka MyTinyTank

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  36. @Tracy - I'm glad you found this blog post and I hope it'll help you as you figure out what's best for your body. Thanks for the link to your blog, I'll be checking it out and following your progress.

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  37. @ Pam...I'm 6 years out and now am experiencing noticeable systems of RH. Probably has been happening for a while, but now it's to the point where 2 glasses of wine is almost causing me to pass out. But, the affects don't normally surface until the next day. Is that consistent with your research?



    My doctor has armed with a glucose tester, but whenever I'm experiencing an episode and check my blood sugar level, it's always in the normal range. I'm not seeing a spike or a drop, but yet I still feel the light headiness and my legs get weak. I almost collapsed in the parking lot at work last week and had to call 911 and go to the ER. ER didn't find anything wrong with me, but I have all the classic symptoms of RH without it registering with the blood test.

    Also, another interesting twist in my case is that back in January, I found myself in the ER and it was later determined that a portion of my digestive track (primarily the stomach) shut down. Therefore, undigested food was sitting in the elbow portion of my digestive track unable to make the journey into the intestines. As a result, I have to take up to 4 digestive enzyme capsules per meal in order to purge. So, I'm wondering how that plays a role because my food isn't always completely digested and I'm certainly not absorbing very much nutrition from the food I eat. So, I am on all types of vitamins and supplements as a result.

    The other thing I'm wondering is if the recent stomach issue has anything to do with my RH because I don't recall experiencing it prior. I've also gained 25lbs during this entire process which began with the stomach/digestive issue in January 2012. I'm concerned that between that issue and the RH that I won't be able to lose the weight even if I revamp my entire diet and add consistent exercise. Because of the RH, I haven't been steady enough to resume a normal exercise program.

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  38. Hi Pam, I am so pleased I found this blog as I am really struggling. I seem to get RH no matter what I eat. I have tried following a strictly low carb diet -weighed and measured- but I still struggled with RH. It seems to be worse after lunch -really terrible- even if I only eat protein. It is not that bad in the evenings even though I eat carbs in my evening meal. I have been prescribed acarbose which works ok for the morning meal but nothing seems to work for the afternoon. I live in total terror of the symptoms.

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  39. Hi Pam, I am so pleased I found this blog as I am really struggling. I seem to get RH no matter what I eat. I have tried following a strictly low carb diet -weighed and measured- but I still struggled with RH. It seems to be worse after lunch -really terrible- even if I only eat protein. It is not that bad in the evenings even though I eat carbs in my evening meal. I have been prescribed acarbose which works ok for the morning meal but nothing seems to work for the afternoon. I live in total terror of the symptoms.

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  40. Hi Pam, it's Amy again. I was wondering if you know of any connection between gluton/ wheat and RH?

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  41. DKinney - I apologize, I accidentally deleted your comment when I was trying to approve it. I've posted it below for all to see. I'm baffled about why you're having low blood sugar issues if you're focused so much on protein in your diet. Have you seen a doctor already?

    ----------------------------------------

    DKINNEY 3/04/2013:

    I've lost over 150 lbs since my surgery January 3rd 2012, and my diet is strongly based on my protein intake!! I start with a protein shake when I get to work or some eggs, later a Chaboni Yogurt my first break, basically by dinner I am upwards of 80 grams of protein a day and it seems to be working well, and I love to get my vegetables and fruit in as well,Lemon or Lime water and rarely any sodas, plus all my vitamins!! I have recently had the low sugar episodes and i'm usually fine after taking a Glucose tablet

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  42. Thank you for the info! I am 10 years out and I "passed out" at the zoo on Saturday. My sugar was 64. It was very scary! That has never happened to me. I have been having tons of night sweats and other assorted weirdness. Thank you for helping me see where the cause might lie. I wish you all luck in controlling your symptoms. I have had way more complications than I was warned about. However, I'm not sure I would still be around without it.

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  43. Thanks, A great post. It reassures me that I have been doing the right things... Only today did I find out that my symptoms actually had a name.

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  44. I had my surgery in 2007 and by 2008 my hypoglycemia was so bad I started having grand mal seizures, all the other symptoms listed above occur on a daily and hourly basis for me. I am on Diazoxide and Acarbose three times a day and have even been through the pre-process for pancreas removal, ultimately the doctors agreed there was no proof that it would for sure help.

    It is now 2013 and I am STILL having severe issues, so much so that my endocrinologist wants me to go out on full to partial disability...to stop working and to move to a slower paced community (in SF Bay Area right now) where I have time to focus on my health and not worry about anything else. Does anyone have any experience with severe hypoglycemia s/p gastric bypass and being approved for disability???? If so I would love any insight you can provide! Thanks!

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  45. @Laurie - I'm so sorry you're having such a hard time with the hypoglycemia and seizures. The only other person I know who has symptoms as severe as yours is Beth at Melting Mama http://www.meltingmama.net/

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  46. Hi Pam,

    I published this post in January this year, but was unable to add my name for some reason, so I'm trying again:

    Unknown1/11/2013 3:04 PM - "@ Pam...I'm 6 years out and now am experiencing noticeable systems of RH. Probably has been happening for a while, but now it's to the point where 2 glasses of wine is almost causing me to pass out. But, the affects don't normally surface until the next day. Is that consistent with your research?



    My doctor has armed with a glucose tester, but whenever I'm experiencing an episode and check my blood sugar level, it's always in the normal range. I'm not seeing a spike or a drop, but yet I still feel the light headiness and my legs get weak. I almost collapsed in the parking lot at work last week and had to call 911 and go to the ER. ER didn't find anything wrong with me, but I have all the classic symptoms of RH without it registering with the blood test.

    Also, another interesting twist in my case is that back in January, I found myself in the ER and it was later determined that a portion of my digestive track (primarily the stomach) shut down. Therefore, undigested food was sitting in the elbow portion of my digestive track unable to make the journey into the intestines. As a result, I have to take up to 4 digestive enzyme capsules per meal in order to purge. So, I'm wondering how that plays a role because my food isn't always completely digested and I'm certainly not absorbing very much nutrition from the food I eat. So, I am on all types of vitamins and supplements as a result.

    The other thing I'm wondering is if the recent stomach issue has anything to do with my RH because I don't recall experiencing it prior. I've also gained 25lbs during this entire process which began with the stomach/digestive issue in January 2012. I'm concerned that between that issue and the RH that I won't be able to lose the weight even if I revamp my entire diet and add consistent exercise. Because of the RH, I haven't been steady enough to resume a normal exercise program."

    Since then, I've really cut back on wine but I still notice that I have these little tremors during the day and during the night when I'm sleeping. I'm really starting to become very concerned about it.

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  47. Pam,
    I've been trying to find information on what is happening to me since 8/9/11. Although I believe I had 'episodes' prior to this one. I had my RNY on 9/21/09, lost over 100 pounds and couldn't have been happier. The following September I lost my husband to a massive heart attach. I went downhill after that. First it was waking up drenched in sweat somewhere in the house after dinner. Then started finding bruises and not remembering how or where I got them, but they were large enough that I should have. Then in August 2011, I left my home to have dinner with family members in a town 14 miles away. I remember my garage door going down, a shaky feeling and next hearing, 'hear are your dinner orders, chicken strips and fries and a hamburger and fries, do you want ketchup with that?' The next thing I remember was the sounds like the proverbial chicken coop and came to in a room full of people 2 hours from my last concious moment. Again, I was drenched in sweat, clammy, shaky. When asked if I was okay, I told them no and that I thought I had wrecked my car. When we went to check the car, everything was fine with the exception of my front tire no longr existed and was sitting on the rim!! I voluntarily didn't drive for 2 weeks to have a battery of test completed, MRI, MRA, EKG, massive blood work, etc. All of which came back basically normal with the exception of 'low blood sugars'. Since then I have been struggling on a daily basis. I have blackouts on the average of 3 times a week. I go to work and come straight home. My neighbor has found me passed out in my front yard and once the EMT picked me up and I came to in the ER, over 3 hours had lapsed. I have no idea how long I had been outside before being found. My oldest daughter has wittnessed and episode and righteously so, can not watch my grandchildren by myself. The only option proposed to me is to have feeding tube inserted. I have tested by blood sugar as low as 27!! Normal levels for me are around 73 - 80. I feel as if I live on glucose tablets. I feel as if my life is slipping away and I have no way to get it back. I am going to try what you have suggested above. I figure at this point, it can't hurt and I am getting despret. I'm sure brain cells are being destroyed every time this happens and I know for a fact depression is setting in. I want to thank you for a glimpes of hope.

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  48. Wow, reading your story scared me. My reactive hypoglycemia hasn't been as extreme, but I have had some of the same episodes that you've experienced. Mine usually happen the day after having any type of alcoholic beverage the day before. It's to the point now that even 2 glasses of wine make me feel really bad the next day.

    Besides that, I have noticed symptoms even without having had alcohol. The only way I've learned to deal with it is to eat something every 2 hours. I have to keep food of some type in my system. Eating too much one of draw backs, but that can be offset by implementing protein drinks and by eating low caloric and low glycemic index foods. I'm no expert and Pam is surely more of an authority on this topic then me, but I would recommend eating more often and including a meat, veggie and a fruit. Fruit for the first 3 meals/snacks each day. Keep low-sugar protein bars on hand. That's better than the glucose tabs. I believe the glucose tabs raise your sugar level fast, but then it will drop quickly and you'll be back to square one. If you take the glucose tab, you must follow it with a protein.

    Good luck and I hope that things improve soon.

    I'm glad I found this page. I learned so much about this condition from Pam and I have learned how to manage my condition. I don't think that the doctor's are giving this issue the attention that it deserves. Most doctors don't even seem to acknowledge it, much less know how to treat it. We're having to learn how to treat ourselves. If you'd like to keep in touch in regards to this issue, you can reach me @ IvaMacLeod@yahoo.com.

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  49. Pam,
    Hello. Thank you for your information regarding RH after bariatric surgery. Are there statistics regarding the amount of patients that get RH. I am considering a revision from the lap band and I have to tell you this RH is scaring me to death.
    Thanks,
    Donna

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  50. @Donna - I have not come across any statistics about how many RNY patients are effected by RH. The ASMBS recently released new patient guidelines for doctors and actually mentions the issue as something for doctors to be aware of and watch for. I don't believe RH is as widespread as it may appear. Yes, it's around and yes many of us deal with it, but many, many, many more patients never have a problem at all. And honestly, for most of us who do have RH after RNY, it's controlled and not a huge issue. My life is pretty normal these days because I know what kinds of foods to avoid in order to control my RH and avoid the blood sugar crashes. I had a low glucose reading last night - but can't really remember the last time I had a crash. It was probably over a month ago. Hope this helps.

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    Replies
    1. Hi Pam....in reading your reply above, and your statement.."and honestly, for most of us who do have RH after RNY, it's controlled and not a huge issue", let me just say it has been MORE than a huge issue, it has changed mine and my husband's life forever! My husband had the RNY 14 years ago, in which around 2008/09 started having these "not so huge issues", started having seizures and as a result has had his head stapled numerous times, with the "life-changer" being in 2010 where he couldn't get to his glucose fast enough, had a seizure in Winn Dixie and fell so hard his brain shifted, was bleeding and swelling, he severed his ole factory nerve and can no longer taste or smell, broke tons of orbital bones in his face, etc. etc., and now lives with a Traumatic Brain Injury! Our lives have not been the same since that day January 16, 2010. We filed for disability in February of 2010 and are still waiting. I have been unable to work as well, so needless to say it has been a journey that only God has gotten us through. It has gotten so bad that he has low glucose readings sometimes 3 to 4 times a day. So anyone out there thinking they hay have this RH or Postprandial Hypoglycemia, please do not take it lightly and seek help now before it gets to that point!

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    2. @Linda - I'm so sorry you and your husband have gone through such a tough time with the RH after RNY. In my comments I don't mean to trivialize the difficult times so many people do have in controlling the blood glucose and living a normal life. However, in all the research I've done and with all the WLS patients I encounter I find that the severe cases, like you describe, is the exception, not the rule. The vast majority of RNY folks who have RH are able to control symptoms with routines, proper food choices, and paying close attention to their body and how it reacts to various foods. I think surgeons need to give more serious warnings about this type of possible side effect after surgery - which doesn't happen often enough, IMHO -- but honestly, doctors don't fully understand what's going on yet. We're all just a bunch of lab rats teaching science how to deal with us. So the more open we can be with each other about our medical experiences, the more we can learn from each other -- and ultimately, the more we can teach our doctors how to better treat us.

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  51. hi Pam & Every one, its caz again, just wanted to update you all on my dealings with this whole ordeal,the symptoms are so bad for me that i gave up eating entirly lost so much weight was rushed to surgery, well i have been on a feeding tube for 5 months now into my old stomach and feeling alot better, i have gained a stone in weight now. If i do the tube feed for 20 hours aday i do not get any rh symptoms at all, if i try to eat through my new stomach (13/9/11) then i get horrific episodes of rh, i have seen the endocrinologist and he has put me on propranalol beta blocker to try and mask the symptoms of eating normaly, fingers crossed its the answer. i do wish you all the best in trying to deal with this affliction xxxx take care all caz xxx

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  52. New to this site, post rny 18 months and under a tremendous amount of stress due to a divorce for the last 6 months. I had no symptoms before the stress and 5 warnings but I did not know what those warning were. In the last 45 days I have had two grand mall seizures (clonic tonic seizures) I have a dull head ache, and am constatly exhausted. My Bariatric surgeons are thinking about giving me an RNY reversal. I was just wondering if anyone else had a reversal? Starting weight was 285 my weight now is 142. I lost most of my weight the first 6 months. Of course I am terrified to get my old health problems back, but I in no way want to have another seizure. Any advice would be welcome. SF

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  53. One of things I've learned recently is the low levels of magnesium is a major factor in hypoglycemia in general. It seems that everyone is testing their sugar levels, but how in the world do we test our magnesium and potassium levels. If you look at low magnesium symptoms, you will find they are very closely related to what we experience during a reactive hypoglycemia episode.

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  54. I posted on 1/11/13 and 5/3/13 as "unknown" about my reactive hypoglycemia and I'm really starting to wonder if it's only that, a combination of things, etc. Is it Idiopathic postprandial syndrome, reactive hypoglycemia or what?

    This entire week, I've been struggling with hypoglycemia symptoms because I had wine and an ice cream cone on Friday. It wasn't until after I read an article ( http://ezinearticles.com/?Exercising-With-Reactive-Hypoglycemia:-Diet-Is-Key!&id=6305695) that recommended eating “fat” , to correct the problem. I couldn't believe it was taking 4 days to recover from this last episode. I did everything I was supposed to do (eat protein, rest, etc), but insomnia kicked in, which is one of the hypoglycemia symptoms. I wanted to get back to exercising, but was terrified that I would pass out. So, after reading the article, I spread on a huge spoonful of melted butter on my green beans and ate them. Sure enough, I was able to get through an intense circuit training that consisted of 3 sets of tire flips, sledge hammer, sit-ups, pushups and cardio.

    Later that evening, I met with my naturopath and she confirmed that "good fats" can offset the effects of hypoglycemia. In addition, she confirmed that I am extremely deficient in most minerals and that's a major issue with hypoglycemia in general. I can't remember all of the medical in's and out's to her explanation. But, all I know is that the cramping, the shakes, etc. are tied to a depletion of minerals during a hypoglycemia attack.

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  55. I have to report an update. Turns out that the bowel issue that I mentioned on this blog a few months back is due to a weak pelvic wall. That's been causing constipation, which has put me in the ER twice since 2012. Oh, the other thing I wanted to report is that I haven't had an episode of RH since I quit drinking wine and been very cautious about the amount of sugar I intake. I know that hasn't worked for everyone on this blog, but the other thing I found out is there's a condition called "Leaky Gut" that is probably linked to my RH.

    I've been advised to follow the Paleo diet to correct this problem and restore my digestive system back to normal.

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  56. @Kim - I'm so glad that things are looking up for you. Cutting out sugar and alcohol will definitely eliminate blood glucose and insulin spikes and crashes, so I'm glad you were able to do that. I recently read about the Paleo Diet and it seems like a good option for bariatric patients. Just make sure you're eating enough protein to support your post-bariatric needs.

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  57. @Pam...Absolutely! Paleo is big on protein. Since I still can't eat the required amount of protein, I'm going to have to continue with my protein shakes. The only difference is that I have to switch to a non-whey/non-dairy type of protein supplement. Which is good to do anyway, since whey is harder to digest and dairy is really not meant for human consumption. Dairy causes inflammation in the digestive track, which leads to a variety of other health issues.

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  58. I am so glad I stumbled upon this blog. I do not have symptoms as severe as others but I can relate to most of what was stated here. I had my first diagnosed RH incident in April. Since I am also on medications to alleviate back pain and migraine, I was confusing the issues and not getting entirely to the root of the problem. On April 19th I spent the day relaxing at home with my husband. We had spoken about going out to dinner that night but we were watching the Masters tournament on TV and it got too late to make reservations. My husband decided to heat up some lasagna we had defrosted. He went to the store to get some supplies. I went to the kitchen to empty the dishwasher and then to the bathroom. I felt sick to my stomach...I thought I had a migraine that day and had taken Imitrex to relieve the pain. Also, on the advice of a friend who only meant to help with my back pain, I drank a glass of tart cherry juice, touted for its antioxident properties. (Word to the wise: not for use by RnY patients.) I tried to be sick but only had dry heaves. Because of the migraine, I couldn't remember the last time I had eaten.
    When I stood up I got dizzy and and I knew I was going to faint. I made it back to the sofa and the rest is a mystery. When my husband got home he puttered around the kitchen, called for me a few times, but assumed I was upstairs in the bathroom. He found me twenty minutes later in a semi-comatose state. He thought I had had a stroke...called the EMTs and our sons and their wives and my sister. I became alert in the ambulance and the technician welcomed me back. Of course, I asked, "From where?". They had started a glucose IV and three hours later I walked out of the ER. Since then I have come to recognize the symptoms. I have been checking my blood and my levels range from 55-215 depending on what I use to bring me back to normal. After reading the blog I see that the simple sugar approach that works well for diabetics only serves to create a spike that eventually results in a drop...starting the cycle over again. My husband will be pleased to know that peanut butter may be my answer after all, since I am always nagging at him to cut down on the stuff. My Primary MD actually sent me on my search today and helped me discover this blog. It is good to know that while this condition is a pain, I am not the only one experiencing these difficulties. Starting today...no more evening glass of wine or going along with my husband on the ice cream trips that he doesn't need either. Balancing my blood is too important and I'll work harder to develop a good food regimen.

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  59. @Anonymous - I'm so glad your husband found you and that you were OK on that first big RH day. And I'm also glad you found this blog post and understand more about how Reactive Hypoglycemia is different than diabetes low blood glucose. Once we get a routine for how to keep our blood sugars in balance, most of us can live a fairly normal life.

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  60. @ Ananymous (07/02/13) - Basically what seems to be going on is that we're experiencing an extreme "dumping" reaction, which is the same thing as RH. As post-gastric bypass patients, we're still supposed to follow the gastric bypasss rules, which is no sugar. Over time, our systems did get used to tolerating some sugar, but after a certain point our bodies started rejecting the sugar with an extreme reaction.

    Good fats are going to be your best friend in the battle of keeping your blood sugar levels in the normal range. But, as some and I have discovered our blood sugar levels don't drop. But, we show all the signs associated with a drop in blood sugar level and this condition is called Idiopathic postprandial syndrome. High sugar/carbohydrates is the the culprit for me and I have to steer clear of them if I don't want to end up in the ER.

    I'm glad you're okay and the more you research, you'll find more ways to define your condition and healthy ways to treat it. So, eat fair amounts of egg yokes, cocount cream, cocount oil, nuts, seeds, peanut butter, etc and you should find your levels evening out. Oh, if you decide to take your diet to the nest level and go "Paleo", there's no peanuts allowed.

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  61. @KimM. -- actually there is a difference between "Late Dumping" and true "Reactive Hypoglycemia." The two are often confused by the medical professionals too. Reactive Hypoglycemia has more to do with the way our body is producing/using/mis-using insulin after a glucose-heavy meal. Late Dumping has almost identical symptoms to RH, but the insulin path is what keeps them from being the same thing. "Early Dumping" is what most RNY folks experience.

    And you're right -- when we signed up for RNY, we also signed up for a lifelong change in the way we eat. So we need to still follow the correct dietary guidelines for the rest of our lives. However, remember that sugar causes dumping in only about 40% of RNY patients, not everyone experiences it. So we have to change our habits of no sugar because it's the right thing to do, not because it causes dumping.

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  62. @Pam - Thanks for clearing up the difference betwee "Late Dumping" and true "RH". The endocrinologist I saw lumped both conditions in the same catergory when he explained them to me.

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  63. @KimM - I'm glad your endocrinologist was able to help or at least had some knowledge to share. Unfortunately, mine told me I was crazy and there was no such thing as RH. Needless to say, he's not my doctor any longer. LOL

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  64. Pam,

    I had RNY in 2004. I have RH for almost 3 years. I am getting to the point where I sometimes have two to three episodes a day. I had been able to control with diet, but now nothing seems to work. I have been to Cleveland Clinic and they really do not have any answers. I am looking at a total revision putting my parts back to where they were before the surgery Will this make RH go away?

    Mary

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  65. @Mary - when you mention 2 or 3 low blood sugar episodes per day, that makes me wonder if you're correcting a low count with too many carbs and not enough fat and protein. Our blood sugar issues aren't the same as diabetics -- carbs will just cause a continual cycle of low blood sugar counts. Are you tracking your food intake carefully, calculating how many grams of sugar, simple carbs vs complex carbs, protein, fat, etc. Maybe keeping close track of everything that passes your lips and recording your blood sugar counts alongside the food log you might spot some patterns that could be adjusted.

    I don't know if a total RNY reversal would work to eliminate RH or not. I believe the Mayo Clinic has been doing some research on bariatric patients and RH... might be worth looking into what they've found.

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  66. As many have mention; SO glad to find this site! I am almost 11 years post RNY. I had many episodes of RH initially; just didn't realize that was what I was having back then. I initially lost 160lbs, but due to medications for breast cancer & menopause, I gained back 70lbs. I have lost 50 of those pounds so far through dieting but reached a platue. I have attempted high protein/whey(25 GM)/low carb(1GM) shakes as meal replacements; but each time have developed post paramidal hypoglycemia with glucose levels measured as low as 38. I do no add fruit & use unsweetened milk as my liquid. The shake is sweeten with stevia. Does anyone have any idea why? I am not diabetic.

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  67. @Ann - I'm glad you found the site and I hope we're able to help. My first thought on your protein shakes is to wonder if you're lactose intolerant. It's a common issue after RNY because the enzyme we produce to process lactose is produced in a portion of the intestine that's bypassed during RNY. So your body might be seeing lactose in milk as pure sugar and reacting with low blood sugar crashes. Is it happening immediately (within 30 minutes?) or it it happening on a delayed basis (90 minutes later)? If it's immediate, it is probably lactose intolerance and dumping. If it's later, then it's true reactive hypoglycemia. What happens when you mix your whey with water or Crystal Light instead of milk?

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  68. @Ann and Pam, is it possible that the sweetener in the whey protein is a culprit? Whenever I have consumed some products with what seems like a lot of sweetening substitute, I experience the dumping affect. Aside from eliminating the culprit, it is wise to add "good fats" to your smoothie. Coconut, walnut or flaxseed oil helped me balance out my RH. Please see this article for more details: http://ezinearticles.com/?Exercising-With-Reactive-Hypoglycemia:-Diet-Is-Key!&id=6305695


    Also, platues can be from your body being to used to whatever you're doing (food, exercise routine, etc.). In addition, women over 40 lose 8% of their muscle mass each year, so in order to burn fat we gotta put on muscle. Adding or lifting heavier weights will do the trick. And, there's no need to worry about bulking up. That typically only happens when enchancement supplements are used.

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  69. I found your story very familiar. I had surgery in 2009 and began having problems immediately. Within the first month I spent most of that month in the hospital I could not keep anything down; culprit a stomach ulcer found after an month and many test to see if the surgery had gone wrong it hadn't. The next year I spent in bed with such severe headaches I considered suicide just to end the pain. I couldn't eat and lost the weight I needed to. Finally getting my eating under control I gradually started feeling better. Then I found that I had become lactose sensitive, and had an extremely difficult time digesting protein, nor could I tolerate protein powders.

    I have now discovered that all this time I was having constant low blood sugar. I researched the internet and found out about RH, I then presented it to my primary care provider and they did Fasting Blood Sugars that didn't go so well my sugar dropped to 40, hence; low blood sugar.

    My problem: since the surgery I can only tolerate processed meats and protein not from meat. I continue to have RH. It hits me so fast that I pass out while driving, doing house work, and many other activities. I often am so weak that I cannot get anything to eat. I will pass out then recover sometime later often with my dogs licking my face.

    I find your article very helpful, I have done everything you've suggested except frequent testing and journaling the results along with what I am eating.

    I am not a person to sue anyone, but; I do believe most of us were misled, never having been told the bad only the good of having surgery. I thought I was just odd and this was just my body reacting I am glad to find others. I think someone should file a class action law suit. I WAS NEVER TOLD THE NEGATIVE EXCEPT CHANGES TO DIET AND DUMPING......

    Thanks again Cindy

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  70. my wife has this also we found that b12 injections keeps it at bay. she is on 1 injection every 10 days to stop the blood sugar drops

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  71. Happened upon this "page" and was amazed at the info here.....I had no idea about all of this...I had my RNY in April of 2009.....I don't do a good job of monitoring any of the foods I eat and I don't exercise either.....initially lost 107lbs. but gained back about half of that....Starting wt was 298....haven't actually passed out but have had a few episodes that were pretty scary.....now that I have bookmarked this site...I can go back and reference the things written here....take the knowledge to my own Dr. and compare "notes" and get my mind back to where it needs to be taking better care of my nutritional needs before anything worse develops and takes a turn for the worse.

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  72. Update. In addition to having what I describe as Idiopathic Hypoglycemia - symptoms of hypoglycemia, but no blood sugar level reading - I have been diagnosed with Pelvic Floor Dysfunction. This dysfunction is described - for me - as having muscles as tight as a fist in my pelvic region. This condition causes a lot of pelvic pressure, pressure to the lower back and even mimics sciatic. In addition, it makes having a bowel movement nearly impossible. I am now going through the process of being treated for it. I have gained about 25lbs that I find impossible to get off because of this condition. When the condition flares up, I can gain 10lbs of toxins and fluid in a week. What I'm not sure about is whether or not this condition is tied to having had the gastric bypass and if it's also tied to my hypoglycemia issue. Those are questions that I have for the specialists that I will see in January. What I do know is that stress was a culprit in me developing the pelvic floor dysfunction and I also know that my reactive hypoglycemia is worsen by stress and lack of proper rest. The more rest I have, the less I feel the symptoms.

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  73. Thank you Thank you thank you

    After a horrendous few weeks culminating in a night from hell last night thank you for this website

    its reassured me that what is happening is a symptom of my bypass and I can take control of this by looking more carefully at my diet.

    tomorrow will be a new beginning off to town for a blood sugar monitor and am going to take the bull by the horns and beat this and get these symptoms under control

    going to say goodbye to the night sweats, tremors, confusion, coordination issues etc etc once again thank you

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  74. Hello all, I just wanted to check back and wish you all the very best for the future, I ended up losing 8 stone 6lb which nearly put me in the grave, I have been tube feed for a year and am now back to a healthy weight ready to undergo a complete gastric bypass reversal, No anount of Drugs/diet or will got me through so i am at the end of the road with this. I do regret the surgery so very much but hey if life was easy it would be so bloomin boring x All the best to you all xx

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  75. Hello and thank you for this post and comments!
    I am 9 yrs post op rny and have rh. I agree with others that we did not sign up for this!
    My hypos are serious - I lost my driving licence 5 years ago after having a tonic clonic type seizure In a foreign airport resulting in a v bad head injury and lost autistic child. I can't work as before and have been saved many times by my family after hypos in hot tubs, baths - all sorts! So please Take it very seriously as it does get worse over time...and you can end up unaware as I was.
    I do have some advice about blood glucose:
    Bear in mind that it is not just the blood glucose level but also how quickly it is dropping and how far that gives the symptoms
    Also at 2.8 (British readings) the brain won't have food but it has 30 mins Stored so I have been conscious with bloods at 1.2 with no symptoms (unaware till brain has no fuel and then have seizure but blood glucose readings may be rising) scary stuff! Esp as that was after 1/2 a chicken packed sandwich!
    My endocrinologist is treating me with sandostatin lar injections every 28 days. I now just have 4 - 6 hypos a day with no unconsciousness but it is still a daily struggle and exhausting.
    I am still not able to tolerate excercise (even shopping) hot or cold and have to take stacks of hypostop
    My advice is to be aware that any change in energy need: illness, walking and so on will affect the balance so prepare for it by having glucose to hand.
    Food wise no sugar or fruit, very low carb and always eat fat and protein!
    Before treatment I could not eat if I was to be alone, couldnt go out alone because I needed other people to identify and treat a hypo as I was unaware as it had got so bad. so please please take this very seriously and take care of yourselves!
    Take readings and record them every 15 mins after food for 3 hrs. If you go hypo take them to the gp and get referred to an endocrinologist for treatment if you are not able to control with diet as some of us cant! As for me im getting max dose of drug from next week and am waiting to see if I can drive again after 5 long years! :)
    Best wishes
    Roo

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  76. I am 24 months out and only last week was daignosed with RH after having my 24 month check up with a blood glucose level flaged at 28. I suggest anyone that is suffering this affliction have a hair mineral analasis to determine a supplemental diet course suited for each individually. We are all deficient of any number of minerals, etc. it will also give you a better understanding of what food's to concentrate on to stay balanced. A detox and good cleansing is a good idea as well, in my opinion. It could take years to get the body back to balancing itself even on the strictest of healthy diet's.

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  77. Hair mineral testing can give you a good idea what minerals, etc. you are deficient in. Knowing that is crucial to knowing what supplements to include in your diet or what foods to concentrate on. It could take years to get your body back to regulating itself.

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  78. Hi, I had my surgery 10 years ago. I so glad I found this sight because my husband is diabetic and keeps telling me I need sugar and I tell him no, I need protein. You have given me the ability to get myself back in to control. The longer your out of surgery the slacker some of us get with our food diet. We have to go back to the beginning and start all over. Thank you so much for your testing and taking the time to put it on the internet. Also all the comments help.

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  79. Well, it's been a year long interesting journey regarding my reactive hypoglycemia. I'm almost cured and found out that what I have is Adrenal Dysfunction. Adrenal Dysfunction causes hypoglycemia and Doug is correct, we are lacking in vital minerals that contribute to this problem. We have to consume minerals (Himalayan Salt is loaded with minerals & sodium - we need sodium, not table salt to stay hydrated). Also, our vitamins and minerals must assimilate in our small intestines or in our mouth (under the tongue). Taking supplements that assimilate in the stomach won't work for us.

    A great book to read is "Is It Me or My Adrenals?" by Marcelle Pick. This book doesn't focus on post gastric bypass patients, but the information will work for you. Another good idea is to see a Naturopath for a holistic approach to resolving your reactive hypoglycemia. Mine has me on a couple of products for adrenal support, plus I developed my own adrenal cocktail that I drink twice a day and that cocktail contains Himalayan salt. I also focus on getting a minimum of 8 hours of solid sleep. I get 10 to 15 minutes of light exercise a day right now (for sunlight, air and activity - vigorous workouts right now can strain already stressed out adrenals). Also, I've learned to eliminate and avoid toxic people, thoughts and situations. You'll need a healthy, clear mind to repair this issue. Worrying about things, negative thoughts and dealing with negative people and/or situations can keep your adrenals stressed out. So, get rid of it once and for all; you never needed that anyway. Hire a life coach if you need guidance on how to do this. I hired David Roppo and put me on a fast track to eliminating my environment of unnecessary nonsense and building my confidence and self-esteem.

    Take care and good luck...

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  80. @Kim thank you for the interesting perspective. I'm definitely going to look up that book and do some research on adrenal and how it might relate to my hypoglycemia too. I absolutely agree about removing toxic people and situations from your life and focusing on the positive surrounding us - for both physical and emotional well being.

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