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Thanks so much. I do plan to do exactly what the Dr tells me to do. I really need to do this. I was scheduled to do surgery in 2008 and at the last minute my thyroid test came back Hyperthyroid. I had been having issues with my heart rate and BP going up but not much weight loss. The Drs couldn't believe I had Hyper thyroidism (Graves Disease) and not hypo since I was a big girl. I had to have it ablated with radiation and now I'm on meds the rest of my life for HYPO thyroidism. After having it ablated, I gained another 50 pounds. I'm devastated by the weight gain and I just can't lose on my own. This really is my last option. I keep praying for GOD's guidance and I have to have faith that whatever happens God is in control. Thank you for your comments. It helps alot.

It expands your stomach and since we have little room it can cause some serious issues. Also it is a big red flag as there is no nutritional value to it at all and pushes the need for artificial sugars or the refined sugar to the extreme. My nut told me that if she sees a patient who drinks soda of any kind it means they are doomed. I took that seriously. I do not drink soda of any kind. Others can handle it. Me nope, and now that I have hypoglycemia (reactive) It is no longer even a thought.

LMFAO, these are bringing back memories. Remember Hypo or Hyper shirts? I vcant remember what they were called but the heat from your hands or pits or something changed the color of the shirt. Like a mood shirt. Good times.....good times....

Without a doubt, if you choose to go to a Dr. outside the US, make your arrangements ahead of time. Not all surgeons in Mexico are out to screw you over, same as not all in the US are upstanding! So with that in mind, plan accordingly. My Mexican surgeon insisted before he banded me that I have follow up care closer to me. He helped me arrange that with the surgeon I would have used had insurance come through---he has done my fills without issue of my being banded in Mexico. Many will simply because that is where they were proctored in the procedure. Where I live there is no close Dr. dealing with bands, so even the one I found and use is over 6 hours away one way. So my surgeon also ask me to contact my local ER and find out about emergency unfills. They would not even talk to me, they did not refuse, they just blanket stated they could handle it. Well I knew from this board that is not always true. So I contacted my former oncologist, and they are adept at accessing ports, and he agreed to both speak with my surgeon in Mexico and provide an emergency unfill should I ever need it. Taking off blindly to have surgery with no details for aftercare is not something anyone should do....but it can be dealt with responsibly. One of my surgeons things he does is the morning you leave the hospital, you have a swallow test done under fluoro, so you get to see your band in place and working---and he gives you a copy of those X rays---for you to have if you go to another Dr. Some surgeons or Dr.s will see no one other than patients they have done. That includes patients banded in the US that have moved. So you do need to do some prep work before hand. My mantra to my kids was always to be proactive rather than reactive----it fits here too! Kat

Yeah I thought it would be okay for the steamed vegetables because I love them but then the nutritionist is like no absolutely nothing so I feel like they don’t really understand the reactive hypoglycemia and the terrible nausea.

I know someone through a WLS support group who developed reactive hypoglycemia after surgery. I think the best bet is to check in with your doctor. Good luck!

Hiya all, I'm new to here and just was wanting to make contact. I am insulin dependant diabetic with sever insulin resistance, I am 1 week away from rny surgery and on day 3 of the pre surgical prep. From what I have seen I don't really have much to moan about, as I am still able to eat actual food, but wondered..did anyone else have extreme cravings, headaches, insomnia, low mood, and agitation when doing the prep? Also did anyone feel just generally really unwell? It's only day 3 but it's kicking the hell out of me. I am able to have the following each day (which I know is more than most), but am worried that I am maybe eating a bit too much to shrink my liver, or that I am just getting it all wrong. The hospital have me the following diet: Breakfast - 1 weetabix Lunch- small portion of lean meat or fish, salad (no dressing), 2 crisp breads or a slice of bread Dinner- small portion of lean meat or fish, 3 small potatoes or 3 spoons of rice, vegetables 1/2 pint of skimmed milk per day (to be used in tea or coffee and my breakfast) A sugar free & fat free yoghurt No sauces no alcohol no fizzy drinks I had a hypo today I am currently 106kg, I weighed 122kg at the start of my journey 2 years ago. I have gone from a 44 inch trouser to a 34/36 inch. Am having the surgery for diabetes reasons not so much for weight loss. Thank you in advance for any replies xx Sent from my iPhone using the BariatricPal App

Some stretch, or growth or adaptation is to be expected - we don't stay at eating only 3 tablespoons forever. This doc gives a good idea of the progression of meal volume that can be expected, and is consistent with my experience - You may or may not get along with his prescription for countering this effect, but it is a viable one. In short, we need to learn to accommodate some increase in eating volume without allowing the calories to get out of hand - taking up that added volume with high bulk, low calorie veg is a good way to do it. As to which procedure to go for a revision, the first thing I would want to know is whether the stretch that your doc sees is unusual - sleeves done by docs early in the learning curve of doing sleeves (and 2012 is consistent with that for many surgeons) may have undue stretch if it wasn't formed well to begin with. Sometimes excess fundus (the stretchy part of the stomach that is largely removed with the VSG) is left behind at the top or bottom of the stomach, or other shaping issues may lead to the problem. If the sleeve is nominally well done, there is probably little to gain be resleeving it - you will lose some at the outset from low capacity due to surgical inflammation and the very restricted diet that we have early on, but overall you shouldn't expect great things from it. Likewise, a bypass is similar in its overall power to the sleeve, but does have some temporary caloric malabsorption that can help get a little extra weight off, but doesn't do any better when it comes to resisting regain; in some patients it is worse in that regard due to reactive hypoglycemia inducing more inter meal hunger. Overall, when I think in terms of revisions, I see a procedure that is more complicated than the original virgin WLS, and usually less effective overall (think in terms of your stomach originally having a capacity of 32-64 oz, and now a few years post op it may have a capacity around 6 oz, so there is less difference to play with. Being more complicated both in implementation and in the reason for doing it in the first place, I like to get a second, or even third, opinion on the matter - different surgeons have different experiences and perspectives on these things. There is also the aspect that while doing a virgin sleeve is a fairly straightforward procedure, and most surgeons are now fairly well up the learning curve in doing them, repairing or revising a faulty sleeve is another matter, so I would look to a surgeon who has done lots of them. In NJ, I would suggest Dr. David Greenbaum as a good guy to consult with. A final thought - what is the capacity of your sleeve now? How much chicken or steak (and nothing else) can you comfortably eat? We usually remain fairly restricted on firm meats for a long time, but can eat an almost unlimited amount of "sliders" - things that just slide on through with limited restriction, which are frequently also pretty junky.

I had mini-gastric bypass in September and started having issues with reactive hypoglycemia after only 4 mos post op. I had revision surgery after having a band for 10 years. I originally planned to get a gastric sleeve, but the surgeon strongly recommends the bypass for patients who are insulin resistant (I'm prediabetic and have PCOS). The hypoglycemia can be scary and I find my diet is now far more restricted than a Type 2 DM diet. I've seen an endocrinologist and am managing with diet (low carb, no simple sugars, high protein, regular snacks) and with taking Glucobay 4 x/day and a calcium channel blocker at bed time. I have to tell you, I regret not getting the sleeve and wish I'd been informed of this relatively common phenomenon prior to surgery (it's connected to late dumping in my case). However, one must weigh the pros and cons. I wish you all the best outcomes. Kerri

there are different kinds of hypoglycemia. the only way to know what kind you have is to get a monitor and start checking your BGL and see how food and eating and not eating is affecting you. you might just need to adjust how and when you are eating, you may have reactive hypoglycemia, or something else. the only way to know is to track and get info.

Hi; I have not read about this topic on here and so I thought I would share my latest health issue. I found this article on it and thought others might find it interesting because it does happen to WLS patients more then you think! What is reactive hypoglycemia? After bariatric surgery you may experience reactive hypoglycemia: • Hypoglycemia means low blood sugar • Reactive hypoglycemia is having low blood sugar after eating a meal or snack This may happen after eating foods that are high in sugar or simple carbohydrates. It is thought to be related to dumping syndrome. How do I know if I have reactive hypoglycemia? You have reactive hypoglycemia if you have: • any symptoms listed below a few hours after having a meal or snack and • these symptoms go away after eating or drinking What are the symptoms of reactive hypoglycemia? You may feel one or more of these: • hungry • sweaty • shaky • anxious • dizzy • weak • sleepy • confused What should I do if I think I have reactive hypoglycemia after having a meal or snack? Having low blood sugar is not good for your overall health and can be life-threatening. • If you think you have reactive hypoglycemia, check your blood sugar. • If your blood sugar is less than 4 mmol/L, you need to treat it to bring your sugar above 4 mmol/LWhat is reactive hypoglycemia? After bariatric surgery you may experience reactive hypoglycemia: • Hypoglycemia means low blood sugar • Reactive hypoglycemia is having low blood sugar after eating a meal or snack This may happen after eating foods that are high in sugar or simple carbohydrates. It is thought to be related to dumping syndrome. How do I know if I have reactive hypoglycemia? You have reactive hypoglycemia if you have: • any symptoms listed below a few hours after having a meal or snack and • these symptoms go away after eating or drinking What are the symptoms of reactive hypoglycemia? You may feel one or more of these: • hungry • sweaty • shaky • anxious • dizzy • weak • sleepy • confused What should I do if I think I have reactive hypoglycemia after having a meal or snack? Having low blood sugar is not good for your overall health and can be life-threatening. • If you think you have reactive hypoglycemia, check your blood sugar. • If your blood sugar is less than 4 mmol/L, you need to treat it to bring your sugar above 4 mmol/L. Follow the steps on the next page. If you do not have a meter, talk to your family doctor, health care provider or the diabetes educator in the Bariatric Clinic to get a meter. When your blood sugar is less than 4 mmol/L: 1. Take 15 grams of a fast acting carbohydrate right away. This will raise your blood sugar quickly. Examples of fast acting carbohydrate include: • Chewing 3 to 4 dextrose or glucose tablets (read the label) or • Drinking ¾ cup (175 ml) of juice 2. Wait 15 minutes and check your blood sugar again. 3. If your blood sugar is still below 4 mmol/L treat again with one of the fast acting carbohydrates listed above. 4. Repeat these steps until your blood sugar is above 4 mmol/L. 5. If your next meal or snack is more than 1 hour away, you need to have a snack that contains carbohydrate and Protein that fits into the stage of diet you are at. Examples of Snacks are listed on the last page. You may feel like eating sweet foods like Cookies, cake and candy. Even though these foods are high in sugar and can raise your blood sugar, your blood sugar will go too high too fast which is not safe. This can then lead to another low blood sugar because too much insulin is released. How can I prevent reactive hypoglycemia? You can help prevent reactive hypoglycemia by following your diet guidelines for bariatric surgery. • eat 3 healthy meals and 2 healthy snacks each day • space meals and snacks 2 to 3 hours apart • eat protein at each meal and snack time • avoid skipping meals andsnacks • avoid or limit alcohol depending on what stage of diet your are at • avoid or limit caffeine depending on what stage of diet your are at • avoid sweets like cookies, cakes, candy, pop, juice and sweet drinks Instead of sugars and simple carbohydrates, eat complex carbohydrates because they release less sugar over a longer period of time. Having a complex carbohydrate with protein will slow this release even more. Try putting any of these together when they fit the stage of bariatric diet you are at: Complex Carbohydrates • whole wheat crackers • whole wheat bread • whole wheat pita • whole grain rice • potatoes • cereal Protein • nuts • cheese • meat • lentils • peanut butter • eggs • yogurt Here are some snack ideas to have after treating a low blood sugar: • crackers and cheese • pita and hummus • nuts and yogurt • melba toast and Peanut Butter

Yes it is called reactive Hypoglycemia. If this is true then it certainly would make me feel a little better, somewhat, maybe. I have to say though. I really really hate that word!

Sleevers are already losing the weight much quicker than regular dieting. Plus, the faster you lose the more loose skin you have when you're done. Malabsorption is neat in that it helps people lose weight, but you also lose a significant part of your intestines that help you absorb important Vitamins. That means you will likely have to increase the number of supplements you take. It's a personal decision, and RNY may be right for some people, but I guess the big points for me were: 1. No intestinal rerouting with VSG 2. Decreased ghrelin production - no hunger makes things a lot different 3. Generally no dumping with VSG - this sounds like it would make me miserable at work/school 4. Intact pyloric sphincter - this takes away the risk of stoma stricture/dilation 5. Fewer long term food/medicine restrictions 6. Delayed reactive hypoglycemia in RNY patients - scares me! 7. Losing weight fast can mean looking unhealthy even though you're skinny - someone called them "fat skinny people" on a thread the other day, which seemed to fit. People who lose weight but a lot of it is muscle, not necessarily the healthiest thing. I guess #1 is the biggest for me. Apparently I'm okay with the doctor taking out the majority of my stomach, but I really don't want them touching my intestines (Is that silly? =p). Maybe make a list of pros and cons for each and see how you feel about it after you lay out your options? You are not forced to have the surgery on the date you're scheduled if you are not sure/aren't ready. If you need to, give it some time. Maybe it is just nerves - I was scared as crap before the surgery and second guessed myself on and off, and now that I'm post-op, I'm really happy I did it. Feel better!

Whenever I go to see the surgeon's office, even though I am 27 months post-op, the word obesity appears on the forms. This threw me for a loop because I am no longer obese. It dawned on me that this is all about insurance. They have to code my visit for insurance billing purposes and since I had WLS, this is the best coding they can use. I was wondering about your hypoglycemia. There is one form that is tied to meals which is called reactive hypoglycemia. Reactive hypoglycemia (postprandial hypoglycemia) is low blood sugar that occurs after a meal — usually within four hours after eating. Low blood sugar (hypoglycemia) usually occurs while fasting. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, lightheadedness, anxiety and confusion. Someone told me that it is like a spike in blood sugar followed by a crash. If this is the type you have then you have a bit of control because you can time your meals.

Natalie - A PB is the result of the stoma or the entrance to the stoma getting clogged so that the pouch above the band does not empty. Stoma=the passage way between the pouch and your lower stomach. When something gets lodged in the stoma, or blocks the entrance to the stoma, food, Water and saliva start backing up in the pouch. If the obstruction doesn't get moved, eventually all the stuff you swallowed backs up into your esophogus and then your body reactively throws it back up. Usually the quick return of your pouch contents is considered a PB. Heaving repeatedly is considered more as vomiting, but in actuality both are technically vomiting. Chewing well and eating slowly helps eliminate the risk of blocking the stoma, but certain foods can recombine in your pouch and effectively make a thick paste/glue which doesn't easily pass through the stoma. Those types of foods are generally breads, rice, potatos and Pasta. Hope this helps...

Sorry you have been having some problems. Here in the U.S. we are required to have a lot of blood work done before surgery. This includes thyroid tests to make sure our thyroid is working properly. I was prescribed thyroid medicine 2 years ago (I don't remember if I was hypo or hyper) anyway, I hadn't been taking that medication and when I went for my recent test my thyroid was fine. I hope you get leveled out and start seeing the weight loss you are hoping for.

Ideally, doctors and anesthesia providers would ask you to quit for at least 2 months and closer to 6 months prior to elective surgery. However, we all realize that this isn't realistic for everyone. You should know that you get the most benefit for reducing complications related to anesthesia if you have quit smoking 8 weeks (2 months) prior to your anesthesia. What you do beyond that is really a discussion for you and your surgeon and anesthesia provider, but whatever you do, be sure you are honest about your smoking. It really impacts how your anesthesia care is provided and can really make a difference in how you do. They know what to expect better if they know you've smoked in the last month, or week, or 24 hours, rather than lying about it. Recent smoking can make your airway more reactive, more difficult to intubate, can make you more prone to bronchospasm and laryngospasm, and can alter your oxygenation capabilities, among other things. As far as the band itself, as others have said the only real effect would be on your wound healing post op.

Matt, thank you so much for taking the time to reply. My doctor told me about dumping syndrome before he did the surgery, but he emphasized that it would be caused if I ate sugary products (which I don't). I did a search of this site AFTER I wrote the hypoglycemia post (duh, I'm a new person here and didn't know I could search this site) and found almost 700 issues of people talking about "reactive" hypoglycemia (not fluctuating - which is what the doctor in the ER called it). With that new terminology I searched the web and found many scientific articles written since 2014 about this "new phenomena in gastric bypass patients." I'm really scared at this point, but I now see that I have got to find a gastroenterologist or endocrinologist to get some serious advice. I can't manage this on my own. I moved to a small town about three years after surgery and at that point was no longer followed by the physician who did my surgery. So, do you really think reactive hypoglycemia and dumping syndrome are the same thing?

The long term complications I've read about after gastric bypass and/or sleeve gastrectomy are nerve issues, dental problems (resulting in root canals, implants, dentures), reactive hypoglycemia, strictures, fibromyalgia, ulcers, fainting spells, chronic anemia, osteoporosis, etc. I don't know if MGB has the same issues as these other weight loss surgeries as there's a lot less info available online. One thought is the perception of risk could be skewed if more people that have issues post their experiences than people that don't have these issues. So I could be getting scared about possible outcomes that are very low risk. It's a conundrum I need to work through.

Some people experience reactive hypoglycemia after RNY gastric bypass surgery. This is irrespective of whether they had diabetes prior to surgery or not. Here is a link for symptoms. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

Aussikiwi, sorry to hear about your thyroid or lack thereof. I have heard that before. That little "innocent" butterfly, called the thyroid gland is a very powerful organ with or without it. I think you're right re: exercising for people who have been diagnosed with any form of dysfunctional thyroid disease, CA, hypo/hyperactive,,,, etc. Sounds like you're on the right track and I'm 3 days away of finding out. Thank you.

I know this thread is pretty old but I wondered how you were both doing. Has your weightloss kept coming off? I'm 6 weeks out from my sleeve after having my band removed 4 months earlier, my surgeon said the band had slipped and there was a massive amount if scarring that he wanted to heal for a while before doing the sleeve surgery. I had my band for about 6 years and had not lost any weight after the first 20kg. I was happy enough because it at least stopped me putting on any more weight. I started having chest pains and after all the tests to make sure it wasn't my heart my band surgeon thought the pain could be due to my band so he ordered a barium swallow. The barium swallow technician found something far more interesting that he said I needed to get checked immediately. I had nodules on my thyroid. i had told my gp that I felt there was something wrong with my thyroid but he pretty much told me it was in my head. Anyway in a whirlwind week I was diagnosed with cancer and was in hospital having a total thyroidectomy and six weeks later high dose radiation therapy. My life has not been the same since. Even with the sleeve I can't loose weight. I found a really great dr who found out that my body didn't convert the thyroxin into the t3 hormone which is the active thyroid hormone that our body's use for everyday functions. I've been on that for 8 months and its made no difference. I still have all the hypo symptoms. Today he has decided that from looking at my blood tests my body isn't absorbing the t3 med so now he is changing that and increasing my dose. He says I should notice a huge difference in about a week and a half. I'm hoping that now instead of losing about half a pound a week through sheer starvation that my body will start releasing some of these terrible fat cells it seems to love holding onto. I'd love to hear from anyone else who had had thyroid cancer and been able to feel good again AND be successful with losing weight with their sleeve. Cheers Tracie

I was diagnosed hyperthyroid but all my symptoms match hypo. Does anyone else have had this? I am so confused, but I hope that my sleeve surg will affect.my thyroid positively. I will have it in april

Typically with reactive hypoglycemia, or even hypoglycemia for that matter, you would feel very shaky, racing heartbeat, you may be sweaty, and nauseous all before passing out. Typically you do not just faint. That could be blood pressure. But also I would think you would feel dizzy or lightheaded from low blood pressure. I hope whatever is going on you find out what is going on and it is dealt with.

I know only what I've read -- this condition afflicts some RNY patients (as I recall, it was in the double digit percent of patients) and also to some but fewer sleeved patients (single digit percent). I don't recall the numbers - sorry. As I recall, when it appears, it seems to be a major pain in the ass and is addressed to some extent by eating certain food combinations throughout the day -- not at the "grazing" level, but just strategic snacking. I've read several research studies on this condition. Here are a couple I remember finding earlier: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190577/ http://spectrum.diabetesjournals.org/content/25/4/217.full That's all I got. P.S. Of course, this may NOT be reactive hypoglycemia, but something else, including some kind of bug. But I knowyou'll let an M.D. diagnose what's going on with you. Best wishes.