Late dumping - Reactive Hypoglycemia

 Late dumping - Reactive Hypoglycemia....Is it the same thing???

 

9.5 years post RNY, having some issues with blood sugar control. 

 

I'm not diabetic.

 

Sometime....intermittently, a few hours after I eat my blood sugar can drop.

 

it started happening a couple of years ago.  At first I didn't know what was happening.  I explained the symptoms (sweat pouring from every pore, shaky, pounding heart, and hunger) to my doctor....he did a bunch of tests and ruled out any cardiac issues.  I was instructed to do a finger stick glucose test if the symptoms recurred.  The next time it happened I tested my glucose, 32.  

 

Since then I have been paying more attention to my diet and liquid management.  I still get hypoglycemic from time to time but not that frequently.  Generally if I eat too much refined carbs. 

 

Recently I have been thinking about how often is my sugar dropping, WITHOUT, symptoms???  It’s obvious to me when it’s really low

That is exactly what it sounds like...RH.

Melting Mama is probably one of the most "well known" posters on OH that has this experience.   She could tell you LOADS of information.

I don't know what late dumping is.
I've researched reactive hypoglycemia as I sometimes get a little shaky and too many refined carbs cab do it. Eating more snacks and spacing out food might help.
(You may want to check out possible effects on your pancreas with the body trying to compensate for too much sugar at once). 

It is very obvious.  In hindsight, the first 6 months out going forward it happened easily with simple carbs.  At two years out I thought it was a thing of the past.  But it began happening again...not too often.  What I have come to recognize is when I eat simple carbs w/o protein or  go a long period of time between meals and eat carbs I might have a drop in my blood sugar- but usually do not.  It is unpredictable.  There are times I just know I'm going to have a significant drop based upon what I ate....but nothing happens.  Then there are times I have a little infraction...and have a drop that catches me off guard. 

If you think this is happening more frequently, and you are not monitoring your BS throughout the day or after specific types of foods, you might want to start testing and journal to see what you discover.

 Yep.  

Early dumping is -

What is dumping, and why am I experiencing it?
Answer provided by Taghreed Almahmeed, MD, FRCSC, and Michel Murr, MD, FACS

Dumping syndrome is a group of symptoms caused by rapid passage of undigested food into the small intestine. The stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in small increments.

After gastric bypass, ingested food passes directly into the small bowel, mixed only with saliva, but not the stomach acid. The component parts of the undigested food remain fairly intact and therefore large.

The small intestine responds by diluting the ingested food through a process of “water recruitment." The “richer" the food, in terms of sugar content, the more water will rush into the small intestine to dilute it. This is referred to as “early dumping."

Early Dumping and Late Dumping

Early dumping occurs a few minutes to 45 minutes after eating. Symptoms are not life-threatening, but can be frightening to the unsuspecting patient. Symptoms of early dumping are:

• Weakness and fainting

• Sweating

• Irregular and rapid heartbeat

• Low blood pressure

• Flushing of the skin

• Dizziness

• Shortness of breath

• Vomiting

• Diarrhea and cramps

Late dumping occurs two to three hours after eating. It is caused by excess insulin produced in response to rapid entry of food and fluids into the small intestine. The high insulin levels lower low blood glucose level and cause symptoms including:

• Perspiration

• Hunger

• Shakiness

• Anxiety

• Difficulty to concentrate

• Exhaustion

• Faintness

The diagnosis of late dumping syndrome can often be confirmed through frequent blood sampling to measure blood glucose.

You can prevent early and late dumping by avoiding the foods that cause dumping. In other words – sugars, starches and fried foods. Eat at least five to six small, evenly spaced meals a day. Take meals dry (i.e. withou****er or beverages, and drink fluids only between meals). Because carbohydrate intake is restricted, protein and fat intake should be increased to fulfill energy needs. Examples include meats, cheeses, eggs, nuts, toast, potatoes and rice crackers. Milk and milk products are generally not tolerated and should be avoided.

Each person has a different tolerance, and you will discover what your personal safe foods might be throughout your post surgery life. Person “A" might have no problem with strawberries and person “B" might experience dumping every time a few strawberries are eaten and person “C" might be able to eat strawberries only if they are a little unripe. You will learn what your own trigger foods might be. Be aware that these may change over time as your bypass matures.

General Measures to Treat Dumping

For early dumping, lie down for 45 minutes until symptoms pass to minimize the chances of fainting. For late dumping, eat small amounts of sugar candy or drink sweetened juice until the symptoms of low blood sugar resolve. Additionally you can supplement food with dietary fibers such as fruit, vegetables and grain products. Many medical therapies have been tested, including pectin, guar gum and glucomannan. These dietary fibers form gels with carbohydrates, resulting in delayed glucose absorption and therefore avoiding a sharp increase in insulin. However in 3 to 5 percent of instances, severe symptoms of dumping can continue despite dietary changes. This results in marked weight-loss, fear of eating and outdoor activities, or even an inability to maintain full time employment.

Medical management of dumping includes acarbose or octreotide. Acarbose delays absorption of food and maintains an even blood glucose level. Octreotide is an analog of a hormone in the digestive system that can alleviate dumping by inhibiting insulin release and by slowing transit of food in the small intestine.

Dumping is Common

Dumping syndrome is a common post-surgical complication after gastric surgery. The symptoms of dumping may cause considerable morbidity. If medical management fails to provide adequate symptom relief, remedial surgery should be offered with the understanding that even surgical intervention may not be successful. Normally most patients have a spontaneous recovery as the digestive system adapts after surgery. Early dumping syndrome usually occurs for three to four months after surgery. Late dumping syndrome can occur for an entire year, but may persist for many years. If you experience any of these symptoms, contact your health provider to review your food diary and implement changes to help you.

Here are some results from here:

Late dumping - Reactive Hypoglycemia

Late Dumping‎ - Mar 16, 2011
Difference between Dumping and Reactive Hypoglycemia?‎ - Mar 7, 2011
Poll: Reactive Hypoglycemia & Dumping‎ - Feb 15, 2011
XP: "dumping" vs. "reactive hypoglycemia"‎ - Nov 29, 2009

More results from obesityhelp.com »

 Can a revision to reduce the length of the Roux limb or even just to decrease the size of the stoma to slow the food passing be helpful for RHG?  

Reading about pancreas removal is freaking me out!

I doubt that.  Your body most likely make too much insulin.

reprint:

New Data on Weight Gain Following Bariatric Surgery

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine. The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain. The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss," said Dr. Roslin.

http://www.lenoxhillhospital.org/press_releases.aspx?id=2106

LOL, sorry it freaked me out too.
I used to think oh, it's o.k. to have a little sugary treat, so what if it makes me a little sleepy...then I read that and I'm normally more careful. I say normally because on Easter I had some sweet things... Who the heck knows everything that's going on in our bodies!

yeah. The RH is typical long term RNY side effect.

Our body makes much more insulin so it responds to carbs and sugars. 
I have to eat every 2-3 hrs. Very low car, high proteins and mid fat. 

With RH - it is very easy to gain weight. Watch for that. The insulin is designed to put the sugar away into cells - if normal cells do not need them - they get stuffed in fat cells. And we need to eat more to bring the blood sugar back to normal. Insulin also prevents fat burning. 

google RH and weight gain...    

 I developed RH about 18 months out. If I eat a carb alone meal I will crash big time. It feels really bad and can take hours to recover from.
I eat frequent small meals that are protein centered. 
Deb T.