Hi Steve,

was your wife diabetic before her DS? I've heard of hypoglycemia being an issue more with people who had diabetes post DS. But your wife's situation seems different, as this didn't show up until the cc was lengthened.

Could I ask the reason for the common channel being lengthened?

With a longer common channel, generally A1C tends to rise due to the greater absorption of carbohydrates. However, i could also see a change from carbs absorbing in a much smaller part of the intestine to well over twice the area, with more carbs being absorbed than before causing BG to rise more rapidly, resulting in the pancreas producing more (too much in this case) insulin leading to lows. This is just a theory, from my t2 perspective. Veterans would know much better than me.

I'd suggest getting a meter and doing pre and post prandial testing to see what specifically triggers these episodes. A poster had hypoglycemia post DS, and they had a CGM to record BG. That was helpful in their case. It may help to eat smaller meals several times a day, high on protein and fat as DS eating goes and reduced carbs. That may help stabilize BG while you're waiting to see an endo.

I hope the endo is able to figure this out asap. I can imagine it being very stressful for her and you.

p.s. reactive hypoglycemia isn't just caused by sugars but high carb meals in general. so she will need to cut back on carbs overall not just sugar. as for protein and fats, the latter doesn't cause BG to rise and the former causes it to rise very slowly. so protein and fat heavy meals with low carbs are unlikely to cause hypos. in fact, they're generally what's recommended for people with reactive hypoglycemia.

Did you start eating something different? I get heartburn when I take Vitamin C supplements. I took me a few weeks to recognize it was an issue.

Revising from gastric bypass to DS is a very complex operation. It requires taking apart your old gastric bypass, restoring the normal anatomy, and then doing the DS. Whether with one anastamosis or 2, this is a lot of surgery and you are right to be concerned about complications as the rate of complications is significant. That's why it's so important to have a surgeon experienced not just with bariatric surgery, but specifically with the DS and with doing this specific revision.

I would strongly recommend that you consult with one of the DS surgeons with this background of experience. Given your location, the best choices would be Dr. John Rabkin in San Francisco, Dr. Ara Keshishian in Pasadena (near Los Angeles) or Dr. Simper in Utah. There is no one in your state that I would trust with this specific revision.

Larra

I think it is modified. My surgeon is in Phx. He has been doing bariatric surgery is for a very long time. I'm just nervous of complications.

I am on a fact finding mission for my wife. She had a duodenal switch quite some time ago now, and about a year back had a revision. She is suffering from - what I think is` called - reactive hypoglycemia. She is saying it used to be triggered from sugar, but now she seems to get low blood sugar no matter what she eats. Does anybody know what might be causing this condition, and if there is any way to control it?

She has been close to passing out quite a few times. Very worrying.

Thank you,

Steve