Fluctuating Hypoglycemia post gastric bypass surgery

[mallory0405 4]

I am 14 years post gastric bypass surgery. About a year after surgery, I started having episodes where my lips would go numb and then I would get confused and shaky and start sweating profusely. After about 30 minutes, symptoms would abate and I would return to normal. It only happened once or twice a year so I ignored it. Until this year. This year it began happening once or twice a week. After a severe episode, and at the urging of a friend, I ended up in the ER close to diabetic coma even though I do not have diabetes. My blood sugar was 34.

I found out the cause: fluctuating hypoglycemia. It is caused by the surgery itself. food empties too fast into the intestine and causes the pancreas to pour out insulin. This eventually causes a fast drop in blood sugar. THERE IS NO CURE. This is a fairly newly-recognized complication of gastric bypass surgery and no one has found any treatment for it - at least none I can find on the web. I just want to get the word out there so people will be aware of this potential side effect. Not everyone gets it. You can get additional details by searching the web.

[Matt Z 4,138]

2 hours ago, mallory0405 said:

I am 14 years post gastric bypass surgery. About a year after surgery, I started having episodes where my lips would go numb and then I would get confused and shaky and start sweating profusely. After about 30 minutes, symptoms would abate and I would return to normal. It only happened once or twice a year so I ignored it. Until this year. This year it began happening once or twice a week. After a severe episode, and at the urging of a friend, I ended up in the ER close to diabetic coma even though I do not have diabetes. My blood sugar was 34.

I found out the cause: fluctuating hypoglycemia. It is caused by the surgery itself. food empties too fast into the intestine and causes the pancreas to pour out insulin. This eventually causes a fast drop in blood sugar. THERE IS NO CURE. This is a fairly newly-recognized complication of gastric bypass surgery and no one has found any treatment for it - at least none I can find on the web. I just want to get the word out there so people will be aware of this potential side effect. Not everyone gets it. You can get additional details by searching the web.

It's called "Dumping syndrome" And it's widely known, that terminology for it is what's odd.

What causes dumping syndrome?

Dumping syndrome is caused by problems with the storage of food particles in the stomach and emptying of particles into the duodenum. Early dumping syndrome results from rapid movement of Fluid into the intestine following a sudden addition of a large amount of food from the stomach. Late dumping syndrome results from rapid movement of sugar into the intestine, which raises the body's blood glucose level and causes the pancreas to increase its release of the hormone insulin. The increased release of insulin causes a rapid drop in blood glucose levels, a condition known as hypoglycemia, or low blood sugar.

[mallory0405 4]

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?

[RickM 1,747]

They aren't the same thing, but have the same basic root cause of rapid stomach emptying from the missing pyloric valve (as with dumping, people with an intact stomach can also experience these things, though it is rare.) In addition to the symptoms that you have noted, RH is also associated with greater inter-meal hunger that can lead to regain, so that is another reason to keep it under control and learn what triggers it in you.

[mallory0405 4]

Well, Rick, you hit the nail on the head when you said it triggers hunger! I just seem to want to eat all the time because my stomach has that achy "feed me" feeling. Thanks for writing. This is the pits but I am slowly getting quite an education on this complication. No fun at all. BUT still glad I had the surgery. Wouldn't trade this freedom for anything!

[newdaydawning 19]

I had bypass (medical revision due to gastric sleeve complication. Not RNY) and experiencing similar episodes, 1 of which came 4 hours after eating a triggering food and ended up with me losing consciousness at home one night.

I went and bought a glucometer. I have a family history of type 2 but have never tested even prediabetic myself. Before my bypass my fasting blood sugar was 70 and now it is in the upper 90s when I test it. I am currently tracking all of my food and nutrition and checking my sugar to see what in the world is going on until I can speak to a medical professional educated enough to really tell me what the heck is going on.

I knew about dumping and its causes but I too associated it with sugary treats and not what I am experiencing so I have little context to frame this for myself. I know we learn a lot from our various programs and from patient to patient sharing but I read more posts that suggested "most" bypass patients didn't dump (I see 30% rate posted quite a bit) and certainly I never thought it would be me dealing with it (ah, isn't that the case with so many things)

[mallory0405 4]

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.

[newdaydawning 19]

2 hours ago, mallory0405 said:

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 would strongly caution you to not rely on your own gauging of symptoms as RH seems to be a bit of a moving target and it can progress to the point where you get no warning. Imagine being out driving with your children. My solution until I get a better grasp is at a minimum fasting blood sugar in the morning, track my food and drink and how I feel and the next step is checking blood sugar after meals and then during an episode while hoping to not have one at the same time, lol. I focus on all the appropriate guidelines and I am hoping as long as I do that this will resolve. My bypass is not long but apparently long enough. I also have emergency gatorade, Peanut Butter packets etc. stashed in my car and various places around my home and I have discussed this with my teens and kids so they won't be scared if I have an episode and will know to get my glucometer. I will probably get a medical Bracelet in case I am in public lest someone think I am drugged or drunk...when your blood sugar dops that low it is so important to get it stabilized. I have found that I have to eat something frequently or have a Protein Drink. I am so hungry at times but some of that in context is probably must being thrilled to be able to eat and drink after the past year with my gastric sleeve misery

[mallory0405 4]

You said it - it IS a moving target. That's why the glucometer drove me crazy. It would read 35 one time and an hour later it would read 275. Up and down like that all day long until I did not know what in the world to do. But your point is well taken. I will get the Peanut Butter packets for the car. I keep orange juice in the house at all times.

By the way, a huge congratulations on meeting your goal! I did not notice that yesterday. Despite these problems, isn't it just the greatest, most freeing feeling in the world?

[newdaydawning 19]

thank you for your kind words. You know, it is so strange. I have been so sick that a lot of the joy of reaching my goal weight isn't really there like I had pictured it. I mean, a lot of issues that were health issues aren't as difficult not being morbidly obese but now I am fighting to keep weight on and have so much anxiety about what my future holds. I see a therapist who has experience working with food issues and it helps but a lot of life is just sadness, uncertainty, a bit of grief I guess, but overarching all of that is gratefulness. I know that not being morbidly obese is a huge gift but I feel so lost now. People stare at me and make comments about my weight. God why didn't anyone say anything when I was eating myself to death? Now I am trying harder than ever and the haters really hate. It isn't always what we picture it will be like. I am working on building up my support circle offline by finding friends with shared interests but my health and special needs kid etc. sort of make that an issue. IT will just take time, I think, to feel that joy. I want to be healthy. I miss my butt and boobs, lol. I was never a butt girl but literally pancake butt here and I need to build lean muscle all over and I know that will take some dedication and time. I am trying to learn from the from the veterans so I can figure out what might be coming down the pipeline. When can I exhale, lol?

[GassyGurl 428]

I had the sleeve and get dumping. Not from sugar, but from liquids, like Protein Shakes, milk and Soup. It's not all the time, and very scary and frustrating. I've almost passed out from it. I did read that bariatric patients should treat it with Protein vs carbs. Carbs will cause a rebound blood sugar issue, where protein is more stable. I now keep emergency Jerky in my purse and have felt much better.

Sent from my SM-G965U using BariatricPal mobile app

[GreenTealael 24,855]

I have the sleeve and also experience dumping and late dumping. I'm new so I still track and read everything. I usually won't go near real sugar, if I do I now what to expect. Are y'all still reading packaging that far out or eating everything/anything?