Hypoglycemia, panic attacks & the gastric sleeve

[Quarry]

I am not liking where my research is taking me.

There appears to be mounting evidence that reactive hypoglycemia occurs in a minority of patients after sleeving. There are posts within this forum describing some of these unfortunate events, often severe, and in the medical literature.

When I was pregnant 36 years ago, before hypoglycemia was as well understood, I suffered continuous panic for weeks on end. I cannot overstate the emotional pain of constant anxiety. I paced so much, trying to distract myself from the psychic pain. Sleep came in fits, lasting briefly, and when I startled awake, the terror was even greater in my foggy mind. My doctor said to drink wine to relax. Yes, really. Idiot. Thank goodness the months went by and the panic phased away.

Subsequently, I have had panic attacks only if I eat a fruit-only last meal of the day. That would guarantee a middle-of-the-night panic attack. I floundered onto the cause and effect, and the remedy-- orange juice. If I chug a shot of juice and step out into the cool of night, I can turn it all around inside of 90 seconds. Poof! Of course, I simply don't eat fruit alone late in the day now, so it's virtually a non-issue.

Now that I'm reading about sleevers suffering from the many different low-blood sugar symptoms (shakiness, sweating, weakness, even seizures), I am inclined to forego sleeving entirely if there's any likelihood I'd have to be on guard against panic every three hours. Yes, I'll ask my doctor about it at my next checkup, but I don't know what he can tell me. They can't predict too much, especially given the sleeve's brief history. As of tonight, I'm not seeing the benefits outweighing this particular risk. If you haven't experienced a panic attack, you just don't know how gruesome you can feel, and you're lucky.

[sraebaer]

Very interesting, my doctor feels I may have this, and I don't know anything about it.

[KarenJean]

Oh no!!!! How sad for you.

[KarenJean]

Hey honey, there's a whole discussion of this on bariatric pal (of course I had to google it)

http://www.*****************/topic/1...-hypoglycemia/

[thenewmetoday]

I have a diagnosis of PTSD and have experienced panic attacks beyond belief. One of the things I know is when my sugars are low, and I check with the glucometer to see where my sugars are and if low treat with juice or a sugar hit. Not really an issue since surg. as my blood tests are normal, You have to listen to your body and eat when needed. I like small meals 4 to 5 times a day.
The weight loss has improved my blood sugars and my sencse of self worth and PTSD is much improved, even though I am not using food to medicate myself.

[Ema]

I am sorry you are considering not being sleeved because of the slight chance of reactive hypoglycemia. They call it reactive because it happens in response to a high carb/sugar meal or snack. If we stick to the protein first then veggies, we make the chance of hypoglycemia extremely small. I have experienced panic attacks and they are no fun. I don't want to experience any more of them.

Talk with your surgeon and get his/her take on it. If you still believe you can't take that risk, then you'll know not to have the surgery. I wish you well in making this decision.

[KarenJean]

http://www.*****************/topic/1...-hypoglycemia/
http :// www dot ************ dot com /topic /reactive-hypoglycemia/

I think this website blocked out half of my link as a competitor, so I typed it out. Just eliminate the spaces and replace "dot" with a period.

[Quarry]

Low Blood Sugar a Potential Complication After Weight-Loss Surgery | news@JAMA

"The researchers also found that hypoglycemia developed in 18% of patients who had undergone gastric sleeve surgery (a procedure that involves removal of most of the stomach, turning it into a narrow tube) ..."

Eighteen percent is pretty significant. And I read somewhere that it develops over time.

[KarenJean]

Look at the paragraph above that. In the study, all patients were given a bolus of sugar and then checked for reactive hypoglycemia. So basically, post-sleeve if we ingest a lot of sugar, 18% of us can expect a hypoglycemic reaction. Yeah, I sort of knew that. I'm very sugar and refined carb sensitive, so I don't touch anything with sugar any more.

[Ema]

Thanks for the article. It is interesting. The 18% of sleeve patients who showed hypoglycemia did so during a glucose tolerance test where they were given a bolus of sugar. The hypoglycemia was in reaction to sugar loading. The article went on to say most of the people did not show clinically significant symptoms which is that, during their normal lives, they did not experience hypoglycemia.

My point with this is that I would not like to see someone not get the surgery because of a fear that may or may not be realized. If you are really fearful, then the surgery is probably not a good choice for you. I would talk with your surgeon and see what their experience with their patients has been. I think it is great you are doing your research.

[KarenJean]

I'm very curious about this because I've had mild hypoglycemic episodes before getting sleeved. I been reading various studies, and this problem seems more common and servere in bariatric procedures that remove the pylorus, which the sleeve doesn't do. But even those numbers are low--.07% versus .005% in the general population.

Quarry, check out the collection of research on the NIH/gov website.

[Ann2]

First of all, if you are not a good candidate for WLS, don't have WLS.

The single serious instance I have read about by a poster on this site re post-bariatric surgery reactive hypoglycemia developed (in her case) by losing weight through a weight loss diet that was very low carbs (no more than 25-30 grams daily) for at least nine months.

When I did my own review of research published online about this topic, I found that something like 3% of sleeve patients suffered (in varying degrees) in their real lives (not during a sugar test) from this malady.

And that's why I chose NOT to eat low-carb since WLS. As low as the odds are of incurring post-bariatric reactive hypoglycemia, it can be a brutal condition to manage. That's why I set my daily carb goals at 60 or higher. As a result, I might be losing a little slower than those who are going very low carb during the weight loss phase of this journey. But I don't care about the speed of weight loss -- just that I reach my weight goal eventually and that I continue to ratchet up my metabolic rate during the weight loss / weight maintenance phase through diet and exercise and by gradually increasing my muscle mass.

For the record, my bariatric surgeon and his team never told me to count carbs or go low-carb. That simply wasn't a dietary prescription.

Finally (again), if you are not a good candidate for WLS, don't have WLS.

But also plan how to tackle your obesity problem without WLS. Because being morbidly obese sucks.

Good luck.

P.S. "Grace" is the handle of the forum member here who suffers from this malady. Here's just one post she made several months ago. http://www.gastricsleeve.com/forum/b...itys-sake.html If you're interested in more of her journey, you can search and read her other posts here. She has contributed a lot to this forum. I should note that Grace had numerous other post-WLS complications, so her problems aren't all due to reactive hypoglycemia.

[jane_vsg_ayla]

I am one of the ones who developed this. But it is a learning process like everything else - it is not something you just put up with, you learn what triggers it and you avoid it...

In my case, as one example of something I learned - I found that my "normal" blood sugar is low (~70), and drinking anything with stevia in it will tank it to the point of seeing stars and shaking. Stevia is awesome for diabetics, not for hypoglycemics! Over time I learned I did not have to avoid it completely, simply pair it with enough carbs (from other sources) and/or protein. It is only a big issue for me if there is no carbs to balance out the lowering impact. You just have to really pay attention to your body and learn what triggers it and what doesnt, and sometimes that can take some time. I did learn that what prevents it the best for me is to never eat carbs alone.. I am not low carb at all anymore (was the first year naturally), now I make sure that if I eat anything like bread or pasta or cake or veggies (anything carby), I pair it with fat or protein in roughly even amounts. For example, crackers or an apple with peanut butter. I also make oatmeal with premade vanilla protein shakes instead of milk - so the carbs and protein balance out pretty close.

I read one article that made a lot of sense to me... Basically when you start to eat, your stomach releases insulin in anticipation of sugar/carbs coming in. It releases enough for a whole meal. Since we no longer eat a whole meal, we have too much insulin and not enough carbs for it to act on, which drops your blood sugar and causes the episode. They suggested an approach to always eat a "full" meal at a time - i.e. 3 meals a day instead of the usual recommended 5-6 smaller meals ... This is of course nearly impossible for us, but in my case I did reevaluate - I was basically eating 10 small meals a day - constant grazing, so my body was just confusingly releasing insulin all over the place. I changed to trying to eat somewhat larger meals a little less often, with a few meals being "bigger" than others.

One thing I saw a few times above I disagree with... If you have reactive hypo, the very last thing you should do during an episode is treat it with a "bolus" of sugar (i.e drink orange juice, eat candy, etc). You set yourself up for a roller coaster effect with that - yes, it will help in the short term, but your state was caused basically by the same thing... You ate too many carbs, so your sugar spiked up, then it plummeted giving you the hypo symptoms. If you then eat a big thing of carbs/sugar to "treat" it, you go right back up to the spike (eliminating your symptoms) but then it is going to plummet again putting you right back into hypo. The preferred treatment is what you should do anyway - moderate, slow digesting carbs (i.e. oatmeal, veggies) as soon as possible. Slow digesting carbs (low GI? I think) do not cause your sugar to spike like quick ones do, so they dont cause the crash after. So step 1 is prevention - avoid fast digesting carbs if possible, step 2 is if you do get symptoms, eat some slow digesting carbs as soon as possible. It wont resolve your symptoms nearly as quickly, but it will prevent the roller coaster effect and get you back to normal. THis is only true for reactive hypo - normal hypoglycemics and diabetics with hypo episodes are very different and the bolus of sugar is a life-saving necessity. Most reactive hypos do not drop as low as those people do, and while uncomfortable it is not so much an emergency that you HAVE to get it up immediately, so the slow digesting carbs as soon as possible will be fine.



I agree with Ann - if WLS is not for you, dont do it. But if you are avoiding it because of something that *might* happen. Think of it this way - am I willing to *possibly* trade one disease (obestity) for up to an 18% chance of getting another (hypo)? Which one would I rather have to treat? If you are truly that scared of being hypo that you would rather treat and manage your obesity instead, then yes you should avoid surgery. Keep in mind though, that obseity generally ends up with diabetes... Diabetics are going to have to deal with hypo episodes as well. So either way, that will be a possibility you will have to learn to work with. Its a lot easier to manage hypo on its own than together with diabetes!

[Damasyn]

Wow , well, frankly to be honest, I dont think you should have the surgery. At least not yet. I think you need to get a hold of your anxiety issues first before the added pressure of surgery. There will most likely be a time when you eat something you shouldnt and have a reaction. You would most likely freak the hell out IF - IF you have these issues pre surgery.

I mean hell, Heart disease runs in my family. Is there a chance for me to get it.. sure, but stressing out over it wont help, it will only hurt . Is there a chance for me to get hit by a car tomorrow ? Yes. Is there a chance for me to win the lottery ? Sure - Is big foot gonna come waltzing thru my yard and pose for pictures ? Doubtful - but hey, it COULD happen :-)

If you cant learn to let go and say WTF . You shouldnt be doing anything drastic.

[Ann2]

Jane, what a wonderful, wonderful post (above) about post-bariatric reactive hypoglycemia, based on your own experiences and research. I learned tons.

Thank you.