low blood sugar side effect question

I've been reading about reactive hypocglycemia on the other boards as being a potential side effect.  I looked into it a bit from other sources and from what I have read elsewhere, I get the impression that it's mainly caused by people eating too many carbs instead of the protein first.
But it's not always clear.

Have any RNYers had this complication when complying with a protein first diet? 

Also, what about iron deficiency and B12?  I was on another website and many people were posting about their problems.  If I take the supplements that  I am supposed to take, how likely are these deficiencies?

I'm not wanting to start a war on the thread, I'd just like some input from people who have actually had RNY and what their experiences were on this - particularly people who had this done years ago. 

I'll be asking at my next appointment anyway, but like to get as many relevant viewpoints as possible so I know what I'm up against in the long term.  (I'm type 2 diabetic so prone to blood sugar issues)

Reactive hypoglycemia seems to be a pretty common problem once people get a couple years out.  I haven't seen any statistics on it, but I'm just going from what I see posted here.  It seems like it's more likely to happen if you eat too much sugar or too many carbs, but I've had it occur other times, as well.  But eating small meals frequently and focusing on protein keeps it from happening very often.

Iron and B12 deficiency, as well as other vitamin deficiencies are very, very likely to happen, even if you take the supplements you are supposed to.  And just so you know, many surgeons do not tell patients the correct things to take.  By "correct," I mean the supplements recommended by the Amercian Society for Metabolic and Bariatric Surgery.  But some docs even tell patients to take calcium carbonate, for example, when we cannot absorb that and need calcium citrate.

I did an informal survey here on OH a while back and found that those that responded had experienced an average of three different deficiencies each.  I would be very surprised if anyone made it to a couple years post op without some sort of deficiency.

The good news is, if you get labs done regularly, you can catch deficiencies before they get really bad and they are almost always easy to correct.

I am nearly three years post op now, and so far I have at various times dealt with low B12, low vitamin D (but almost every one is low in vitamin D before surgery, and I feel sure I was too, I just didn't get it checked until post op), vitamin A and zinc.  However, I have corrected all those and last time I had labs done, everything was great.

I find the RH scary because one woman (on another website) had permanant brain damage.  I know this can happen with low blood sugar, but I have to believe that she must not have been following her program or montitoring properly for it to get that bad.  My expectation at the moment is that I may get RH despite my best efforts but as long as I monitor it, I shouldn't experience severe (permanent) side effects.

The only lab work I've had done is the hpylori and one other thing I can't quite remember what it was for now.  I haven't had blood work done for nut deficiencies.  My surgery is on 14th next month and I see the nut. tomorrow.  I know my PCM mentioned I should have blood work done within 30 days of surgery and I am just inside that now, so I guess I'll ask if they are going to have that done.

So far most of my info has come from these boards.  I've been to the seminar, the initial appointment which was very general, and one general nutrition appointment (outside the insurance clearance appointments)  All I have scheduled now is the 2nd nut appointment tomorrow, the pro-op a week before surgery and of course the day of surgery. 

Is this typical?  Just doesn't seem like a lot to me.  Tomorrow's appointment is a two hour affair so maybe I'll feel differently after that.  I intend to join a support group.  I would have gone this last monday, but I have been sick this week.  I won't get another chance until after the surgery because it's monthly.

I assume that despite the issues you have experience, you have no regrets regarding having the surgery done?

Oh, I'm very happy with my RNY.  I am definitely glad I did it.  The problems I have experienced have, for the most part, been fairly minor stuff, at least to me, and pretty easy to deal with. 

As far as the education you've gotten ( or not gotten) from your surgeon, it really seems like each doctor has their own ideas about that.  I did not attend a seminar.  I had an appointment with the surgeon, then went to a three hour class where they talked about the different types of WLS and nutrition and a bunch of other stuff, had one appt with the dietician, another appt with the surgeon and then some pre op tests. 

Anyway, if you feel you haven't gotten the info you need, ask questions.  Lots of questions.

I will say that the information I got from my surgeon and dietician was not all correct and there were many things they left out.  For instance, my surgeon said I should take Caltrate for my calcium supplement.  But Caltrate is calcium carbonate which we do not absorb.  We need calcium citrate.  When he told me to take Caltrate, I pointed out that it is carbonate and told him I planned to take citrate instead.  He said, Oh, OK.

I'll probably get a lot of information tomorrow.  Maybe many of the problems people have stem from a lack of info or wrong info from their doctors and/or dietician.  I think if people are going to offer WLS they should keep themselves up to date with the info they pass out. 

I will be listening carefully tomorrow to see which cacium supplement they recommend.  Just seems to me like they should know the difference.

Glad you have no regrets and it's working well for you.

I agree with you, they should know the difference.  But the fact is many don't.  There are still docs out there telling people to take Flintstones and Tums and that's all the vitamins they need.  Um, not even close!  But I don't mean to suggest no docs or dieticians are giving out the correct info.  Some have kept up to date with all the latest guidelines.  It's just that many have not.

I imagine many problems do result from getting the wrong info or not enough info from health care professionals.  Then there are problems that result when people get the info but don't comply with whatever they've been told to do.  And of course, some problems can occur no matter what you do to try to prevent them.

I agree.  I'm glad I found this site.  Lots of useful info.  I will be listening closely tomorrow to see what they say.  Hope they give good advice on vitamins etc because that will make me feel better about all the info they give me.

RH - reactive hypoglycemia - or low blood sugars can happen to me anytime.
And avoid sugars. All sugars - even the natural like in milk and some fruits. Some fruits, even limited qty may cause that - some may not. And the line which ones, how much and when - can change from day to day.
I can get low blood sugars when I exercise. I never know. Running is out for me. 
I can get RH in the morning when I do not get some fat with my protein drink.   or any other foods. Carbs in the morning for me - are a big no-no. Even when I combine them with proteins, and fats  - more than 10 gr may cause a severe RH.  Or it may not.  I can feel when my BS is dropping. I always carry food with me, and have food in every car I drive (mine, company, my BF).  If my Blood sugar starts dropping - I know I have to eat. not in 30 min - in 5-10 min. 
and so on.  The inability to predict when and how low my BS can drop is what I hate the most about post op RNY RH.

Deficiencies: then can happen even if - when you supplement as per doc and everybody else advice.   too many vits and minerals are not good - not enough are not good.
Some supplements will work for some people - but will not work for others. i.e. My labs are OK now (except iron - not sure) but now I am on weekly B12 injections (normally - people are good with once a month-  I need 4 per month, I take a bunch of extra vits and minerals, and just recently had iron infusions.  The oral supplementation - even when I switched to a special iron - did not work for me.  I hope the infusions - will give me some "lift". 

So - yes - in short - even when you very dedicated and follow the rules - you may develop RH, and vitamins and minerals deficiencies.  

I have not have any "sugar", desserts, bread, pasta, potatoes, rice, etc... in over 1.5 years.  
so - avoiding sugar and desserts - may work for some - but not for others. Its not that simple. 
BTW: I had to increase my proteins intake to 120-160 gr per day to have mid normal proteins in blood. less than that  = and my levels are low normal - and I get tired. 

our body is so smart - it can convert protein into sugars - and that in turn may cause low blood sugar .... RH... that's why some people report RH after a low carb protein shake. 
Also - Sugar alcohols and some artificial sweeteners may affect person insulin release making it difficult to maintain good blood sugar levels. 

Ok, maybe not what I wanted to hear, but definately what I needed to hear.  Let me ask you, despite these complications that you have, is it worth it? Do you have any regrets?

I can't imagine me backing out now because my health is not that good and I honestly don't believe I could keep the weight off in the long term without surgery.  It seems a bit of russian roulette as to what our body does after surgery.  I was very encouraged reading a post from someone called Jenny who had no complications after ten years and I put it down to her following the plan properly. 

Did you have diabetes before surgery?  I wonder if people like that (including me) are more suceptalbe to RH than others and that may be why some people seem to be able to eat things that I didn't think you were supposed to after surgery.

I guess my testing kit is not something I will be able to get rid of after surgery.  I was kind of hoping it was.

I suppose my game plan will be to test often and experiment with what I can and can't eat. i.e. milk and fruit.  I had no plan to eat starch, rice or pasta in any case. Even then if I am understanding this right, my body could change even 5-6 years from now and not react well with foods that I could tolerate up to then. 

My Health was very good before RNY. Normal to low BP, no diabetes, no other issues. Due to genetics, back problem and steroids - I gained too much weight.  And with my back injury - every time I tired to exercised - the back issue would return... Plus my age and hormonal changes... Made it close to impossible to lose weight.

Was it worth it? hmmm.. not really... I had a few issues before RNY , and now - I have many different ones.
If I could do it again - I would never had the RNY - I would get the sleeve (VSG) or DS. With VSG - I may lost less weight - but have more chances to have more normal life.  And with DS   - I may have the same issues as I have now with RNY - but with much more flexibility, no RH.  And with DS - there are higher % to keep the weight off. 

WLS - absolutely. VSG or DS.  Band - never... RNY - only if other options are not available

from my blog:

I would have WLS, but not RNY. If I could choose again I would have VSG.  I had RNY. I live with it every day. I lost all my excess weight, I am "normal" on skiny side.  But I would really try to choose a surgery that would offer me a chances of more "normal" life.  I dump on sugars - but that is OK,  the reactive hypoglycemia, and other issues make me very angry sometimes.

There is so many reasons.
-I do dump, but that's ok... 
-I developed reactive hypoglycemia (RH) that makes me eat every 2-3 hrs or else. Not able to eat most carbs, fruits, drink milk, etc.  I am on a such a strict diet. And still it is effortless to regain and a ***** to try to lose that again. Some study links that (regain) to RH or excessive insulin response after RNY.  
-Can't do much cardio due to RH
-Not be able to drink with meals is really though the longer you are post op.
-Not be able to take NSAIDS (Advil, etc, for pains).
-Having major issue with alcohol..Never had that before RNY. Every day is a struggle... The only way I can control that is not to have ANY ever again. 
-Depression and anxiety post op.  
-Feeling sick so often, that is it not fun. Unless I cook it - I am afraid to eat it. 
-Bread, pasta - get stuck every time.  not fun
-Develop early menopause (but that is most likely a side effect of weight loss in general)
-Skin problem - I think I may have issues with some minerals - vitamins deficiencies.  

- And the list goes on and on... I also had some complication including GB removal, 2 hernias and 2 surgeries for that, cataracts - may or may not be RNY related. 

- Let's not forget the nausea.  Morning nausea, still get it on and off. Drink too much - get nausea. Drink too soon in the morning - nausea, cold drink in the morning - nausea... and so on. get it?  Driving after drinking my protein drink - nausea. 
My friend's pouch is as sensitive.  Though some people do much better.

I think that with VSG I would have much better chance of more "normal" life.   
And if VSG would not work - then the DS can be done as revision. 

Having migraine headache and you have to choose a pill that may help you but can cause ulcer... so it is like " do I keep hurting now (and Tylenol does not touch that) or consider hurting later...?" what is the option.  When you are so sick from the hurting head that you wish someone would just shut you?

I didn’t take any NSAIDS and still got the ulcer. So now I am on daily antacid pills. Adds extra cost and extra side effects.  

I do not mind being on diet. But now - I panic when I do not eat within 3 hrs of the last meal. Low Blood sugar is not fun... Had it a few times below 30..

Also - would not mind to have a day or 2 every month that I can be "normal".  When you go out with friends and everyone is sharing an appetizer or 2 and you can't have any of that if you do not want to get sick. 

Do you know what I can drink now when I go out? Decaf coffee with cream.  Used to love plain water. Now can’t drink that.  I have to take special iron (heme - expensive) because any other bothers me. And so on… the list can go on.

Even when I was dealing with complications during the first year – I had a hope that once that gets resolved, I will be able to live rather normal life.  not so… the longer post op I get – the more food intolerances I develop.   Sadly, that does not help me to keep my weight off.  It is a very hard work. Every day.   I have 10 lbs regain.  My clothes are tight. But - even if I do not lose that 10 lbs - I still am OK.  I do not want to be size 4.  It did not look good on me.  But I do not want to gain anymore.  

But most my symptoms can be corrected with a strict diet. And since I am at goal, and a "huge success" I am "normal" weight, size 6, Low body fat.  The regain I have is 10 lbs.  But it is difficult to get rid of that.  But that still makes me size large size 6 - small 8.  I need to follow up with my diet, exercise.  It is what it is.   I deal with that, daily.  I do not need to eat starches. I can eat some fruits, cheese, nuts, etc.  And - living almost 3 years with nausea - I kinda know what to do when it happens. 

So ... I can’t eat desserts, etc, or carbs, or drink alcohol.. or.... drink milk, or any drinks with splenda (developed allergies...lol) or.... yea... the list can go on and on and on... but there is so many things I can eat.  So let's concentrate on the positive... 

I am a great cook and I can make such a great food .. that I have problem keeping any for me.  My friends and coworkers love it.  Meats, cheese, egg casseroles, non-starchy veggies, fish, etc.  And with small pouch - I have hard time finishing my plate many days anyway...
I learn how to bake without sugar or flour of artificial ingredients.  I do not use sugar alcohol or soy products... 
I can whip a great meal, 3 -4 courses, including healthy WLS friendly dessert.  It takes some time and motivation to do that... but it can be done. And it may take a whole evening to eat all of that - or just try some... lol..  

I still have days, when my pouch is acting up that I hate the RNY with passion.  Because even if I follow all rules - there is no guarantee that I will not get sick... sadly... .  

After all ... maybe getting RNY was the best surgery for me?  I would never know... 

That brings me to the end: 
Whatever surgery you get - be dedicated.  Any obstacles - work with them, not against them. Once you make decision - stick with the program.
No matter how much nausea you will get - make sure you get the proteins and liquids and vitamins.   Consider that "medicine" you body has to have to survive.  There is no ifs, not maybe... 
Once you decide - learn about your surgery and what you need to do to be great at it. Not for anyone else - but for you