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

So you don't think I've got reactive hypoglycemia? Sorry a bit confused as I'm not oregnant I'm 48 and a year post op these symptoms only came on a few weeks ago and this is what another experienced sleever said I had and fits my symptoms. I will ask my GP for a blood monitor when I see her next week and as I'm in the uk I hope they supply it on the NHS even though I'm a self pay bariatric patient.

Look mine came on fast and hard..The first time it happened was in the grocery store...I grabbed a bag of pecans off the grocery shelf ripped open the bag and started to eat them...I was dizzy and bumping into things. I was sure I was going to faint. I had no idea what I was doing and was slurring as my husband asked the lady to ring the pecans in and handed me the bag again and told me to sit down and wait for him...

Next time it happened when I had a treat. My eating was really off and I was not eating to be exact. All of a sudden I wanted ice cream. My hubby ran out and got it..He said well at least it is milk..That one was worse then the first...I did pass out with that one...It was at home though..My blood sugar was 2.2. Supposed to be 5 or a little over...

I did go and get a monitor and the works and now I can feel when it is coming on so I have to eat 3 meals and 3 little Snacks....

No one can tell you how you feel or if or not you have this condition. Go to your Doctor and explain. Or call your team. My nut recognized it immediately and sent me to my family doctor..Where he said yup it is so!!! Do this...I have been working on it now and hopefully I can do it with proper eating and not meds to control it.... @@musiclover

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.

My blood sugar dropped to 38 when it hit me I got wobbly & wierd feeling @ work, sweating very bad, shaking uncontrollably all happened in 30 seconds or less & it drained all my energy for 12 hrs. This feeling was like instant death but awful in slow motion

Sent from my iPhone using the BariatricPal App

Once you know you are prone to hypoglycemic incidents post op, you need to be very aware and pay attention to your body.

I have had numerous episodes but it took me a while to figure out what was driving it. For me, it has nothing to do with cupcakes! It has entirely to do with hours between meals.

I usually eat 5 to 6 small meals per day now. If I do that, then I don't have a problem. If I go 3 or 4 hours without eating something small like cottage cheese with some strawberries, I know I will have an episode.

I was definately someone who had instances of this when I was heavy but now, they happen more frequently if I am not careful.

The bad news is they happen fast! On several occasions I did not even recognize what was happening to me until I was nearly passed out. My glucose has gone as low as 32 before I figured out what was happening and I was home alone. I remember my hands trembling so bad I could not get my glucose tablets open as they were sealed.

Now, if I even start to feel the small signs I check my sugar. If it goes below, 70 I know it's time for something to eat.

I do try to keep sugar to a minimum and if I do indulge, I make sure there is Protein to go along with it.

Once I figured out what was going on, I seem to be able to manage it a bit better however I still have one or two episodes per week.

I just keep glucose and my meter available and I will usually pack something if I am out for the day.

I was never diagnosed with reactive hypoglycemia, but when I was pregnant, my blood sugar would drop to the high 40's (normal fasting is 70-100). I managed it by eating several small meals - every 3 or 4 hours - making sure I had good amounts of Protein in each. Which also cleared up my all-day morning sickness. Outside of pregnancy, I've had a few times where I got clammy and shaky and knew what it was and got some sugar on board quick.

You can get glucose meters and supplies without a prescription, but a prescription is required for insurance to cover the cost. But it's important to be working with your doc and team regardless.

I'm not far along enough to see if it's better or worse after the sleeve, but I'm on the lookout for it. This is a great topic, thanks for posting it!!

I had a very bad episode on vacation last year. I passed out in front of my grand daughter and worse the tide was coming in on the Bay of Fundy. As much as I am now used to this condition it can still rear up even when I am properly maintaining my Protein intake and everything. I find that if I get too excited about something happening it can happen anyway. My count goes down below 2 which 5 is normal.

It has caused some issues with my over all health and some weight gain. It is just another symptom of the choices we make regarding what we feel is best for our overall health.

Even with this nasty part of it. I am still happy I did it....

Just a caution about this problem - artificial sweeteners can cause it in some people too. you wouldn't expect artificial sweeteners to raise your blood sugar but they can in some people, and then it drops very fast. This happens to me when I use some of the artificially sweetened coffee additives.

In addition to Protein at meals and Snacks, try to include a bit of good fat (real butter, coconut oil, olive oil, etc) which keeps your blood sugar stable longer.

Just a caution about this problem - artificial sweeteners can cause it in some people too. you wouldn't expect artificial sweeteners to raise your blood sugar but they can in some people, and then it drops very fast. This happens to me when I use some of the artificially sweetened coffee additives.
In addition to Protein at meals and Snacks, try to include a bit of good fat (real butter, coconut oil, olive oil, etc) which keeps your blood sugar stable longer.

Look at coffee mate regular. I T says zero sugars, yet the 1st ingredient is solid corn syrup. Drops me and I tested it with a glucometer

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What types of "snacks" do you keep on hand for this issue? I'm interested in knowing what would be doable during the liquid phase particularly. I'm thinking cottage cheese for the soft food time but this is not something you can have on hand in your purse on the go. Now, before WLS I always carry almonds in my purse. That's not doable after surgery....