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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.

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?

You have forgotten to relax and trust your team! Don't pack a ton of stuff. In between walks, try to sleep. You're going to be loopy as all get-out anyway. Don't buy anything new like a phone charger for one night. You're overthinking - big time. Buying more stuff might make you feel like you're getting prepared, but it's not necessary. No regular socks, they won't let you wear them. Bring a hairbrush, toothbrush. Don't bother with makeup. I wore the hospital gown for my entire stay. I didn't want to bleed all over my clothing. You might bring a shawl for your shoulders. Any type of garment with sleeves is a pain because you'll have an IV. If you use hypo-allergenic wipes, I'd bring those. Just take a deep breath, you're going to be fine. We're all in your corner!

As Fluffy said, differences for different programs - and also for different individual needs. I never worried about carb or fat counts as those don't bother me, just calorie count as that is what ultimately drives the weight loss. There is too much good nutrition associated with foods that are nominally carbohydrates for it to make sense to place arbitrary limits on them; on junk food (high calorie/low nutrition stuff) yes, but not solely on the basis of something being high carb or fat - the calories are an adequate limitation. With your bypass, however, and the prospect of dumping or reactive hypoglycemia, a reasonable carb restriction can be in order, particularly for simple carbs and/or sugars, at least until one figures out ones' individual tolerances.

Disagreements on opinion are allowed, personal bashing and bullying of individuals is not. Everyone here is entitled to share their opinion, but if the opinion differs from your own it is no reason to become so reactive. Good day.

My mother, grandmother, and great-grandmother had Hashimoto's. I have it. Surprisingly, it skipped my daughter. You might have Hashimoto's thyroiditis. It tends to pass to females. You need a simple antibody test to confirm the diagnosis. Depending on your age, you might still be flip-flopping from hyper to hypo. You're probably in a hypo state now.

Sorry to hear about your scary episode. It is a little bit common for some individuals to experience a type of hypoglycemia called "reactive hypoglycemia". It seems a little soon because you are less than 5 months post-op. But in your case the alcohol may have played a part. I remember the first time I had a little wine post-op, it almost threw me for a loop. Here is a couple links to the condition. 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

The following is a list of abbreviations commonly used on this board. ACL = Anterior cruciate ligament AGB = Adjustable gastric banding AMRAP = As Many Rounds As Possible (crossfit) AT = Aspiration Therapy BB = belly button bc = because BCBS = Blue Cross/Blue Shield BDD = Body Dysmorphic Disorder BED = Binge Eating Disorder bf = best friend BM = bowel movement BMI = Body Mass Index bp = blood pressure BPD = Borderline Personality Disorder or Biliary Pancreatic Diversion bs = blood sugar btw = by the way C25K = Couch Potato to Running 5K CBT = cognitive-behavioral therapy CC = common channel c diff = clostridium difficile cos or cuz = because CPAP = continuous positive airway pressure CRNP = certified registered nurse practitioners CT = Computed Tomography (commonly called CAT Scan) cw = current weight CXR = Chest X-Ray DDD = degenerative disc disease Dr. = doctor DS = Dumping Syndrome or Duodenal Switch EBT = Endoscopic Bariatric Therapies EGD = Esophagogastroduodenoscopy EKG = Electrocardiography ER = emergency room ESG = Endoscopic Sleeve Gastroplasty ff = fat free f/u = follow up GB = gastric bypass GERD = gastroesophageal reflux disease GI = gastrointestinal GIF = Gastric Intrinsic Factor GNC = General Nutrition Corporation store GP = general practitioner or family doctor HBP = high blood pressure hr = heart rate hw = highest weight ICU = Intensive Care Unit Idk = I don’t know IGB = intragastric balloons IF = Intrinsic Factor IMHO = in my humble (honest) opinion IMO = in my opinion IUI = Intrauterine insemination LAP Band = Laparoscopic Adjustable Gastric Band LES = lower esophageal sphincter lol = laughing out loud LSG = Laparoscopic Sleeve Gastrectomy med = medicine MFP = my fitness pal MGB = Mini Gastric Bypass msg = message NAFLD = nonalcoholic fatty liver disease NASH = Nonalcoholic steatohepatitis nf = non fat NG = Nasogastric NP = nurse practitioner NSAIDS = Non-steroidal anti-inflammatory drug NSV = non-Scale victory (“scale” means “weight scale”) NUT = nutritionist OA = Overeaters Anonymous omw = on my way Onederland = a magical place or destination for those trying to lose weight. It might correspond to attaining a weight in the hundreds or losing a hundred pounds. op = operation OSA = Obstructive Sleep Apnea OTC = Over the counter Oz = Australia PB = Productive Burps PCOS = Polycystic Ovary Syndrome PCP = Primary Care Physician PICC= Peripherally Inserted Central Catheter PM = private message (email) PMS = premenstrual syndrome POSE = Primary Obesity Surgery Endolumenal postop or post–op = post-operation or post-surgery PPI = Proton Pump Inhibitors ppl = people preop or pre-op = pre-operation or pre-surgery PTSD = Post-Traumatic Stress Disorder PVC = Premature ventricular contractions RA = Rheumatoid arthritis RH = reactive hypoglycemia RN = registered nurse RNY = Roux-en-Y RTD = ready to drink Rx = Prescription medicine RYGB = Roux-en-Y gastric bypass SADI-S = single anastomosis duodeno–ileal bypass with sleeve gastrectomy s/f or sf = sugar free SG = Sleeve gastrectomy SIPS = stomach intestinal pylorus-sparing surgery smh = shaking my head, scratching my head SO = significant other SOB = shortness of breath st = stones (a unit of weight measurement) sw = weight at surgery tmi = too much information TPN = total parenteral nutrition TT = tummy tuck TTC = trying to conceive Ty = Thank you. [but according to the urban dictionary “Ty” is also an abbreviation for “a total stud with a massive carrot”.] u = You UGI = Upper Gastrointestinal VSG = Vertical Sleeve Gastrectomy Vit = vitamin wks = weeks WLS = Weight Loss Surgery WOD = Workout of the Day w/o = without wt = weight

I originally wanted a sleeve; however, the surgeon strongly recommended a mini gastric bypass owing to my history of insulin resistance (PCOS, gestational and prediabetes). I heeded his advice; however, am now dealing with significant reactive hypoglycemia. This results from carbohydrates being rapidly absorbed causing immediate high blood sugars and then rapid reactive lows. These lows can be unpleasant and sometimes scary. I'm now on a drug that slows the absorption of carbs, but I have to take it every time I eat and there are some unpleasant side effects. So while I'm generally happy with the results of my surgery (I'm within 5 pounds of my goal), in my situation I do wish I'd gone with the sleeve.

I don't know how many are "many" (there is something called "adverse selection" that is common in online forums, where negatives outnumber positives because everyone with a complaint will post about it, but those with nothing to complain about are largely silent, so things tend to seem worse than they are,) but it does happen for a few reasons. The sleeve is predisposed do reflux problems due to its geometry and physiology. The volume of the stomach is reduced much more than the acid producing potential, so it takes a while for the body to adapt, and sometimes it doesn't. Also, the sleeve is considered to be a "high pressure" system in that the stomach is often closed off by the pyloric valve at the bottom, so excess gas, fluids or solids have no place to go other than back up; the bypass is a "low pressure" system as there is no pyloric valve in the system, so excess gas can vent down into the intestines. In contrast, the RNY due to its geometry and physiology is predisposed to dumping, marginal ulcers, reactive hypoglycemia and bile reflux. With either procedure, this does not mean that everyone will experience these problems, just that this is the natural result of the anatomical changes that have been made. Another compounding factor with the sleeve is the relative experience level of the profession - in the US, the sleeve has been routinely approved by insurance for about the past 6-8 years, while the bypass has been routine for around 40 years. This means that there has been some revisions needed due to inexperience in some of those early sleeves - the surgeons may have been well experienced doing bypasses and bands, but a new procedure, even a straightforward one such as the sleeve, brings along its own subtleties and nuances that take practice to master. Resultant shaping issues can promote or exacerbate the reflux problem. In the US, most bariatric surgeons are now far enough up the learning curve that most are now making routinely making functionally competent sleeves (one should always seek out a surgeon who has several hundred of whatever procedure one is interested in under his belt.) However, now the problem is, as it has been since early on, is that many are not very experienced in correcting any problems that may crop up with a sleeve, so the natural inclination is to stick within their comfort zone and revise to a bypass when a problem occurs, rather than correct the sleeve. So yes, the OP is correct in some respects that there are some unnecessary revisions being done, though not necessarily just for the sake of charging for two procedures. As time marches on and the industry gets more experience with sleeves, I would expect that the revision rate will decline as both the sleeves will be made better overall, and the surgeons learn how to repair them when necessary rather than revise them, much as the bypass has matured over time and some of its predisposed problems are less common as they have learned how to mitigate them to the extent they can (bile reflux isn't too common anymore as they have worked out techniques to minimize its occurrence, for instance.) Another factor that may skew the impressions some is that the bypass is a difficult procedure to revise - it is something of a dead end surgically speaking. If poor weight loss performance or regain is experienced, there is little point in reversing it and revising it to a sleeve as they are both so similar in performance that there isn't much to be gained. There are minor tweaks that are offered - tightening of the stoma or intalling a band over the bypass - but overall results are generally pretty poor. Revising it to a DS, which can offer improved weight loss and regain resistance, as well as diabetes remission, is a very complex procedure that only a handful of surgeons are capable of performing. So, we don't see a lot of bypasses revised for that reason, though sometimes they are reversed if there are significant complications that can't otherwise be resolved, though that isn't a trivial option, either.

Several individuals that undergo bariatric surgery experience a type of low blood sugar after the surgery. It is known as reactive hypoglycemia. This is independent of whether you were diabetic prior to surgery. Here are a couple links to the condition: https://www.ridgeviewmedical.org/services/bariatric-weight-loss/enewsletter-articles/reactive-hypoglycemia-postgastric-bypass https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

The regulation of type I and type 2 will differ as yours is autoimmune and mine is metabolic. You do not have any information on your profile so not seeing how much you currently weigh. I am still very large at 265 lbs. As my weight comes down my BG will also change as it has already changed due to weight loss. I am taking a lot less insulin now than 5 weeks ago. The ultimate goal is NO insulin resulting from a large weight loss. I know its possible. When my BG gets to 5 I start to feel hypo. Everyone is different I really wish that I could just 'go back' to protein shakes. Very early post op i could not eat or drink much. But the hunger I am experiencing NOW is what is throwing me off and I am trying to satiate myself. I did not get to almost 300 lbs because I decided I could just not eat. Said no morbidly obese person. LOL that is funny. I am going to check with my doctor in Mexico if they will allow me to take an appetite suppressant since my blood pressure is now very good

I would test before Breakfast and 1 hour after dinner. You want to take advantage of what little info you are able to gain. What is your typical fasting blood glucose level? Those are exactly the times that I test. Post surgery my BS is about 12 for fasting. I purposely do not take a lot of insulin at night because I live alone and if I go hypo there is no one here to help me get glucose or shake out of it if I am sleeping. I am happy with 8-10 for fasting levels right now I was a completely out of control diabetic. I only started to reign it in about 4 months ago when I had my ah ha moment. In my out of control days I was regularly at 26-31 at night and fasting levels of 18-23. Crazy numbers

Also, its possible your diabetes would be better controlled if you did cut out the carbs. A lot of what you mentioned in your diet is carb based. If you aren't using appropriate insulin to counteract the carbs, then you'll never get it in control. That is true. Remember I ate what was left around the house and from when my parents were here with me but they have returned to Canada now. I really don't know how much insulin to take based on a new restricted diet. I used to take 70 units of long acting and 50 units of rapid acting in the morning and at night when I was close to 300 lbs. Now I am taking 35 units of long acting in the morning and 20 units of rapid acting at night (so I don't go hypo when I sleep) But I am reaching between 15-18 in my glucose readings by the time I take the rapid acting at night. So today I took 40 units of long acting to see if that works better

Congrats! Only 17 days! I think it really doesn't "get real" until you are in pre-op getting poked and prodded. Yes you can experience hair loss, you can attempt to reduce this by making sure your protein levels stay high through out the process, you can take Biotine supplements as well, but the sad fact is, this doesn't guarantee you won't lose hair. It's not even really "hair loss" because you aren't really losing hair... like we typically think of when we hear "hair loss" it's not generally not permanent. the loss happens because surgery causes your follicles to enter a rest phase, which is normal, but the shock causes more of them to go into rest than normal. So when they finally reactivate, they push out the hair they were holding onto, in order to grow a new strand. Since a larger than normal percentage of follicles are doing this at the same time, the appearance of "hair loss" happens. The hair generally grows back normally.

Hair loss is common, however it's not exactly "hair loss" in the normally used sense. Your hair is thinning because surgery caused your body to trigger a "rest phase" on more hair follicles than would normally be at rest. When they reactivate, they shed the hair they were holding. This appears to be "hair loss" in reality it's just a larger percentage of the normal shed process happening at once due to the surgery. Good news is, the condition is seldom permanent and re-growth typically is complete. It's just going to take some time to get all that hair back to your preferred length. I'd avoid any cosmetic tattooing for at least 6 months to a year to allow your body to get back to normal. I'd hate to hear that you had the tattooing, then your hair grew back and it looks silly or funny now.

I was about 220lb and 5'2'' prior to my MGB last September. I look fine and feel good around 150lb and since this is my 2nd go round with WLS (I had a lap-band reversal in 2016 due to malfunction- regained a bunch of weight), I knew that the weight wouldn't come off as fast or as easy. I'm also in my mid 40's. So my goal is pretty conservative. The surgeon made my pouch pretty "generous," so I can eat a relatively decent amount of food (at least a cup almost from the get-go). However, my diet needs to be something that I can live with in the long term and life with food is good for me now. I eat a healthy diet (which I never could with lap-band), avoid simple sugars (I've been having issues with reactive hypoglycemia and I'm also a "dumper") and I continue to exercise 5-6 days/week as I've done for the past 12 years. My advice is to not worry about charts and BMI's. See where you're body leads you and think of the long game. We know that dieting and restriction doesn't work in the long term and usually eventually leads to regain. You need to find a way of eating that is liveable for you.

I am more than 14 months post-op. I do not dump, which happens to approx. 30% of gastric bypass (RNY or MGB) patients typically after consuming sugar. Nor do I experience Reactive Hypoglycemia (RH), which may show up 1+ years after gastric bypass; it is low blood sugar occurring 1-3 hours following a meal. Eating too fast or not chewing food properly and then getting the foamies and/or needing to vomit is not the same thing as dumping (aka rapid gastric emptying). Make sure you’re eating small, moist portions of protein and to eat slowly, and then these incidents should abate. Good luck.

I'm a pretty solid atheist (despite my mother's best efforts), and for the first few years after making that public declaration I was pretty reactive to all "I'll pray for you" or "God bless you" or other religious-themed messaging, but I think it was residual irritation from the same feelings that made me leave religion in the first place. Basically, I stopped going to church quite young because I knew bone-deep that I did not believe any of the same things that the people around me believed, and it felt wrong to fake it or even to be silently present. It's just weird to sit in a group of adults who have gathered to profess earnest faith in something that you think is unreal, it makes you feel uncomfortable and vaguely feels like you're gently mocking them (you're NOT mocking them, but the feeling is too close to when you're playing with children who have very firm rules and opinions about a game of make-believe, and you don't want to treat religious adults like children, so everything can get pretty uncomfortable). So I think when I fixed myself solidly in the secular world, I resented it when people thoughtlessly brought their religious talk into my newly-fixed sphere. Along the lines of "hey, I respectfully didn't bring up science and the fallibility of the Bible in the spaces where you worshipped something I don't believe, so have the same respect for me in my non-religious spaces". Eventually I mellowed and decided that a lot of religious jargon is just another way for people to say "I'm thinking of you". I mean, there is a certain quality of tone - you can definitely tell the difference between an "I'm telling you that you're important to me and in my thoughts" and an "I am holy and godly and this is another way that I make myself feel good by being publicly pious you heathen" type of pray-for-you - but overall I can mostly shrug it off as a turn of phrase. Part of the mellowing may have occurred from living in areas with not just a huge variety of religions but also some non-Judeo-Christian cultures and languages sprinkled in, so you eventually get used to people just using their own heartfelt phrases to indicate that they value you and want you to know that. (I mean, I never realized that watching a couple of teenagers shout and stomp and stick their tongues out at a suited man in an airport would make me tear up with emotion, but then I was regularly exposed to hakas.) At a certain point it's all just habit, it's the intent that matters. Except for the church ladies who are engaging in holier-than-thou posturing. THEY can cram it, but then again, don't we all feel that haughty better-than-you people can cram it in general? Some people just use religion to do it.

Hey folks, I will be following here. I have had reactive hypoglycemia in my past, pancreatitis in 2015 and am the adult child of 2 diabetics, not diabetic yet another reason why I have an upcoming RnY b.s. instead letting my faulty sugar heredity catch up with me So this subject resonates with. me so hard even you can feel the vibration.

https://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/{1dc23215-49dc-4ad7-90da-346ba16663d6}/post-gastric-bypass-hypoglycemia-a-serious-complication-of-bariatric-surgery Bypass people have more hospitalizations for hypoglycemia and tend to have more severe symptoms, but sleeve folks can get it, too. Research on this complication is ongoing. Of 175 eligible patients, 120 were randomized 1:1 to RYGB or SG; 117 (93%) completed the 12-month follow-up. Reactive hypoglycemia was detected in 14% and 29% of SG and RYGB patients (P = 0.079), respectively, with the effect of treatment in multivariate analysis significant at P = 0.018. Daily hypoglycemic episodes during continuous glucose monitoring did not differ between groups (P = 0.75). Four of 59 RYGB subjects (6.8%) had 1 to 3 hospitalizations for symptomatic hypoglycemia vs 0 in SG. The static β-cell glucose sensitivity index increased after both treatments (P < 0.001), but the dynamic β-cell glucose sensitivity index increased significantly in SG (P = 0.008) and decreased in RYGB (P = 0.004 for time × treatment interaction). Whole-body insulin sensitivity increased about 10-fold in both groups.

Thank you all for the kind words. I generally try to avoid being reactive and angry on these kinds of threads, but I know I was a little extra raw here. This week....wasn't my best week. Has been a bit stressful. Sorry how much that showed. In addition to the car impound/salvage yard/doctor appointments added to my schedule, I'm also taking the kiddo to and from work.....and have my inlaws as house guests for the next two weeks. (grateful to be sharing a few days with other family and friends).....and trying to find and purchase another kid car. It's a lot. On the plus side, I'm averaging about 18,000 steps a day between cleaning and chasing a million errands...and now, entertaining family, cooking, doing activities, etc. Have my period now, but am bound to have a nice weight loss at the end. That's way too much information. But yeah....this whole mess should be helpful on the scale. I'm exhausted. I'd take tomorrow off....except that it's kiddo's birthday, and her new roommate at college is ALSO coming for a visit and plans to stay the night tomorrow. And all these visitors would have been great if not for having my prep time grossly cut by the tree accident. Hubby is chipping in, but has crazy unexpected issues at work to deal with, too. It's just been nuts. Won't say I'm sorry about how I feel.....but I will say I'm sorry about my lack of tact and extreme reaction. Was extremely honest, but perhaps not my finest moment.

For my pre-op blood work they did the following tests which totaled 56 results: IRON AND TOTAL IRON BINDING CAPACITY, COMPREHENSIVE METABOLIC PANEL, CBC (INCLUDES DIFF/PLT), C-REACTIVE PROTEIN, HS CRP, HEMOGLOBIN A1c, HOMOCYSTEINE, FERRITIN, FOLATE, RBC, T4, FREE, TSH, VITAMIN B12, VITAMIN D,25-OH,TOTAL,IA, HELICOBACTER PYLORI, UREA BREATH TEST, VITAMIN B1 (THIAMINE), BLOOD, LC/MS/MS, NICOTINE AND COTININE, LC/MS/MS, SERUM/PLASMA It's just to make sure they have your full baseline to compare with post-op and follow up, and to make sure you aren't already deficient in anything or have any bacteria or issues that would cause complications during surgery. Totally normal stuff!