Reactive Hypoglycemia?

[ouroborous 519]

So after a couple of unpleasant incidents, I've done some digging, and as far as I can tell I have been suffering from reactive hypoglycemia (RHG). All of the symptoms I get are hypoglycemic (flushed/chills, nervousness, trembling, slight mental confusion, feeling like I'm going to collapse, etc., all coupled with a sort of panicky hunger -- "I have to eat NOW or I'm going to fall over!"), and it's relieved by eating (but only if I'm careful and eat high-Protein foods, carbs just make the swings worse). I'm curious if anyone else has gone through this with the sleeve.

Incidentally, some call this or confuse this with "dumping syndrome" -- they're not the same, but they may be related. Eating in a way that leads to dumping apparently can dump a lot of blood-sugar spiking food into your small intestine at once, faster than your body can properly deal with. So part of the "eat every two hours" thing is to eat smaller meals and avoid dumping. The Wikipedia article (http://en.wikipedia.org/wiki/Reactive_hypoglycemia) mentions this.

I am not diabetic, according to NUMEROUS tests by my PCP (given my weight and a family history, it seemed like a good precaution). Apparently, RHG is very common for WLS patients about 15-20 months out (I'm ~19 months out). It's made worse by not eating lots of small, high-protein meals, by not getting enough cardio, and by consuming too much caffeine. I'm guilty on all counts, but it seems like caffeine is really the worst offender for me. I don't do well with moderation, and I've discovered that when I really go overboard on caffeine, I get bad RHG, often at night. Also, it seems to be the combination of caffeine and carbs for me -- I don't drink caffeine at night, but my nighttime meals lately have been carb-heavy (spaghetti, for instance), mostly for convenience. And it seems like my RHG is happening mostly in the evening.

So, I'm curious who else has struggled with this, and how you dealt with it. Unfortunately, since I changed jobs in mid-June, I'm not yet eligible for health benefits so I can't go see a doctor about this. That will be changing soon (next week, I think), but I really don't think this is an emergency condition, especially since I seem to be able to manage it by eating healthier, avoiding caffeine, and so on. Mostly I'm looking for support and advice

[TijuanaPlication 87]

Wikipedia states here http://en.wikipedia.org/wiki/Reactive_hypoglycemia that reactive hypoglycemia "is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring within 4 hours^[1] after a high carbohydrate meal"

It also states "There are different kinds of reactive hypoglycemia:^[4]

• Alimentary Hypoglycemia (consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery)"

So this it's saying that re-active hypoglycemia is a form of dumping, which I've experienced pre-surgery.

You sound like your suffering from low blood sugar as eating relieves your symptoms, although wikipedia terms this as hypoglycemia and it's back to citing dumping again.

I'd say you have hypoglycemia in the common usage sense and not the way it's most commonly used in the WLS community. See here for further wiki details:

"Hypoglycemia (common usage) is also a term in popular culture and alternative medicine for a common, often self-diagnosed, condition characterized by shakiness and altered mood and thinking, but without measured low glucose or risk of severe harm. It is treated by changing eating patterns." http://en.wikipedia.org/wiki/Hypoglycemia

It's something I used to experience more in my skinny teenage years due to not eating enough.

The main things are to try and low carb/high Protein it and to eat little and often (you have to be vigilant to not get into grazing though).

I hope you can get into a better routine with your new job soon.

[grannyk 58]

My daughter was sleeved last summer and she has had this reaction several times to eating high carb and high sugar foods like Pasta, rice without Beans and some sugary Desserts. She is not diabetic. One time when she was feeling all the things you mentioned in your post, I took her blood sugar with my glucometer and it was 53...LOW!! So she drank a little milk, ate a couple bites of Peanut Butter and felt better in about 5 minutes. I think the best thing to do is just to avoid the things you know trigger the episodes. There is nothing I want to eat bad enough to make me feel that lousy!! Kathe

[SmokyMtnGal2011 10]

A fantastic information topic. I had no idea of what I was experiencing and you nailed it. I am reviewing my food journal now and figuring out my triggers. Thank you so much for the post and the wisdom. I LOVE THIS SITE AND YOU GUYS AND GALS!!!!!

[SuperMom 33]

I would try getting a hand held glucose meter at your local drug store. Some are even free when you buy the strips. Check to see what your glucose is to make sure it is the problem. It would be helpful to your doctor for diagnosis anyway. Try keeping a journal to to see if certain foods are causing the problem. There are some food allergies etc that can make you feel weird too.

[Amanda131 214]

I've actually been a diagnosed reactive hypoglycemic since age 14. I have kept it at bay for 15 years through my diet... even when I was obese. The secret to RHG is to never eat sugary foods alone. You must pair it with a complex carb and/or Protein. If I was to eat a candy bar alone my blood sugar would be in the 50s within a two hour window. However, if I ate a balanced meal followed by a candy bar then I would typically be okay.

When you have an RHG spell orange juice is the best thing to ingest to quickly right your blood sugar levels. You can also purchase glucose tablets for these incidents (I keep a pack in my car). This is a quick fix though and must be immediatly followed by Protein and/or complex carbs to stop the cycle. To be properly diagnosed for RHG you would need to see your doctor and chart your blood sugar levels and symptoms. Further testing would include scheduling a 6 hour Glucose Tolerance Test and possibly a follow-up 72 hour Glucose Tolerance Test. RHG is not something to be taken lightly. True suffers can pass out from too low of blood sugar- it's terrible, trust me.

While I have lived with this issue most of my life and gotten pretty used to it, I have noticed an upswing in "incidents" since surgery. I had attributed this to having to learn how to balance my eating differently than I need pre-surgery. It never occurred to me that surgery may have exacerbated the issue. Thanks for the heads up!

Amanda

[ouroborous 519]

Thanks for all the followups, folks!

I've discovered (I think) that most of my problems with RHG are due to caffeine; when my caffeine intake is too high, any deviation from the "perfect" sleeve diet (you know, mostly Protein with some complex carbs thrown in, in small portions regularly) can send me into hypoglycemia.

Today I cut my caffeine intake about in half, and so far I'm having NO problems. Of course, it's now bedtime, which is traditionally when I have issues, so... we'll see.

I have some blueberry juice and Protein shakes in the fridge in case I need a late night blood sugar/protein boost. Hopefully, I won't need it.

[ouroborous 519]

So, again with the bedtime hypoglycemia, although not as bad. It's 2:00am and first I was up with the shaky/wobbly feeling, which I dealt with with a small glass of skim milk. Now I have all kinds of aches and pains and bad gas. Almost feels like flu, but it's not.

So instead of reactive hypoglycemia, maybe this is just nocturnal hypoglycemia? I don't have diabetes, so this is all really confusing. I can't wait till I can see a doc again...

[Nancy Rivers 24]

You really need to be checking your blood sugars if you think it's any form of hypoglycemia. By the way, diabetes is the OPPOSITE of hypoglycemia - diabetes is too much sugar in the blood, hypoglycemia is too little. While I am diabetic, my sister is boarderline hypoglycemic - her sugars will dip below 60 if she's not careful. When the blood sugar is below 60, things like what you describe can happen.

If you don't have a glucose meter and test strips - get one! Test your blood sugar when you have these episodes. After you eat, wait another 30 minutes or so and test again. Testing when you first get up in the morning will give you the "fasting" blood sugar reading. Testing 2 hours after eating gives you an idea of how your body is reacting to the food you are taking in (although, I would test immediately before I eat and then 2 hours later to really understand how a food reacted in my body).

Then when you go to the doctor, take the blood glucose readings with you - it will help your doctor.

[ouroborous 519]

I think I have a blood sugar meter somewhere, and I'll try to dig it up.

I guess I've been avoiding directly measuring my blood sugar because FWIK non-insulemic hypoglycemia is usually caused by problems with your pancreas, which I do NOT want to contemplate...

For now, since the problem seems to be related to/worsened by my caffeine intake, I'm weaning myself (further) off caffeine, and trying to stick with the "many small, protein-heavy meals," and I'm going to try to have a protein-heavy "snack" before bedtime (probably just a Protein shake). Oh, and cardio exercise, since that seems to help people with hypo-g.

[ouroborous 519]

So last night was a (hopefully successful) experiment. I focused on limiting caffeine during the day and eating properly, plus I got in some decent aerobic exercise (~2 mile fast walk). When I came home from work, I had a very protein-heavy supper, and no food after ~8:30 pm.

Then, at bed time I drugged myself to sleep; although this isn't healthy or sustainable, I had suspected that I might be a little hypoglycemic at night, but not enough to be really dangerous (just judging from the symptoms), and that what was really hurting me was the lost sleep. In fact, all day yesterday I had odd shooting pains that (in retrospect) I recognize as the effects of sleep deprivation.

And the result was the first good night of sleep in a week or so -- I slept straight through from about 10:00pm to 6:00am, without getting up once. I'm going to repeat the process today, going from the theory that as long as I'm doing all the things (eat right, exercise, limit caffeine) that I know are good for me, and as long as none of my symptoms are truly dangerous, it's more important for me to get a good night's sleep than it is to wake up and fret about mild nocturnal hypoglycemia.

It's strange how much like a scientist you have to be, if you want to lead a healthy life -- you have to perform all these little experiments, and monitor the results, then adjust your behavior based upon the outcome!

[Spindoc 0]

I think I had my first episode tonight. Was sweating uncontrollably and feeling faint while driving. I had a grandma with low sugar so I pulled over for some OJ. It helped. I am 8 months post-op. could this be hg? Do my night sweats have anything to do with this? I'm scared to sleep for fear of not waking up.

[sasicas 194]

Bumping this as I was researching what is going on with me. I'm about 18 months out. Lately having increasing issues where I get super jittery. Seems to be when I've had too much caffeine and/or not enough to eat. This morning I had a cup of coffee then a small pancake and then another cup of coffee. Jitters came, dizziness came, headache started. Sat down ate some chicken and I finally going back to normal.

At this point I know my labs have been fine other than being anemic, which my doctor thinks describes a lot of the dizziness I get now. No matter how slow I get up I can get a few feet away and everything goes black. I'm ok to just stand there while everything is black, then vision goes back to normal and I'm good to go again. We know that my bp seems to drop quite low if I don't eat enough too, found that out after my last surgery, they wouldn't feed me with my bp being dangerously low. My bp didn't recover until I was allowed to eat again.

Just when I think I'm finally getting to some kind of normal my body decides to go all crazy. I suppose it's time to go see the doctor again and see what, if anything, needs to happen next.

[vsgtanya2011 4]

I'm almost 10 months out and I started having these same issues (weak, shakey, heavy sweating, the feeling that I need to eat something to make me feel better) at about 6 months out. When it started, I was still eating extremely low carb (less than 45g per day) and my nurse told me to start introducing more complex carbs, which I did. I now eat about 70-100g of carbs a day, which come from fruit or milk in my Protein shake. I still get these attacks every few weeks and it's not after having an unusual amount of carbs. In fact, the last one I had was after I specifically had a low carb Breakfast because I knew I would be eating a higher carb lunch. After reading this string I'm wondering my attacks are brought on by caffine. For the first 4-5 months after surgery, I did not drink coffee at all. Now I drink 1-3 cups a day and my attacks usually happen in the mid morning. I exercise regularly (3-4 times a week). I'm going to experiment and only have one cup of coffee a day and I'll see if it improves.

So glad I found this post!

Tanya (vsgtanya2011 on YouTube)

[lucy00us 7]

I've been suffering with all those symptoms for the past two months, but it's have gotten really bad in the past 3 weeks. I'm so glad that I found this post. I started measuring my sugar levels and I'm going to cut some of the caffeine intake...I've been drinking coffee like crazy lately and I stopped doing my zumba classes due to a crazy schedule.

I just schedule a doctor's appointment for next week and I will reduce my caffeine intake as well as increasing my Protein foods. The feeling with low sugar levels is the worst ever!