Lack of Protein or Dehydration?

I am 2 years out and occasionally (maybe once a week) I start getting shaky, hot where I start sweating and feel as though I am about to black out. I would say I was dumping if I had eaten anything, but it usually happens when I haven't eaten yet or it's been a while since I ate. I am always drinking water and get all of it in by the end of the day if not more, but when it happens it's usually at a time before I have gotten it all in. So I don't know if it's a lack of protein or water. I usually start chugging water (yes I can do that) and eat a high protein food (yes at the same time even though I know your not suppose to) and I will start feeling better shortly after. But since I am doing both and honestly afraid to do one or the other, in case I pick the wrong one and actually pass out, I don't know which one is actually making it happen. Today was especially bad and even though I gobbled up 22g of protein and chugged 46oz of water I still do not feel "normal". Does anyone else go through this or know why it's happening?

Thanks for the help.

Sher

Sher, sounds like Reactive Hypoglycemia to me.

What is Reactive Hypoglycemia:

Two types of hypoglycemia can occur in people who do not have diabetes:

• Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals.
• Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease.

Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.

To find the cause of a patient’s hypoglycemia, the doctor will use laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body’s use of energy.

Reactive Hypoglycemia

Diagnosis
To diagnose reactive hypoglycemia, the doctor may

• ask about signs and symptoms
• test blood glucose while the patient is having symptoms by taking a blood sample from the arm and sending it to a laboratory for analysis^*
• check to see whether the symptoms ease after the patient’s blood glucose returns to 70 mg/dL or above after eating or drinking

A blood glucose level below 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. The oral glucose tolerance test is no longer used to diagnose reactive hypoglycemia because experts now know the test can actually trigger hypoglycemic symptoms.

Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric—or stomach—surgery can cause reactive hypoglycemia because of the rapid passage of food into the small intestine. Rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend

• eating small meals and snacks about every 3 hours
• being physically active
• eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
• eating foods high in fiber
• avoiding or limiting foods high in sugar, especially on an empty stomach

The doctor can refer patients to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet to treat reactive hypoglycemia.

I have these articles for reference on Reactive Hypoglycemia (or late dumping as some articles are calling it)
Endocrine News
Endocrine Today Blog
Evaluation and Management of Adult Hypoglycemic Disorders An Endocrine Society Clinical Practice Guideline
Low blood glucose levels may complicate gastric bypass surgery
Gastric Bypass Linked to Abnormal Glucose Tolerance
Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia
Pathophysiology, diagnosis and management of postoperative dumping syndrome which is the video posted by MeltingMama and done by the Joslin Clinic who specializes in Diabetes Care.

Reactive Hypoglycemia is a miserable condition. You go high with your blood sugar and then drop really low very fast. It's like riding a roller coaster that you can't stop.

Liz

Since this is happening when it has been a while since you ate I would think it is probably reactive hypoglycemia. I don't know how long you are going between meals.

I find this is more likely to happen to me if I:

A - eat too many carbs at a meal compared to protein

B - go too long between meals

I usually try to spread my 3 meals into 6 mini meals so I am fueling my body every 3 hours or so.

Dehydration will usually make you feel weak, shaky and headachey, but not sweaty.