Reactive Hypoglycemia, Seizure

 Hi all,

I wanted to share something scary that happened to me this weekend while we were camping.  Apparently my blood sugar dropped very rapidly, and I had a grand mal seizure (now called Tonic-Clonic). Luckily, my friend who was with me is an MD, and she handled it well, but it was terrifying.  I was taken about 30 minutes away by ambulance, and upon arriving at the hospital after being given a full bag of glucose, my blood sugar was still just 60.  I didn't have any symptoms that I was aware of until just before it started.

I have had several episodes of RH since the surgery, though nothing like this before, obviously.  I have an appointment with a neurologist next week.  Anyway, I know that there has been significant talk about RH with RNY, but I have seen less about it with VSG.  I'll update if I find out any useful information.

I'm so sorry you had to deal with a grand mal. Scary stuff! I had RH prior to my surgery and had passed out a couple of times AFTER eating. It was tricky to figure out what it was because my blood sugar would be back to normal within just another hour or so. I had to really watch what I ate and when I ate it after it happened once or twice. It tended to happen if I ate a meal with pasta or if I ate a WHOLE lot of bread. Typically pasta is what triggered it.

However, I have not had a real issue with it since my surgery. I've gotten dizzy and light-headed maybe twice but both times I had eaten something "carby." I find that I am more susceptible to RH if I have been eating low-carb for awhile prior to the incident. It is almost like my body doesn't know how to handle it.

My husband is diabetic and I use his blood glucose monitor whenever I start to feel yucky to try to stay on top of it. I do hope you figure out how to manage it. I don't know enough about it to say whether it is always manageable, but mine is definitely triggered by carbs after periods of low-carb eating.

How do you stay on top of it if you feel the symptoms coming on? I have type 2 diabetes and am having surgery to try and get that into remission but don't really want to trade one disease for another!!! Is there any way to prevent RH? Eat often? Always have a snack on you? Sugar pills? Juice?

In non-bariatric surgery patients, RH is considered a strong marker for those who will eventually be diabetic. Basically, your pancreas overreacts to the presence of sugars and pumps out way more insulin than is necessary, binding so much of the blood sugar that not enough is left to function propertly. Because your body's reaction to sugar is so out of whack, it is considered a sign that the body's response to sugar is suffering and eventually your pancreas will "give up" and no longer produce the insulin you DO need to handle blood sugar, hence the diabetes.

The best prevention, of course, is don't eat a carb-loaded meal. I will tell you that sugary sweet foods don't affect me as much as pasta does. I think it is easier to consume (at least pre-surgery) large amounts of pasta without getting queasy as opposed to sweet sugar. But those who have it will have their own less-tolerated foods. Like the original poster, who consumed soft-serve, a combination of both milk sugars and sucrose sugars.

When I start to feel light-headed, I try to eat some protein and fat immediately. A piece of cheese, dried sausage, or peanut butter usually helps. It is tempting to pick up a single piece of candy, like a Kiss or a peppermint patty, because that will also make you feel better and WILL work in a pinch, but it is one of the reasons I had trouble losing weight before surgery. I would "self medicate" by eating a piece of candy every two hours or so to ward off the RH. Not a good solution. Your best snack is going to be one that isn't a favorite food or a slider food for you.

I tend to follow a very low carb diet now anyway, so my episodes usually occur if I eat a piece of wedding cake on an empty stomach, for example. A small bit of carbs doesn't cause RH for me.

I hope this answers some of your questions.

It does. I never had RH but got diabetes anyway. Its under control but if I eat carbs I do get a spike to about 180 or so. Have been close to 200 only once that I know of. Morning fasting blood glucose before the liver dump is usually around 100 or so. I am on metformin, 1000 mg daily.

Hoping to put all that away post VSG but I sure don't want RH! That was one of tge deal breakers gor me when I was considering RnY.

Oh Jet, I'm sorry to hear this! Do you have any idea of your triggers? Why are they sending you to a Neuro? Is it just a precaution due to the seizure? Have they referred you to an Endo?

I've seen only a few folks have RH issues post op.. but I've read it can happen anytime you have any sort of gastric surgery, just some surgeries are more prone to causing it than others..

 Thanks for the responses, guys.  It seems to have been triggered by my eating half a soft serve ice cream cone.  It happened a couple of hours after that.  I guess I'm not sure why they're sending me to a neurologist?--It seemed like that was standard.  I do know they want me to have an MRI just to be sure there's nothing in there to be worried about. ;-)  I guess the scary thing for me is that there was no notice--no shakiness, light headedness, queasiness, none of the things that I've had with other episodes.  Just all of a sudden my vision was very distorted (sort of like in a scary movie), I was screaming, and WHAM, seizure.  I can tell you I won't be eating any more ice cream cones!  

What an incredibly frightening experience! I am so very sorry that happened to you, but so glad you had help. Do you mind me asking if you had type 2 diabetes prior to surgery? I am sure the neurologist is to rule out a neurological cause for the seizes, but if you blood sugar was 60 , I hope if you are not already you get under the care of an endocrinologist ASAP. I will take this to heart as a diabetic pre surgery, to not just assume once I no longer need meds post op that I will necessarily not have blood sugar issues still . Sounds like you are going to need to test your sugars after eating to keep tabs on things . I'm so glad you are okay, and best wishes ...make an appointment with an endocrinologist. If you are in San Jose area ( I see you are a Jossert patient) I see a Dr. Dyron Jue located behind oconnor hospital. I have Aetna. I love him. Take care!!

Jet, so sorry you went through this.  I believe the neuro eval is to rule out anything else.  My husband passed out while driving a couple of years ago.  Even though they were able to pretty much determine that the cause was from having pneumonia (he didn't know) with fever and low oxygen, they still did a neuro eval to rule out anything else.  My guess is in your situation that the neuro is a precaution only.  Best of luck, and let us know how you make out.

 Thank you both.  Yes, I believe the neurologist is a precaution.  And no, I don't currently see an endocrinologist.  No diabetes or pre-diabetes, just this.  I do have a message in to Dr. Jossart, so maybe he'll suggest the endo?  Ugh, this was not what I wanted!  

Anyway, thanks for your kind words, all.