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Disclaimer - I don't give medical advice. I'm just sharing my experience with this. I have reactive hyperglycemia. It started a year out. I am four years out. I'm still managing lows. Reactive hypoglycemia is your pancreas over functioning. Your pancreas will periodically dump a larger amount of insulin into your system. This is what causes low blood sugar. Treating/managing low blood sugars is not much different than managing diabetes. For me, RH is life long. My pancreas function is not going to change. You said " cannot/will not eat carbs and sugar" Try to get out of the mind set of "bariatric rules" You are treating a health issue. This is doable and you still can work your healthy plan. Keeping blood sugars level : I had a consult with a dietician outside of the bariatric program. I have a blood glucose meter. I test often. I eat five to six small meals (all within my calorie and macro range). I add Low glycemic carbs in small amounts and not every day or every meal. Example - One day no carbs the next day I will have small amounts with lunch and diner. Low glycemic carbs don't spike your sugars. (sweet potato, lentil, beans, brown rice, whole wheat and plant based (fruits veggies) I am carb sensitive. Carbs make me gain weight. My preference is to alternate days and meals and eat sweet potato and plant based carbs. Managing the low sugars: You will not be eating sugar daily. Just like a diabetic, Serious lows will involve real sugar to bring low's back up. Glucose tablets work. I can tolerate watered down orange juice. (full strength upsets my stomach) It may be trial and error to figure out what sugar choice works for you.

Being dizzy, lightheadedness, fainting can also be caused by low blood sugar. There is a condition that occurs in Gastric Bypass patients called Reactive Hypoglycemia. One man in our bariatric surgery support group developed that condition. After fainting one time, he figured out the cause and then learned how to control the condition. Here are a few links. https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass/ https://www.stjoes.ca/patients-visitors/patient-education/f-j/PD 7972 Reactive Hypoglycemia after Bariatric Surgery.pdf

Ok, so yes, I've had 1 episode of RH. Sorry you are dealing with this. But it's common. I would personally NOT add carbs. By keeping enough protein and fats in your diet to be truly keto, you will level and flatten out your blood sugar/insulin response. When you add carbs, you increase the amplitude of the blood sugar rollercoaster and the severity of the RH. The big thing to know is if you are truly hypo or if for some odd reason, you're turning into a T1 diabetic (not producing insulin) and that sometimes happens suddenly to adults. It's called LADA. But, if it were me (and it is), I'd buy a test meter and carry it with you at the first sign of symptoms. I'd buy packages of peanut butter you can squeeze into your mouth. And also carry glucose tablets in your purse. 5g of glucose tablets will raise blood glucose usually about 10points. So in an emergency you eat 2 of them and bam, emergency gone. Then you follow with a packet of peanut butter. Or nuts. Then you have to be on the lookout for the rollercoaster that "might" happen for the next day or two. I followed about two hours later wtih a very low carb, higher protein/fat mini meal. And had no other issues.

The thing I've found with hypos as a diabetic is they happen if I have a long gap between eating. So I would recommend splitting your calories into 3 meals with 3 snacks spaced evenly. Try eating some cheese and/or nuts for your snack (something with a bit of protein), and a smaller meal to balance the calorie load. Eg Breakfast 7.30am, snack 10.30am, lunch 1pm, snack 3.30pm, dinner 6pm, snack 8.30pm. You should still carry some fast absorbing sugar (eg glucose tablets) just in case. And do healthy carbs for your meal eg veggies and beans, mixed with your protein of course. Sent from my SM-G930F using BariatricPal mobile app

The general advice for a hypo ( non wls ) is to have something that is high in sugar and easy to absorb, liquid is better than solid. So orange juice, high sugar cordials etc ( avaoid carbonation). Alternatively foods such as honey or jam also wok quickly. Then once the person appears to be returning to normal it should be followed up with a good quality, low gi carb e.g a banana or whole meal bread sandwich. Obviously for wls patients i imagine the recommendations would be a little different . However it is still important to raise and stabilise the blood sugar.

In the Diabetic world we call them hypos. The difference is usually a timing thing. If you're dumping pretty soon after eating, try and lie down and take it easy for a little bit. If it's more than an hour after eating, your blood sugar may have dropped too low (due to increased insulin response to the sugar you ate earlier). In those cases, I do a spoonful of honey or juice or if I'm out and about I've even done proper (not diet) Coke. You need a bit more sugar in your blood but not too much or you'll start the cycle all over again. Sent from my SM-G930F using BariatricPal mobile app

I have reactive hypoglycemia (RH) (but not dumping - that is controlled by limiting your sugar intake). To control RH, my PCP suggested I eat some protein - or something along with protein - every 3-4 hours to keep my blood sugar stable. It seems to be working - it's really cut down on my "episodes".

If you are getting late dumping...or reactive hypoglycemia, keep something quick on hand to raise your blood sugar. I keep fairlife chocolate milk in my fridge. It is higher in sugar and carbs but also has some protein in it. I drink it as soon as I start getting heavy sweats, which is my first sign of low blood sugar. Once I drink some I feel better in 15 minutes.

OMG! I'm so sorry to hear of your kiddos both being T1!! So glad you knew how to manage it. It had to be so much tougher. And all the worrying about them! Jeeze!!! TY for the very useful advice!!! The frosting gel is a great idea! It's so weird about the "pee in your pants"! I woke up sweating profusely muttering about "so hot" and then I just sat there and couldn't move--like paralyzed and watching myself not do anything to help myself take clothes off. Then I had to pee SO BAD and almost thought I was gonna pee myself. It was that, that finally roused me enough to get up and move--cuz I didn't want to pee in the chair! OMG! That would have been terrible! So I stumbled to the bathroom and couldn't coordinate my hands enough to get my pants down. And I just had to start peeling layers off and I slung them all around the bathroom, just to get down to panties to pee! It was so weird, like I was trying to do stuff with mittens on or boxing gloves or something! That's why I think I was maybe in the 40s? Did not know of the convulsion thing. My mom had hypo. And when she bottomed out we knew to get OJ and peanut butter and follow the juice with the peanut butter. So once we had the bg reading, I stumbled into the kitchen and got out the pineapple juice and applesauce and drank the juice quickly and then the applesauce, then I followed with an ounce of cheddar and 1/2oz of almonds. Shoulda done the peanut butter but mine has sugar in it too...:( So I got some almond butter and will do that in future and also have a can of OJ beside me with my meter. I don't think I will be eating at that restaurant again soon! So sorry to hear of your scale woes! ((hugs)) It will move soon. I have great faith in you and your sticktoitiveness!!!! You rock!!! Thanks for posting that link. Will go check it out.

Morning folks. Sorry - gone all day with my 6month check-ups! Good news is that I have another 6 months under my belt of "dating NED" and am good for another 6months. Yippee! Interesting news is that I have to wear an "event monitor" to see why I'm having skipped beats, and we're trying to figure out how to get rid of my last bp med. More scary news...we went to a new restaurant for lunch yesterday and I split a cup of chili and burger balls and came home, fell asleep, and woke with a 36bg! I have my first reactive hypoglycemia attack and it was so so so scary. Sweating profusely, heart racing and skipping, shaking so much I could barely navigate or use my arms/hands, could barely coordinate a thought to speak. And had to forceably make myself go get a can of pineapple juice (only juice in the house) that I keep for making a marinade and some unsweetened applesauce to try to get my bg back up to normal. I was successful in doing that (thank you God). But holy whackadoodle! It was scary larry for a while. Also before saying BS, you'd be dead at 36bg, we use a Fora brand bg meter which I "think" may read low by 10-15points from bgs measured with drawn blood. But it was still very dangerously low, I'd say at least in the mid-40s to low 50s judging on how discombobulated I was and how bad I felt the rest of the day. I also got my fasting insulin back and it's awesome! It went down from 14 to 2!!! So my IR is in remission right now it looks like! IF appears to really be working metabollically for me. My bg this morning was 76. I am planning on doing an 18-6 today but will watch it. @GreenTealael so MAN! I can relate to your posts now about your RH or dumping. I think it may be very similar? How are all of you doing?

For me, sugar is sugar, my body doesn't care if it's from fruit or a packet. (I had VSG). Protein and fiber help slow down digestive emptying, so yes they might help. But higher protein/fiber shouldnt be justification to eat higher sugar. I have found the low glycemic foods to be "better". Once it starts, you just have to let it pass. For me, it's not consistent. It seems to happen with more liquid type foods and isnt always tied to grams of sugar. High carbs in general can do it, but high sugar always does. It sometimes seems random and I havent figured it all out yet. I can eat kit kats, but not drink a premier protein shake. I can't eat mashed potatoes or soup. Oatmeal is fine. I can eat dry cereal fine, but I cant eat it with milk. I also get late dumping/reactive hypoglycemia. Between 2 and 3 hours, my glucose crashes. It sucks. Sent from my SM-G965U using BariatricPal mobile app

Every person is different and everybody will have a different experience. I have never once vomited postoperatively, but I was never a person that was prone to having stomach issues pre op either. The only time I have experienced chest pain was after eating too quickly and you learn fast to slow down. Certain foods may cause discomfort at first...but you can try them again later if this is the case. As far as dumping goes, I mainly do not dump and can tolerate small amounts of ANY food so far. I have had several episodes of what I think may be reactive hypoglycemia but that’s another story. There are those of us out here that have had zero issues like myself. If you are close to surgery, avoid negative posts that discuss complications. Remember that people are more likely to complain about something than praise something. Go cruise Instagram for inspiration of those that have lost weight and share stories on there. Remain positive and remember that this procedure is a safe procedure with an overall low risk of complications.

The "Hair loss" is called Telogen Effluvium https://www.webmd.com/skin-problems-and-treatments/hair-loss/effluviums#1 It's not really "Hair loss" it's just a larger % of your hair follicles going into rest at once, so when they reactivate they shed the hair they were holding and that gives the appearance of "hair loss". Fear is normal, NSAIDs are not the only pain relief out there, there are options. Pretty much everything you've listed is normal fears, and pretty much, all of those fears, you'll laugh at down the road. I was 370 at my largest. I'm 210 now, I have some extra saggy skin, but it's really not THAT bad and it's totally hidden under even decently tight clothing. Just remember, staying overweight *WILL* kill you. If something was to happen during your surgery, the best place for that to happen, is in a hospital. No one but you can tell you if what you are going to do is right for you. You have to make that call. Weigh out all the pros and cons, and make your decision based on that, no one is going to look down on you for making the best decision for your life that you can.

RNY-to-sleeve revisions happen, but it's apparently mostly because of severe reactive hypoglycemia and other really weirdly specific complications. Sleeve-to-RNY is more common in part because the sleeve was eventually conceived as a safer surgery to give people with much higher BMIs, with the intention of converting them to RNY once they lost enough weight that that was a safe option for them. They started doing it as a standalone procedure when many of those patients opted not to come in for the second surgery, being successful with just the sleeve. But sleeve-to-RNY absolutely does happen, still, especially for people who have uncontrolled GERD or who can't lose enough weight with the sleeve alone. In my pre-op testing they found some small lesions in my esophagus, which might have been esophagitis or might have been a small amount of GERD. I went with the sleeve despite that, because I also have arthritis and might need to take ibuprofen and other NSAIDs again, ever, in my life. (Also, I had been taking large amounts of NSAIDs over a long period of time, and they may have been responsible for some of the damage they found.) I can't tell you how that turned out for me, since I'm only a week post-op, but I will say my doctor didn't try to sway me toward RNY at all, and given that I also had a hernia repaired, I'm pretty hopeful that it'll all turn out OK.

If it truly is reactive hypoglycemia, eating small meals and snacks more frequently will help. Eat a little something every three hours you're awake. Fasting would be contraindicated. A gall bladder issue would be an extremely common reason for the symptoms you are describing. Reactive hypoglycemia is possible, but is very rare and would surprise me. 25-30% of weight loss surgery patients who have their gallbladders develop issues requiring treatment. Gallbladder attacks are often set off by high fat, high protein foods. Sensitivity to eggs is often reported. Nuts, too. Spicy foods and fatty processed carbs can set off attacks as well. Talk to your doc. If it's gallbladder....it's a horse in a field of horses. If it's reactive hypoglycemia it's a unicorn.

Well I'm up late for a terrible reason. But I thought I should leave record of this because you don't see it on the boards often. I had VSG but I have the unfortunate side effects of dumping and late dumping possibly even reactive hypoglycemia. I need to confirm the later with my doctor the next episode. The very first time it happened or that I can remember, I was 4 months post of in Naples. I was taking a coffee and felt a wave of flush wash over me but it disappeared immediately. Thought nothing of it. The next time I was in Paris, Nothing out of the ordinary lol. I had a pettit croissant and then a spoonful of panna cotta and I thought I was dying. Not exaggerating. Room spinning, heart racing, sight failing all in french subtitles. Took an hour to pass in a highly ornate turn of the (17th) century bathroom. The next few times I was on home soil eating (safely/properly cooked) homemade curried chicken breast. Then roasted lamb, next a tossed salad , then means and even once Greek yogurt! But not dessert/pastries again? Whatever...I'm sure it will happen again Absolutely no rhyme or reason. Every time it happens now I can't predict why, when or what foods will cause it. Just tonight peanuts and salmon pate. My usual suspects. I nearly went to The ER, it was that bad but I passed out in bed. Well now I'm awake to tell the tale. So I maybe a unicorn, who knows, but if you are banking on VSG not causing dumping syndrome, you may be surprised...

I'm a Type2 and had a lapband back in 2009, starting at 153.5 kilos. I lost 20 kgs. However I had a lot of problems (sprung a leak in the tubing in the beginning and it never really worked for me) so I'm having a revision to mini gastric bypass. The thing with my diabetes is I get hypos if I eat high carbs (sugar) and then nothing else for ages. So eg. a croissant for breakfast and then by 1pm I'm having a hypo. My theory is that the body overshoots the insulin for the croissant so I have too much floating around that has nothing to do but send my blood sugar crashing. When I go keto, eg keep carbs to between 20 and 50 grams a day, I simply don't get hypos. So you may find the problem for you is too many high sugary carbs and surgery and limiting your carbs will really help re: hypos. My doc says they perform this surgery specifically to send diabetes into to remission, so it's definitely something to consider. Many blessings Sent from my SM-G930F using BariatricPal mobile app

CHART 1 Correlation of nutrient deficiency and its cutaneous repercussions NUTRIENT Biotin Alopecia, glossitis, keratosis pilaris, periorificial dermatitis, seborrheic dermatitis and erythroderma Copper Depigmented and thinning hair, alopecia, delayed wound healing Iron Pallor, koilonychia, glossitis, alopecia Selenium Delayed wound healing, psoriasis, skin cancer Vitamin A or Retinol Xeroderma, acne, brittle hair, and keratotic follicular papules most commonly in the anterolateral surface of thighs and arms, which may spread to the extensor areas of the upper and lower limbs, shoulders, abdomen, dorsal region, buttocks and neck; phrynoderma Vitamin B2 or Riboflavin Mucositis, lip and angular cheilitis, glossitis, xerosis, seborrheic dermatitis, scrotal and vulvar eczema, erythroderma and toxic epidermal necrolysis. Vitamin B3 or Niacin Pellagra, photosensitive dermatitis in symmetric areas, cheilitis, glossitis. Vitamin B5 or Pantothenic acid Purpura, leukotrichia, seborrheic dermatitis, angular stomatitis and glossitis. Burning feet syndrome. Vitamin B6 or Pyridoxine Seborrheic dermatitis, glossitis, oral mucosa ulceration, lip and angular cheilitis, photosensitive pellagra-like lesions Vitamin B9 or Folic acid and B12 or Cobalamin Lip or angular cheilitis, Hunter's glossitis; diffuse, symmetric hair and mucocutaneous hypo-and hyperpigmentation Vitamin C or Ascorbic acid Poor wound healing, keratosis pilaris, perifollicular petechiae, ecchymosis, purpura, brittle hair, scurvy (gingivitis, bleeding gums, keratosis pilaris), Sjogren-like syndrome Vitamin D Atopic dermatitis, psoriasis, skin infections, acne, autoimmune cutaneous diseases and skin cancer. Vitamin E Atopic dermatitis, acne. Vitamin K Purpura, petechiae, ecchymosis, hematoma Zinc Acrodermatitis enteropathica (alopecia, acral and periorificial symmetric, erosive and eczematous rash), dry, brittle and thinning hair, delayed wound healing, paronychia, stomatitis, psoriasiform dermatitis, blepharitis, angular cheilitis, vitiligo-like lesions Protein Aged appearance, erythematous or hypopigmented lesions most evident in flexure areas; hyperchromic lesions with smooth, fissured or erosive surface; brittle, slow growing nails, onychomadesis; follicular hyperkeratosis, pale extremities accompanied by edema; dry, brittle, dull, and thin hair, with brownish-red color before becoming grayish-white, flag signal with alternating dark and light stripes in the hair; angular cheilitis, xerophthalmia, stomatitis, vulvovaginitis

I loved all these different replies and it just goes to show that we are all so different in the way we are made and in the way we react to the surgery. My son, who is 20 years younger than me, has not had any problems from day 1 post-surgery. I think he could eat the kitchen sink and not have a reaction (he has kept his weight off, too). I, however, have had many problems with different foods and medications and other complications (low iron, anemia, reactive hypoglycemia, nausea). I wonder if our age at the time we had the surgery comes into play here.

The science does not support that high of stats on reactive hypoglycaemia in bypass patients. It seems in your case, you did not continue to have it with the sleeve, but now need the rny to combat something causing you daily pain and a definite issue. I would go with fixing the current known issue.

We had one individual in our support group that developed reactive hypoglycemia after gastric bypass surgery. He even fainted. As a result he looked into the condition and found that he could easily control it with his eating habits and by being sensing the pretriggers to the condition. So it did not really bother him except for the first time it happened. The figure you cited "happening to 1/3 of bypass patients" seems overly high. I would not give it much weight. But since you experienced this condition before, it might be more of a concern in your individual case. It is your decision, but if it were me I would eliminate the Gerd by gastric bypass and be hyper-vigilent about monitoring the potential for reactive hypoglycemia and using dietary means to control it should it arise.

Here is where you weigh out the risks. I bet the risk of getting reactive hyperglycemia is a lot lower than the risk of weight related heart issues, diabetes, knee and back issues... etc etc etc. So, weigh out the risks and make the call. Personally, some ultra rare issue that almost no one experiences... isn't enough of a risk to outweigh all the things that WILL happen if one continues to be overweight.

So I was reading an post yesterday and now I am having serious second thoughts. I may not even show up tomorrow to surgery. The post was about Reactive Hypoglycemia, a side effect to bypass that can develop 2 the 10 years post bypass. In the post, the patient had symptoms 1 to 2 times a year at first and now is having them 2 to 5 times a week. Patient occasionally passes out because of it. When I had my sleeve six years ago I had experienced those symptoms and I just thought it was because I forgot to eat. It was a weird feeling of dizziness, confusion, and I was with a client at the time and I nearly passed out. It scared the crap out of me. I started doing research online and discovered an article from 2017 that identified that this is happening to 1/3 of bypass patients and is not something that is discussed typically with there doctor. Reactive hypoglycemia may be related to dumping syndrome but can be far more dangerous. In extreme cases the bypass needs to be reversed to fix the problem which brings me to my fear. In my case they will not be able to reverse my bypass after I have it as they are removing the stomach because the polyps I developed taking PPIs for Gerd. So now my challenges is do I live with Gerd and run the risk of getting Barrett’s syndrome and Possible esophageal cancer or do I have a bypass and run the risk of getting reactive hyperglycemia ? Thoughts anyone?

It's so good to find someone with a similar problem (though I am really sorry you are experiencing this). A friend gave me a glucometer but I drove myself crazy with it and finally gave it back. I can tell by my symptoms that I am about to have an "attack." I have discovered that the correct term is "reactive hypoglycemia" and it first started showing up around 2005. Then it started being reported at scientific conferences and being written up in peer-reviewed scientific journals starting about 2012 (all this discovered from a search on the web under "reactive hypoglycemia post gastric bypass surgery"). It's can also be called "late dumping" although diarrhea and stomach cramps don't seem to be associated with it. It is most prevalent in gastric bypass patients. I think I mentioned earlier in a post that I only had these episodes once or twice a year until this year. Then, after shopping with a girlfriend all day, we stopped at McDonald's and got a large mocha frappucinno. At her house my lips started going numb and then I didn't really know who I was and could not talk straight. Her husband was a diabetic and for some reason she decided to check my blood sugar which came in at a whopping 34. Off to the ER where the physician on call told me it was "fluctuating hypoglycemia." I am searching for an endocrinologist or gastroenterologist now to see if I can get some help for this. In the meantime I am reading everything I can about what foods to eat. "Protein first," all the articles say coupled with a food that has a low glycemic index (I still don't know what that means). Searching for the sweet spot in the management of this condition!! We can journey together. Thanks for sharing.

I'm 14 years out from gastric bypass surgery (RNY) and still get nauseated when I eat meat and many other things that I won't bore you with. I still have a protein drink every single day to compensate for the loss of protein from meat products. A young woman stopped by my house the other day asking for advice. She was six months out from surgery and still experiencing nausea with most foods, especially meat. Why would your doctor think your throat had suddenly gotten too small when you have been eating all your life prior to surgery without this issue? I don't think so. My son had this surgery and he doesn't have any problems at all. Yet I have a lot of nausea, reactive hypoglycemia, trouble with low iron and a couple of other things. Each of us is different. Most doctors don't seem to know that!! Give it time. Take it slow. Very slow.