Reactive Hypoglycemia - Post Bariatric Surgery

[Grace]

Hi All -
Some info out and some info gleaning going on here.

I've felt lousy since about May. Shakes most of the time, head tremors, feeling like I want to eat constantly, dizzy, constant headaches, some migraine type with one pupil larger than the other, not sleeping well, terrible mood swings....etc, etc.
Yes, I have an appt with a neurologist for the head and tremors and have had mris of my head and spine and a CT scan of my sinuses. All were within normal parameters but I'm bringing them with me. And I saw gyno. All ok there.
Now that you have the backstory here's what I think is up, at least partly.
I've been eating more carbs, GFbread (I'm gluten intolerant), rice sticks with sauce, some bread crumbs on foods, essentially I was up to about 75 or 80 carbs a day on a regular basis. This was what my NUT wanted and I was trying. Also, for the headaches and mood swings I was eating some carb just before bed, usually sweet potato (from potatoes not prozac).
I just couldn't fathom why I've been so weak and tired.
Sat we were working outside getting things ready for the storm.
I had egg beaters, cheese and a 1/2 gluten free english muffin to power up for the work. That gave me about 15 gms of protein and 17 carbs. This was about 8 am. We were outside working (not terribly hard, I thought) and I flat out fainted at about 10:15. Wham, out... Hubby was a fireman with emt training and once I woke up and he decided it wasn't desperate he got me some juice. (I only drank about 2 oz) Well my heart started racing and I felt better but odd. Rested, ate some protein and after a while felt better but carried some candy in my pocket (I know, duh)....
Kept feeling lousy and when I nearly passed out again I finally got a clue and took my blood sugar (had to dig up a kit, took 30 min)... it was 45. Well, then, ok. What the hey?
I have never been diabetic. The highest my A1C has ever been was 4.6 when I was gorging on carbs daily. However I have in the past had issues with my sugar going too low, which of course like many folks I treated with sugary foods.
So, long story a bit shorter, I spent Sat evening reading up on hypoglycemia.
Turns out there is mounting evidence of some bariatric patients hitting 10 months or so out and getting reactive hypoglycemia. It seems to hit between 10 mo and 18 mo. Essentially from what I understand, the pancreas sends out a disproportionate amount of insulin for the food being eaten.
Too much insulin floods the system and wham, blood sugar goes too far down. I'm not a doc, but they are calling it postprandial reactive hypoglycemia.
So, all of yesterday I worked on calming my system by eating almost entirely protein at 2 hr intervals. I had 9 carbs all day. My blood sugar mostly stayed between 83 (fasting) up to 115 after a meal and down to 75 about 2 hrs later just before I ate again. Since it did that with just protein I can only imagine when I was eating sweet/carby foods like bread, fruit and ww ice cream the last few months.
I'm going to call my doc to get an appt for testing or to be told how to do it at home but for now I wanted to make folks aware of this issue in case you find you are craving sweets and then feel lousy and want more to feel "better". Fight the urge, have some protein and complex carbs and keep it level if possible. Careful with simple carbs, they'll hit harder.
I also don't know the answer to this but the literature I'm reading seems to indicate it's protein and a bit of complex carbs 5 times a day. Well now, isn't that convenient since that's how we're supposed to eat anyway? But it is a bit depressing to know that after all this we may have issues with sugar but in the wrong direction.
BTW, I do not feel this has anything to do with why we get weak just after surgery for the first few weeks...that's mostly dehydration and lack of nutrition, IMHO.

Anyone else about a year or so out have such issues when you get more than about 60 carbs a day and/or eat sweets?
Sorry for the book. Just think when these things come up we should share.

[niamh]

So glad to hear you're ok - must have been frightening for you both yesterday. Sounds like you're onto a reasonable theory, hope you can get some good answers from the docs about this pretty quickly. Be well.

[suegirl]

That's scary considering I suffered from hypoglycemia when I was a teenager and early 20's.. I really don't want to repeat that...

[pack89]

So sorry for your troubles, and I hope you are on the right track to getting it fixed. I also thank you for your post. I feel we must all share info as it's still a relatively new procedure and everybody reacts differently, so there is no real "standard" to go by.

[WandaLeaner]

I have hypogycemia now, and im a month away from sleeve. I will be sure to mention this to the docs, and keep my monitor close by. My usual after a regualr meal is usually in the 4';s (canadian scale is different.) 6 is normal, fasting, so 4 is brutal! I always have a few candies in my purse, and don't touch the artificial sweeteners. This will be the biggest change for me. I think a trip to the dietician is in order for me before the surgery.
Im so glad that you are feeling better and hope that you get this worked out! Sounds like you are on the way to a solution!

[overweighttoolong]

Grace, thanks for the information, we all need as much information as possible. I am sorry you had such a terrible time yesterday, thank goodness your husband is a calm, cool collected man and you didn't end up in the ER with them yelling at you for not eating!! Good luck with the docs and the nut sounds like a great idea. Take care.

[Everdreamer]

AGH!! I am so sorry you are going through this...I hope this issues improves for you...is there any medication that can help you?

[scgal21]

Thank you Grace for posting this info! I too have had some issues with hypoglycemia as well as low blood pressure. I had both of this problems pre-sleeve, and have been feeling exhausted and just not myself. I have to watch what I eat very closely, as well as listening to my body. I hope you get to the bottom of your issue and feel better soon! Please keep us posted.

[Grace]

AGH!! I am so sorry you are going through this...I hope this issues improves for you...is there any medication that can help you?

I don't think so - most meds for sugar are to bring it down.... All I've read says it's all about what you eat. There is a severe condition (much worse than mine) where there is a surgery but it's very rare.

[marilynlw]

Thanks for the info and hope you feel better. Please let us know what the NUT says. I'm sure it will help some of us too.

[jane_vsg_ayla]

Hey Grace we must be on the same wavelength I have been reading a lot lately trying to figure out the world's energy crisis (well, at least my own energy crisis) and dizziness and mood and sleep issues. I ordered a glucometer a week ago due to my suspicions around hypoglycemia. My level is about 78-80 a few hours after eating, but 62 fasting this morning, and 65 just now 30 min after dinner (dinner was 1 carb and 14g protein!). So I am guessing it was even lower with the higher carbs I was eating. I spent last night researching exactly what you did It explains a lot! I even read the same kind of articles about postprandial reactive hypoglycemia. I came to the same conclusion you did - keep carbs (total, not "net") strictly below 50g for now and spread the protein out. The other thing I learned was that even though we are told to focus on protein, they dont tell you when to stop. I pushed hard and was eating way more protein than I needed. Turns out excess protein is basically a carb anyway! So for now I am keeping it to right around 60-70g until I find my limit. Everything else I eat to make up my calories will be fat (adding heavy cream to my tea, real eggs and cheese, etc). I am very careful to eat at least 1400-1500 calories daily - I have no intention of living on 1200 or less my whole life! I want my body to learn to burn that much, not lose energy down to where I just maintain on 1200. And our bodies are apparently content on burning whatever is available - so I will give it almost no carbs and just enough protein to use for what it needs, then if it wants to burn anything else it can burn the fat.

I found several sites about something I had not heard of - "nutritional ketosis" (similar to atkins but NOT atkins). Researched it a lot in the past two weeks and decided I want to give this a try. The promise of greater energy (eventually, with moderate protein and a little extra salt) and increased mental clarity (brain fog is a chronic condition lately) I figured it couldnt hurt to give it a real try. So today was day 1 of a 30 day experiment and I did pretty awesome so far today sticking to my goals and it was pretty easy. Only one dizzy moment. 30 days should give me enough time to see improvement. And I am tracking *everything* from bood sugar to mood to water to salt etc. I *will* figure this out

Let me know how it goes for you with your doctor! And if you learn anything new let me know - seems like we are on the same path. I have maintained my weight for most of this year (up and down the same 3-5 pounds). I am happy with where I am, but have excess fat around the middle that is just ingrained and wont budge. I dont care if I lose any more weight, just want to burn that fat off and build up some muscle. But I kind of what to be awake for it and not have the world spinning either. Diet plays such a huge part, that I really hope this gets me a little closer to learning what MY body thinks it is doing

[Grace]

Judie, thanks so much for posting! I'm really interested in where you found info on nutritional ketosis? Sorry you are having the same issues but oddly relieved to have some company in this. I've always known I feel better when I eat fatty foods and I did indeed cut back on fat by about 75% this spring when my gallbladder started to act up and NUT said I'd only lose more weight if I ate low fat.... which seemed odd because I always (pre-gallbladder) felt best when doing the atkins "fat-fast" which is lots of fatty meat and salad veggies for carbs.
I'll join you in your program if you will share and together we might come up with a strategy for others this happens to....
Seems like it's fatty proteins and about 10 complex carbs 5 times a day? Is that right?
thanks again!

[Mbenson5]

So scary to pass out! Glad your husband has some medical training! Sounds like you are figuring it out. Will be nice to see your dr armed with such great information. That's a long time to feel bad. Adding my thanks to you for taking the time to share with all of us. Great info to tuck away in case it happens to any of us. Keep us posted!

[Mini me]

This is really interesting. I am only 8 weeks out from surgery and mostly feel fantastic. But there are times I get quite 'heady' and feel like I am going to black out, but don't, then I come good again. Can this be related?

[jane_vsg_ayla]

There are two main places I started out reading, and they reference a few books which are very heavy on science. Usually that is good for me, but I found it hard to just find out what to do practically. I read almost this whole site, but started with this page - How can I lose weight? « The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D.. And this guy has done a 6 month experiment that is very encouraging - ATLCX (Episode 32): Jimmy Moore | Nutritional Ketosis 6-Month Update « Jimmy Moore's Livin' La Vida Low Carb Blog with charts and graphs for each month. There is a ton of info on why you need good fats, and how your body uses them and how saturated fats are not all evil. But its very interesting to read about how your body needs fat to burn fat. They dont emphasize calorie counting, but I know i have to still watch that. (They just say to cut back on your fat while keeping carbs and protein total grams the same, which is the same thing as cutting calories). They explain a lot about how the low-fat craze is partly responsible for the obesity epidemic, etc. Plus I am looking forward to having shinier hair

Very excited if you join me! I had a hard time getting up to 1300 calories yesterday even with the added fats and I feel like I ate a lot. My final stats were 109g fat, 58g protein, 22g carbs (7g sugar) and sodium 3000g (that is supposed to help with the lightheaded-blackout on standing since I usually dont get much salt anyway). I was only really hungry once around lunch, and I hear that will go away the longer you do this and your body adjusts. I am also trying to work up to a 12 hour fast daily - meaning i go 12 hours between my last meal or snack and breakfast. My fasting glucose this morning was 65...

Let me know what you think!