Iron Deficient Anemia and Hypoglycemia after RNY

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I am 8 years lost op from RNY and having an extremely difficult time. Last year (2016) after having extreme fatigue, fainting spells, racing heart beat, some tachycardic issues, whole body jitters/shakes, I was diagnosed with having Iron Deficient Anemia. Extremely low ferratin levels warranted 2 IV Injecatfer iron infusions. After 3 weeks, I felt fantastic and have felt great for over a year. Several weeks ago I started feeling all the same symptoms as before. My Hematologist did lab work but my ferratin levels were "within normal range" despite having dropped almost 40 points in 3 months. Since I was symptomatic, they approved another of iron infusion. I started to feel slight improvement of my symptoms after 5 days, but then all of those symptoms returned with a vengeance. My Hematologist is positive my symptoms are not from my IDA. I have seen every specialist to rule out other issues. Everything has been deemed ok. 

I went back to my PCP and he ordered a ton of lab work, including a 4 hour GTT. I had that done 3 days ago. It was absolutely awful. I was having uncontrollable jitters, severe cold sweats and my eyes started to dialate. The nurse on staff at the lab almost called 911. 

PCP called today to tell me that I have severe Hypoglycemia and that is what is causing all of my dizziness, lightheadedness, shakiness and fainting. He is positive changing to a low-glycemic diet will fix it. The concern I have is that those symptoms are pretty much constant 24/7. If I am lying down or sitting with neck support, i usually feel better. 

Is it possible to have hypoglycemia symptoms CONSTANTLY, or is this not a true hypoglycemia diagnosis?? I have not noticed any increase in symptoms before or after i eat. I pretty much feel lightheaded and like i am going to pass out all of the time. I am thinking maybe a copper deficiency, which results are still pending. Or is it a nasty combination of Iron Deficient Anemia, hypoglycemia and another vitamin deficiency??

I am supposed to see a Nutritionalist at the hospital this week. Would it be better to see a specialist that works with gastric bypass patients or an endocrinologist? Or is there someone else I should seek out? (I have already seen a neurologist, opthamologist, ENT, gastroenterologist, etc)

4 hour GTT results:

Fasting: 79

1 hour: 105

2 hour: 40 (lab repeated the test to verify results)

3 hour: 67

4 hour: 83

My hgbA1C was normal at 5.4

 Any thoughts would be appreciated.

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I am very sorry for what you are going through.  You should not be shy about seeking a second opinion from another physician if your physicians are not sure how best to proceed.

We are here to support you.  

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Hello Mestali - it sounds like you're going through a pretty rough time, and I'm sorry to hear that. In my readings around various WLS forums, I've run into the idea several times of GTT being a bad way to check for hypoglycemia in RNY patients due to the way we process sugar. That's where dumping syndrome comes from, of course. I don't have any research on hand, but you might look into asking your PCP to research this, or trying to find a PCP who understands these considerations. I don't know anything about this, but your question reminded me of some concerns I've run across. Worth looking into.

I hope you get this figured out soon!

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Mestali, I think this kind of hypoglycemia is thought to be due to excess insulin production after eating a meal. You were not hypoglycemic until 2 hours after the glucose challenge.  A low glycemic diet should be the first thing a person with this syndrome tries. Take a look at this article from the Joslin Clinic.

Hope this helps ---

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