Treating Reactive Hypoglycemia

Hypoglycemia After Gastric Bypass Surgery

What is hypoglycemia?

Hypoglycemia refers to low blood glucose or blood sugar.  While "dumping" is a result of too many sugars and makes you sick 20-30 minutes after eating,  low blood sugar caused by reactive hypoglycemia can make you feel bad and it can be dangerous, since your brain requires a certain amount of glucose to function normally. Severe low blood glucose levels can cause passing out (loss of consciousness), seizures, car crashes, or other more serious outcomes. In people without diabetes, glucose levels are typically above 70 (3.8 Canadian) first thing in the morning, before eating and usually range from 70-120 (3.8 to 6.6) at other times of the day.  (although it spikes shortly after eating). 


The main organs in your body that are important for maintaining normal blood glucose levels are your pancreas and your liver. The pancreas makes and releases insulin into the blood stream. Normally, when you eat a meal, the pancreas makes insulin and the insulin helps to keep blood glucose levels from rising above normal.  People who have high blood sugar, often having a problem with their pancreas.

The liver is also very important to help maintain blood glucose levels. The liver makes glucose, particularly between meals and overnight when you are not eating, so your vital organs can get the glucose they need to function normally.  The liver ships out glucose to other body parts and is the distributor for your body.

There are two broad categories of hypoglycemia:

(1) Fasting hypoglycemia - refers to low blood glucoses in the morning, or when no
food has been eaten for many hours.  You may wake up hungry, moody or feeling faint.  Some people have to keep something by their bedside to consume before getting out of bed (but this is rare)

(2) Postprandial hypoglycemia (also called after meal or reactive hypoglycemia) - refers to low blood glucose levels within a few hours after eating.  It is "reacting to food".  The food is what sets off the chain of events for your blood sugar to go up and down like a roller coaster.  It's "what you eat" that is usually the problem and so, you must take steps to eat differently with your RH in mind.


Postprandial hypoglycemia is also referred to as Reactive Hypoglycemia.  It is a result of how your body is adept at processing sugar.  If you eat something high in sugar or carbs, a lot of insulin is released in response to eating, and the insulin removes too much glucose from the blood.   The insulin's job is to bring blood sugars back down but because it is getting all the sugar in the blood stream at once it is pumping out too much and bring blood sugar further down than expected.  (When you had your pyloric valve sugar was slowly released and then insulin was also slowly released).  Because the valve is gone, the sugar spikes you up fast and the insulin is released too fast.  In some cases, this may be very severe i f the pancreas is making too much insulin.

Most often, reactive hypoglycemia shows up around the 1-2 year mark post gastric bypass...but can occur anytime really after the first 6 months, when the sugar response in gastric bypass patients becomes 20x as strong.


Symptoms:
You may feel some or all of the following syraptoms within 1 to 4 hours after eating:
Weakness
Racing or rapid heartbeat
Nausea
Extreme hunger
Headaches, especially first thing in the
morning (may indicate a low blood
glucose has occurred overnight)
Dizziness
Sweating
Difficulty concentrating or thinking
Nightmares or bizarre dreams - may
indicate a low blood glucose while you
are sleeping
 Importantly, you may have no
symptoms, but others may notice that
you are staring, not paying attention,
seem less attentive, or are "not looking
quite right."  Much like a brain fog. 
Some also have a numb mouth or tongue. 

Treating Lows:

It is critical to treat a low blood glucose quickly so that your brain has enough glucose to
fimction normally and to prevent you from passing out.  An important tool is a glucose meter or blood sugar metre used by diabetics.  They can be costly but if you have the coverage, get one.  It will make it much easier for you to figure RH out.  Keeping a journal with blood sugar readings and foods, will help you greatly to learn what affects you and how it affects you.  Most patients have a dropping point when their blood sugar starts to drop and will eventually become critically low.  You need to know when that point is by testing at the 1 hour mark and every 10-15 minutes there after. 

 When your blood glucose is toolow, you need to eat food with sugar in it to bring your glucose level up quickly. You need to eat food with sugar, even though you may experiencing dumping syndrome (abdominal
cramping, lightheadedness and diarrhea),

1. Stop what you are doing - sit down.
2. Test your blood glucose, i f possible, to make sure that it is low.
3. Eat 15 grams of sugar in the form of one of these "hypoglycemia treatments":
a small juice box works great)
- 3 tsp sugar
-3 tsp jelly
-small box of raisins
-3 glucose tablets or 4 dextrose tablets >
- 7-8 lifesavers (chew and swallow)
-5-15 jellybeans (sugar content varies from 1-3 grams per bean - check label)


4. Retest your blood glucose after 15 minutes. Repeat treatment if glucose is under 80.
5. After you treat the low glucose, eat a protein food (but not low fat ones) to prevent
the low from returning - this is a critical step.  You want protein to keep it sustained.  Otherwise you will keep going low, high, low, high.  Always carbs plus a protein:

Some examples of protein foods to have are:
a. roast beef (1 ounce).
b. regular cheese (1 ounce)
c. regular cottage cheese (1/4 cup)
d. regular ricotta cheese (1/4 cup)
e. peanut butter (1 tablespoon)
f. nuts (1 ounce)
g- whole milk (1 cup)

6. Keep glucose tablets or glucose gel with you at all times. These are available at any pharmacy and do not melt or require refrigeration. Keep some in your pocket or purse, next to your bed, and in your car for emergency use. You don't want to take the time to search for a sugar food when you are having a low blood glucose! You may also find that 4 ounce juice boxes are convenient for the car.  Honey packets work well too.  Never ever drive when you may be feeling like you are having an issue.  You could easily cause an accident and kill yourself or others. Stop and pull over if ever you feel like your blood sugar may be affected.  Eat and test. 



Being Proactive

It is really smarter to be proactive rather than reactive to lows.  Every time you pass out from reactive hypoglcyemia it may lead to permanent brain damage. You must treat it seriously.   Working to prevent a low is always better than to reactive to contant highs and lows.  Plus, being reactive rather than proactive can also lead to cycles of eating when you are not supposed to and can easily lead to regain!

1. Modify your diet.  Chances are that it was a food that caused the problem to begin with.  What did you eat?  Learn what  your marker time is for your blood sugar to dip.  For instance, for me it is at the 1 hour, 15 minute mark.  If I dip, I need to know that is when I need to eat preventatively.  But again, if you can avoid a low by changing what you eat that's always better. 

• At meals, eat controlled portions of low glycemic carbs.  Add fat to your eating.  Many protein foods have fat in them and the fat in the protein food also slows the digestion of the carbohydrate. This will lead to less of a "spike" in blood glucose after you eat and result in less insulin secretion (which is what you are trying to avoid).
• . Carbohydrates that are high in fiber are typically slowly digested. Read labels and look for whole grains rather than "enriched" flour, which has much of the fiber removed.
• Avoid high glycemic carbohydrate foods 
• Avoid eating only carbohydrate at a meal or snack   Always eat a carb with a protein. Always!
• Avoid eating carbohydrate in excess amounts (stick to 25 garms of carbs per meal.  Remember, it's not just sugar --but it's also carbs because carbs turn into sugar!). 

AVOID some fruits: bananas, pineapple, • • • •
watemelon, raisins, cantaloupe, grapes, plums
all finit juices
refined cereals, such as Corn flakes. Rice Krispies
regular pasta and rice rice cakes or popped com
Refined crackers, such as Saltines, Ritz,
white bread, rolls, bagels
pretzels
starchy vegetables: potatoes, corn,
winter (orange) squash
sweets: candy, cakes, cookies, ice
cream, syrups, soda
alcoholic beverages

• Avoid sugar alcohols, such as sorbitol or mannitol.
Include a high protein food with each meal and snack. High protein foods
include fish, chicken, turkey, meat, eggs, cheese. Look into paleo/primal eating.
• Include healthy fats with each meal, such as soybean oil, olive oil, canola oil,
olives, nuts, nut butters, seeds, soybeans, and avocado. Fish, such as mackerel,
salmon and blue fish, not only contain high quality protein, but healthy fats also.
• Include high fiber, non-starchy vegetables with most meals. Examples are
romaine lettuce, broccoli, asparagus, summer squash (yellow, zucchini & spaghetti
squash), tomatoes, carrots, turnip, spinach, kale, collards, cauliflower, eggplant,
green beans, cabbage, and cucumbers.
• Try eating 6 small meals a day, rather than 3 larger meals. If you eat snacks
between meals, choose non-carbohydrate foods, or select a snack from the attached
snack list.
• Before exercise, eat carbohydrate with protein, such as whole-wheat crackers
with whole milk, regular cottage cheese, or peanut butter.
• Drink liquids primarily between meals. Water or decaffeinated, unsweetened
tea/coffee are best.





Many reactive hypoglycemia patients have had excellent results with a paleo or primal diet.  You can google the terms for a shopping list.  Mostly, you need to cut out the carbs and focus on proteins.  If you bake, use alternative flours (coconut, almond etc) and add fats.   These types of baked goods will affect you far less than goodies made with traditional white flour and sugar.  Read and learn.  marksdailyapple.com is a good source for information!

Mix-and-Match Snacks
Remove all tough skin and chop seeds and nuts

1. Hummus and pita
1 oz whole-wheat pita with 2 TBS hummus
2. Extend Bar (www.extendbar.com)
These are made with uncooked cornstarch, a very slowly absorbed carbohydrate,
and can prevent low blood glucose levels. It may be useful to eat one at bedtime (to
prevent low blood glucose in the middle of the night) and one in the mid-morning
(to prevent low in late afternoon).
3. 4 oz light low fat yogurt topped with 1 TBS chopped nuts
4. 1 medium apple and 1 TBS peanut butter
5. Toasted cheese and tomato on wheat
Top 1 slice whole wheat bread with 1 oz cheese or avocado and 2-3 slices tomato.
Toast in toaster oven.
6. Cottage cheese and berries V2 cup strawberries or blueberries and V2 cup cottage cheese topped with 1 TBSchopped soybeans. Sweeten with Splenda if desired.
7. Veggies with dip1-cup raw baby carrots or broccoli florets and 1/3-cup cottage cheese vegetable dip
8. Top an 8-inch whole-wheat tortilla with cup refried beans, V4 cup shredded
cheese, and 1 TBS salsa. Microwave for 15-20 seconds and roll.
9. Celery and peanut butter
4 - 3 inch raw celery sticks and 1 TBS peanut butter

10. Ricotta cheese dessert
cup part skim ricotta cheese mixed with 1 packet sugar substitute. Sprinkle with
cinnamon and 1 TBS almonds.
11. String cheese and crackers
1 mozzarella string cheese and 1-2 RyVita or Wasa whole wheat crackers
12. Tuna salad pita
1/2 (loz) whole-wheat pita filled with V2 cup tuna, 1 TBS mayo, and alfalfa sprouts
13. Tomato and cottage cheese
1 small tomato cut in wedges topped with V2 cup cottage cheese and sprinkled with
chives
14. Smoked salmon and cream cheese
1 slice whole-wheat bread topped with 1 TBS cream cheese, 1 thin slice red onion
and 1 oz smoked salmon
15. Egg and spinach salad with chick peas
1 sliced hard cooked egg, 1-cup baby spinach, cup canned chickpeas, 1 TBS
olive oil and balsamic vinaigrette. Toss spinach with vinaigrette, place in serving
dish, sprinkle with chick peas and place sliced egg on top.

8 Years Post Op RNY

I know that when reading many blogs for RNY, people get upset because the journey ends at a year out or two, and many don't write posts on how they are doing after many years.  For that reason, I like to update my blog so that people can get an idea of what life is like many years post op RNY.  Now, I've always been a bit abnormal in some ways - easy peasy recovery, very few issues....but we all know that the experience of surgery is different for everyone.  So here, I'll update you about how things are and tell you about anything new I've learned or experienced:  

The Good:

-Life is pretty typical - I continue to be very active and to walk 5 to 10 miles a day is not unheard of for me.  I am active and busy and still enjoying life without having to worry about turnstiles, getting in the backseat of a two door car, that one size won't fit all, and all the typical stuff of morbid obesity.  I can say that I've sideswiped many possible health issues and I can confidently say that I know that I won't ever go back to being morbidly obese.  While I definitely have my challenges most days with my eating, I am pretty confident that I understand how to manage my weight now.  Hopefully there won't be any obstacles with this and I can keep doing what I'm doing.  

-My deficiencies seem to be okay.  Not much different than before.  Not improving much, but not getting terribly bad either.  I'm still osteopenic (since year 1) but it is the same - no worse/no better and I'm okay with that.  Iron still sucks but not enough that I need infusions.  Still vitamin d deficient (aren't most Canadians? yes!).   Other than that I'm holding my own and that's a good thing!

-While I go up and down on the scale (I can be as close as 5 lbs to my goal weight or as high as 20 lbs over - and then I get my act together and work on it) I'm staying fairly the same.  That's a good thing even though I can really beat myself up over it.  

-The clothes in my closet are one of two sizes.  I've bumped up one size from my lowest so I guess in the scheme of things that isn't too bad.  I am still working on getting down. 

The Bad:

-I beat myself up over regain constantly.  

-There are days that my eating is out of control.  I am still a slave to sugar.  Some days sugar wins, and some days I win.  It sucks.

-I still want to get back to goal and it's a bugger to control the eating most days. 

The Ugly:

-The skin.  Hoping to get a tummy tuck come Fall/Winter.  I have OHIP approval for a panni so I'm just having to save money for the upgrade.  

-Some days my reactive hypoglycemia kicks my butt but I'm far better at managing it now.  I had two pass out incidents but for the last few years manage it fairly well without problems.  I understand it much better now.  

Really there's not much in the way of ugly to be honest.   No big complications or problems.  Have never been in the hospital overnight since my surgery.  No horror stories at all.  

Dawn