Delayed Hypoglycemia & Gastric Bypass

BrandNewKimmie
on 3/22/13 6:02 am
RNY on 02/21/12

I'm 13 months out and have lost 130 lbs, at my healthy weight with no complications. A couple months ago I began to get really tired at times and would feel very faint,very hungry, jittery, with a strange sensation in my chest - almost like a vibrating sensation. The nurse said that it could be low blood pressure and a range of other things. My labs came back fine.

I just ate lunch and felt fine until I stood up about an hour later and I feel extremely faint and tired, jittery, and extremely hungry although I just ate. I feel like I'm on a high from caffeine - although I haven't had any. After Googling my symptoms I ran across "Delayed Hypoglycemia & Gastric Bypass" at http://www.livestrong.com/article/468882-delayed-hypoglycemia-gastric-bypass/.

These are my exact symptoms!!! Has anyone experienced this? Making an appt with my doc next week but just wanted some feedback from my anyone else who has experienced the same thing.

                            
southernlady5464
on 3/22/13 6:17 am

Sorry you are dealing with reactive hypoglycemia (delayed is just another name). It is a farily common "side effect" of the RNY unfortunately altho the surgeons don't mention it. They do talk about dumping with the RNY but they "forget" about this one...and I have also seen it referred to as late dumping.

You can search OH for "reactive hypoglycemia" and a boatload of posts will show up.

Here are some articles on the subject:

NIPHS Noninsulinoma Pancreatogenous Hypoglycemic Syndrome

See the bottom of that page:

Mayo Clinic doctors have recognized and reported on a seemingly rare but serious complication following gastric bypass called non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) or post-bariatric surgery hypoglycemia. After a person eats, this condition can result in very low blood sugar levels that lead to severe neurologic symptoms, including visual disturbances, confusion and (rarely) seizures.

It’s not just Mayo doctors tho, I found other links as well:
Post-pradial Hypoglycemia

Noninsulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) caused by an activating glucokinase mutation

Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline

Electrical short-circuit in b-cells from a patient with non-insulinoma pancreatogenous hypoglycemic syndrome (NIPHS): a case report

Clinical features and morphological characterization of 10 patients with noninsulinoma pancreatogenous hypoglycaemia syndrome

Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline Section 2.0

New Data on Weight Gain Following Bariatric Surgery

Surg Endosc. 2011 Jun;25(6):1926-32. Epub 2010 Dec 24.

Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia.

Roslin M, Damani T, Oren J, Andrews R, Yatco E, Shah P.

Source

Department of Surgery, Lenox Hill Hospital, 186 East 76th Street, New York, NY, 10021, USA.

Abstract

BACKGROUND:

Symptoms of reactive hypoglycemia have been reported by patients after Roux-en-Y gastric bypass (RYGB) surgery who experience maladaptive eating behavior and weight regain. A 4-h glucose tolerance test (GTT) was used to assess the incidence and extent of hypoglycemia.

METHODS:

Thirty-six patients who were at least 6 months postoperative from RYGB were administered a 4-h GTT with measurement of insulin levels. Mean age was 49.4 ± 11.4 years, mean preoperative body mass index (BMI) was 48.8 ± 6.6 kg/m(2), percent excess BMI lost (%EBL) was 62.6 ± 21.6%, mean weight change from nadir weight was 8.2 ± 8.6 kg, and mean follow-up time was 40.5 ± 26.7 months. Twelve patients had diabetes preoperatively.

RESULTS:

Thirty-two of 36 patients (89%) had abnormal GTT. Six patients (17%) were identified as diabetic based on GTT. All six of these patients were diabetic preoperatively. Twenty-six patients (72%) had evidence of reactive hypoglycemia at 2 h post glucose load. Within this cohort of 26 patients, 14 had maximum to minimum glucose ratio (MMGR) > 3:1, 5 with a ratio > 4:1. Eleven patients had weight regain greater than 10% of initial weight loss (range 4.9-25.6 kg). Ten of these 11 patients (91%) with weight recidivism showed reactive hypoglycemia.

CONCLUSIONS:

Abnormal GTT is a common finding post RYGB. Persistence of diabetes was noted in 50% of patients with diabetes preoperatively. Amongst the nondiabetic patients, reactive hypoglycemia was found to be more common and pronounced than expected. Absence of abnormally high insulin levels does not support nesidioblastosis as an etiology of this hypoglycemia. More than 50% of patients with reactive hypoglycemia had significantly exaggerated MMGR. We believe this may be due to the nonphysiologic transit of food to the small intestine due to lack of a pyloric valve after RYGB. This reactive hypoglycemia may contribute to maladaptive eating behaviors leading to weight regain long term. Our data suggest that GTT is an important part of post-RYGB follow-up and should be incorporated into the routine postoperative screening protocol. Further studies on the impact of pylorus preservation are necessary.

PMID:
21184112
[PubMed - in process]

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

MyLady Heidi
on 3/23/13 8:02 pm

Amazingly my surgeon brought his up in his introductory seminar I attended for gastric bypass, and lets see now that was in 2004, nearly 10 years ago.  It never was a secret about dumping or RH, maybe if the original poster was not diabetic she didn't understand the severity of the issue but that does not mean that gastric bypass surgeons don't warn about it.  I was diabetic and have RH now and control it through my diet, protein focused meals, no simple carbs alone and I am fine.  Too many crackers alone and I wake up sweating and shaky, does it still happen, yup, but eating a protein and carb together handles it.  Stop maligning RNY because you chose something else.

BrandNewKimmie
on 3/22/13 6:42 am
RNY on 02/21/12

Thank you very much!!! I try not to self-diagnose however when I read the symptoms, I literally had chills because I've been experiencing these exact symptoms for the past few months. I will seek medical attention however I feel better that I somewhat know what's going on with my body. Thanks for all the info.

                            
Linda_S
on 3/22/13 12:36 pm - Eugene, OR

I have it, as does Melting Mama (Beth).  It can be very scary.  I've not had seizures, but Beth has.  I have, however, had blood sugar as low as 23 and my doctor was surprised I was conscious at the time.  Besides the sickness, extreme hunger, sweating, dizziness, etc., the worst of it for me is the visual disturbances.  When my sugar drops, it's like someone dropped a pebble into a pond - ripples.  Sometimes it happens when my sugar is fairly normal - in the 80s.  I hate it when it won't go away.

The other really bad thing is, when your body produces too much insulin, it's really easy to gain weight.  I've put on five pounds over the past few months.  I've been charting my food and exercise and I really should be losing.  I eat about 900-1100 calories a day, I walk about an hour a day with the dog, and I eat no refined carbs.  Not sure what's going to happen, but I can't get fat again!

Success supposes endeavor. - Jane Austen

BrandNewKimmie
on 3/22/13 3:34 pm
RNY on 02/21/12

Does is ever go away, how can we control it? Has your doc mentioned any foods that you should stay away from because of this? Sorry that I have so many questions, I'm very concerned....how often do you have episodes?

 

Thanks :)

Linda_S
on 3/22/13 3:45 pm - Eugene, OR

You need to avoid simple carbs - bread, crackers, cookies, cake, pasta, rice, potatoes - anything starchy, especially if it's white.  You shouldn't have sugar.  I've even come to the part where I can't have artificial sweeteners.  My brain reads sweet as sugar, and pours out the insulin, and my blood sugar falls anyway.  You need to eat vegetables, some low-sugar fruits (some berries are okay - don't eat bananas!), protein, and healthy fats.

Do have some sources of sugar on hand in case your blood sugar falls and you get dizzy, sweaty, etc.  If your blood sugar is really bad, you may know because you will be very confused.  You should then have a life saver, a few smarties, some juice, or something that will raise your sugar, followed by some protein.  Don't eat too much sugar -- they had me taking those diabetic sugar tablets at first and it was way too much -- set up a rollercoaster for me.

I'd recommend you see your doctor and dietician.  Ask your doctor to prescribe a blood sugar meter for you so that you can test your sugar when you're feeling sick.  When this first started for me, I had to test in the morning, and then before I ate, and an hour after I ate.  It showed a classic reactive hypoglycemia pattern.

Success supposes endeavor. - Jane Austen

Linda_S
on 3/22/13 3:45 pm - Eugene, OR

Oh - and, no, I don't think it ever goes away.  It's a bummer.

Success supposes endeavor. - Jane Austen

H.A.L.A B.
on 3/22/13 9:22 pm
Lots of us have that. In most cases can be controlled by a diet. It took me app 1 year to figure out what I can eat and what I need to avoid. How often to eat... Etc. But eventually I can control it. My diet is very strict - but doable. Most docs don't know how to help us.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

Ladytazz
on 3/23/13 12:37 am

About a year ago I started having symptoms.  I bought a glucose monitor and at one point my blood sugar was in the 30's.  Real scary.  I started keeping snacks with me like cheese or a protein bar and I haven't had it since.  I keep my monitor with me at all times just in case.  I didn't really change my eating since I have avoided refined carbs and eaten sugar free and gluten free since I had my surgery but I did start eating more often.  I eat at least every 2 or 3 hours.  I don't know if that is what helped but whatever it was I'll take it.  It is a horrible, scary feeling and I feel bad for those who experience it frequently.

WLS 10/28/2002 Revision 7/23/2010

High Weight  (2002) 240 Revision Weight (2010) 220 Current Weight 115.

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