Loosing Lucy

Hypoglycemia after RNY, how common/severe

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Hi all, 

I've been reading through lots of old posts and am noticing a reasonable number regarding post bypass hypoglycemia. Seems like it's actually quite common and sometimes quite debilitating with very little that can be done to treat it. 

I'm starting to get a little worried as I currently don't have any health conditions (other than being morbidly obese) and my reason for doing this is to reduce my risk of developing any sort of disease/ health condition. It would really suck if in my attempt to avoid that I developed a very debilitating condition as a result of the surgery!

There also seems to be very little research into the issue. Has anyone seen any (credible) research on prevalence and prevalence of the various severity levels. What I've read ranges from 0.36% to about 36% although I think that was including all severity levels.

Edited by Prattlebangs

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I developed hypoglycemia about 1.5 years post-RNY and it took a little while to pinpoint exactly what (and how much) triggered it because not everyone reacts to the same foods.  Ultimately, my triggers boiled down to starchy carbs (cereals, breads, cookies etc. and beans), but provided I avoid all of the foods that bring about a drop in my blood sugars and eat at regular intervals, I can avoid a crash.

According to this study in 2017, 13.1% RNY patients deal with it.  How Common is Hypoglycemia After Gastric Bypass?

This is another study worth reading:  Hyperinsulinemic Hypoglycemia After Gastric Bypass Surgery

But if you type "hypoglycemia" into our search engine at the top of this page, it'll being up a lot of good reading.

 

 

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I have it and it really can be debilitating until you get it under control. I have been told it is much rarer than people imagine. My sister's bariatric surgeon says he's only seen it twice in his practice and he's done thousands of surgeries. I've also had specialists tell me it's over reported by patients self diagnosing. Mine is now managed fairly well by medication. As you can imagine I've done heaps of research on it because very few medicos seem to understand the condition (even less dieticians sadly). I don't know where I found it but there was one research paper I read that suggested it most commonly appears in patients who weren't diabetic prior to surgery and have a smaller pouch with a larger opening from the stomach to the intestine. I was told before my surgery by my surgeon that my particular anatomy would require a smaller pouch and because my revision was due to my original opening had scarred over that he would be making the opening larger to compensate. All that being said, I did have occadional hypoglycemic episodes before surgery, I just didn't know what they were. The condition can also be referred to as hyperinsulinemia as well as late dumping syndrome if that helps in your research. It really all comes down to your insulin response to blood sugar. If your body excels at releasing loads of insulin like mine does, then reactive hypoglycemia is unfortunately a real possibility.  I didn't know it at the time but my A1C whenever it was tested was always around 4.5-4.6 which is deemed excellent glycaemic control.

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I’ve only had a couple of episodes, but I try to stay away from bad carbs.  My worst episode was in January.  I ate some pretzel crisps.  When my daughter found me I could barely stammer out to get glucose tablets.  I usually sweat profusely.  When she had me the tablets she said she thought it was weird because the palms of my hands were wet.  I really don’t eat many carbs.  

Not sure if it’s related but I was diabetic before surgery.  

Edited by Cheesehead

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1 hour ago, Cheesehead said:

I’ve only had a couple of episodes, but I try to stay away from bad carbs.  

You're lucky then Cheesehead. At its peak, before I knew what it was, I was having multiple episodes everyday. Now I take acarbose, I only have them maybe once every couple of weeks.  Even then it's usually only if I eat out, and not as severe as it used to be. I don't get sweaty with it anymore, just feel like I've down a round or two with the bottle of brandy! You just never know where those sneaky chefs have hidden some sugar, seems to me like it's in everything they cook these days. I always take a tablet before I eat anything that someone else has prepared. So many people I know throw condensed soups or other processed sauces into their savoury dishes for an easy way to add flavour....that will get me every time!!!!

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Thanks for the articles cinwa, and the feedback from everyone. Aussie Bear, like you I suspect I already have hypoglycemic episodes on occasion after reading the symptoms and my A1C tests also come back in same range, despite the large amounts of sugar that I eat on a regular basis. I've always been glad of this, that my body has adapted so well despite how badly I treat it. I just hope it doesn't come back to bite me now.

Does anyone know if the risk is lower with a SG? I know it can still occur but is it less likely? I'm still not keen on the idea of having most of my stomach completely removed though.

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2 hours ago, Prattlebangs said:

Does anyone know if the risk is lower with a SG? I know it can still occur but is it less likely? I'm still not keen on the idea of having most of my stomach completely removed though.

My understanding is that reactive hypoglycemia doesn't happen with sleeve gastrectomy at all because it is all about sugars hitting the intestines without being broken down. To be honest the risk is so low even with RNY that it probably shouldn't even be a consideration. I've read all kind of stats regarding dumping syndrome but usually those stats include both normal dumping which is usually fat related and far more common, as well as late dumping which is blood sugar related. From memory the stats refer to late dumping as between 5-10% of  all dumping syndrome sufferers. Even then many are mild enough not to require treatment. I just see myself as drawing the short straw. I definitely rather live with RH than with GERD which is much higher risk with SG than reactive hypoglycemia is with RNY. A discussion to be had with your surgeon if you are really concerned about it.

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I had hypoglycemic episodes before surgery after eating simple carbs without any protein (hello frosted flakes) and still have that potential.  However since having my sleeve I have only had 2 episodes, one was yesterday and it was a bad one.  Totally my own fault, I didn't have my protein and only ate apple slices with some low fat caramel dip that my husband bought.  It was labeled "light" so he bought it thinking it would be lower sugar for me but not reading the label of course it was low fat, meaning pure sugar.  Dumb mistake on my part and totally avoidable. So, mine are not surgery related but just part of the joy of being me, and should be able to be controlled by diet unless I am stupid.

The people who do have reactive hypoglycemia post-WLS I think would tell you that the benefits of having WLS far outweigh the inconvenience/risk/issues of hypoglycemia post-op, at least that's mostly what I hear.  For sure, the health risks of obesity are far more likely to occur than any from WLS.

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