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Late Dumping Syndrome

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I have been struggling with this problem for a while and finally started to do a little research on dumping syndrome. In the beginning, I rarely "dumped", except on ice cream. The past couple of years I've been having what I call 'spells'. They happen at least an hour after eating so I didn't attribute it to dumping at first. I thought I was getting migraines, which I get often and they usually start with me seeing an aura. I start by feeling confused, then I sweat profusely from head to toe. I do sometimes see the aura, which is why I thought these were migraines. The confusion is so bad that I sit there and can't remember who I am, where I am, or how I got there. I had an attack the other day after eating 'low fat' yogurt, which I figured was loaded with sugar but I ate most of it anyway. I ended up getting diarrhea really bad, then I went to get up and fell down, bumped my head on the bathtub and woke up with my husband lying behind me on the floor, holding my head up, cuddling me and wondering what the heck happened. He said I was conscious and talking to him during this. I, however, don't remember much of the episode. 

 

When I get like this, I feel really cold afterward and really hungry. I crave sweets especially. I didn't attribute this to gastric bypass surgery until I asked my neurologist if it could be related to a drop/spike in blood sugar and he agreed it sure sounded like it. He recommended I get a blood glucose monitor to check my sugar during an episode (that's if I'm conscious enough). So I was reading about the 'Late' dumping syndrome. It seems to happen at least an hour after I eat. I feel fine at first, then these symptoms appear out of nowhere. That's what happens with the late syndrome and the other symptoms; dizziness, confusion, sweating, diarrhea, passing out, all seem to fit. When I've dumped early, I usually feel like crap for a half hour then I either puke or lie down and I'm fine. The late spells, seem to last quite a bit longer and are a lot more severe. It scares me frankly. Lately I try not to drive after I've eaten. I've had spells while driving but I was conscious. Lately I've lost consciousness, but I seem to know when I'm going into a spell, which makes me believe I can get off the road in time, but still, it scares me.

 

I've read that since food doesn't get digested the same as a 'normal' stomach, sometimes too much sugar gets into the bloodstream too quickly, then your body produces too much insulin to combat the sugar spike. It's kind of a yo-yo effect. I have a job now and I worry about it happening at work, so I've been trying to keep to eating protein for lunch and staying away from the sweets.

 

Does anyone else get these? Is this a long-termer thing? I had my surgery nearly 5 years ago. I've had bloodwork done and that always comes back good. My bp is usually normal. I was drinking alcohol and smoking cigarettes, but have since given those up. I am usually stone cold sober when these happen anyway. Just wondering if there are others out there that have had these and if so, what are your strategies to combat them? 

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research reactive hypoglycemia....similar to dumping...but can be more extreme. Mostly diet controls it....frequent, small meals with mostly protein, slow digesting carbohydrates. Limit anything with -rose in it...lactose, fructose, sucrose, dextrose.....

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Wow. I'm sorry you're experiencing this. For me it's a medication I take that makes me not remember for about an hour after I take it. At least I know what it is! Sounds like really bad late dumping. The farther out I get the more sensitive I seem to become to "chemicals" like the above mentioned. Good luck with this :mellow:

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I have reactive hypoglycemia. Sure sounds similar. Shaky, irritable, irrational and can pass out. Cereal with milk used to be my worst culprit. Alcohol could cause a real hypoglycemic situation. Not uncommon to occur 2+ hours after ingesting carby-sugary foods.

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I'm also one of those reactive hypoglycemia folks- first episode was the worst with a glucose level of 43 (right before the passing out phase)! Too many carbs at one sitting was the culprit and Cinwa/Corrine educated me- I now do the mini meals every 3 hours and watch the carbs (even the good carbs can trigger it if I have too much).......My episodes occur  about 2 - 2 and 1/2 hours after eating- I get really hot, red-faced, and sweat profusely, hands shake, can't concentrate and get that "woozy headed" feeling.

 

Knock on wood- haven't had a "spell" in about 9 months!

 

Nancy

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Thanks for the comments and advice. I've been very careful this week and my doc gave me a blood glucose monitor. The worst part is I hit my head a week ago when I passed out and it was really swollen. Now my eyes and under my eyes are black and blue. My doc said it may go all the way down my face, but for now it seems limited to my eyes. Good thing I can use purple eye shadow. I got checked out and other than a pain from pulling a muscle in my chest, I'm feeling ok now. Had my protein dinner last night. It was rough to eat a lobster (or about half of one anyway). I felt fine afterward. ;)

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I haven't passed out....so I figured it wasn't too bad...but during the testing...I dropped to 27! Then bounce back okay. So weird when you ingest 75grams of carbs for the test....you think you should spike and stay there for awhile. I never went above 110. Dang pancreas works too well! The symptoms were particularly worse last year...then I found out Wellbutrin (which was started last year) can cause significant hypoglycemia.....been off that med 3 months and haven't had any episodes. I really wonder if I truly was as psycho as the docs think or it was simply crazy blood sugars causing the majority of the symptoms I was having last year or so.

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I think this is what is happening with me. It seems like it just started happening all of a sudden after being mostly fine for 7+ years. My biggest problem (besides the obvious symptoms) is it happens with almost EVERYTHING I eat now :/ Just to "see", today I ate some yogurt and a string cheese. Total carbs was 12, sugars 9, protein 24 and sure enough about 2 hours later I was feeling stupid...which is how I like to describe it. This makes no sense to me. I have started carrying glucose tabs with me and they stop the shakes almost immediately. That about screams hypoglycemia. I saw my Dr later this afternoon and he said, eat small meals frequently and high in protein. Really? I had no clue, ugh!!! I am so frustrated :( I did get him to do bloodwork and my A1C at least. I'm following protocol, I take my vitamins, I've maintained 100lb loss and, up until a few months ago, my sugar threshold was in the 30g range!! I'm scared to eat, I have 5 kids, I NEED to be ok to drive and function...any suggestions or things I should consider/look into?

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The A1C and a fasting glucose will be normal....one of the tests is the 4 hour OGTT test to see at what point you dip and recover. Other than diet....I've read about surgery to remove parts of the pancreas in severe cases. People worry about hyperglycemia.....but it takes awhile to die from that when its type 2 diabetes related...hypoglycemia can take you out overnight. I haven't seen any particular protocol...you can test your self...gets very expensive...and doens't always mean a whole lot. The problem with glucose tabs is then you're set up to create another hypo episode. If you can get an endocrinology referral...they might provide better guidance if it's real severe.

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It just dawned on me that about the same time I noticed my blood sugar troubles I was also switched anxiety medications from Celexa (which was screwing with my potassium and causing heart palpitations which mimicked closely an anxiety symptom :/) to Zoloft. Looking into Zoloft and hypoglycemia there seems to be some correlation but usually in higher doses and I am at the minimum. I don't think the switch in drugs and the onset of blood sugar dips is coincidence though. Oh how nice it would be to have everything written in big bold letters for me because all of this guesssing and possibility is making me tired lol

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I started having problems exactly 3 years post-op; started with episodes I called major "dumping"... shaky, sweaty, dizzy, heart pounding, weak, etc.; I had never really had dumping problems before and mentioned it to my NUT at the 3 year post-op visit; she said it sounded like a blood sugar problem. Got a meter and started checking my sugars; sure enough; I was getting readings as low as 25; most of the time in the low 40's about an hour or two after meals. This wasn't just happening after high carb meal; it would happen after mainly protein too. When I'm extremely low - bad things happen; I'm confused and I can have a black-outs of sorts where I wander around and do things or say things I don't remember; sometimes I'm told I can't even speak; everything comes out garbled. Also started noticing weird things in my bedroom when I wake up; things would be pulled out of drawers, closets; I've found pills dumped out on the floor and often find food wrappers in the bed... scary! Apparently I get up and wander around at night and don't have any idea what I'm doing. The past few months I started keeping food on my nightstand: protein bars, cheese sticks and life savers; it seems to have slowed down my wandering; in my low sugar state of mind I must know I need to eat something and go searching for it. After really low episodes I often feel tired and have bad headaches. Discussed with my doctor and he referred me to an Endocrinologist. The Endo ran more blood tests... Cortisol, A1C and had me keep more detailed blood glucose monitoring for a month; the Cortisol and A1C were normal and my monitoring showed lots of very low sugars; mainly after eating. I was in the hospital with a gallstone in January so they had a recent CT scan of my abdomen and nothing showed up on my pancreas. Endo suspected a condition being seen in more and more Gastric Bypass patients called: Islet Cell Hypertrophy or sometimes referred to as Nesidioblastosis it's a form of acquired hyperinsulinism where the pancreas starts over producing cells that create insulin. She put me on a drug called Acarbose that can slow the digestion of carbs in the body and told me to eat smaller, low carb meals with snacks every few hours; didn't help for me, but it seems to help a lot of other folks. Endo decided to put me on a 7 day continuous blood glucose monitor and had me keep a food diary of everything I ate along with the carb values to get a better view of my blood sugar levels and how they were reacting to food. Wow... that was an eye opener! I knew my sugars were low after eating, never knew they also tanked at night while I slept and pretty much stayed in the 30 - 45 range most of the night.... no wonder I wander. Final test showed during the 7 day period my blood sugar was below 55 more than 30% of the time... not good! There was one more drug they could try called Diazoxide; it slows down insulin production in the pancreas; turned out that wouldn't work I have severe sulfa allergies and it has a sulfa base. The Endo said the problem is beyond what she can treat and has now referred me to a specialist at the University of Chicago Medical Center. She said the next step is a Arterial Calcium Stimulation test... sort of like an angiogram where they go in through the groin up to the pancreas and inject a medicine into the veins and measure samples of how the pancreas reacts. This should confirm if the problem is Islet Cell Hypertrophy or determine if the problem is a insulin producing tumor "Insulinoma". Either way, she firmly believes surgery is probably the only way to resolve. For severe Islet Cell Hypertrophy they usually remove part or all of the pancreas; not sure yet what that entails; just setting up my consult with U of C right now. If you are having similar problems; get a referral to an endocrinologist for further evaluation. Also... I was trying to rebound some of these attacks with juice; but the Endo said I should only do that for really low blood sugars; otherwise I would likely have another low rebound in a few hours. She told me to have a combo of about 15-20 carbs and protein to level off my sugars; protein bars are good.

Edited by Peg

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You sound like me when I get a severe low sugar.  It sounds like your body is producing to much insulin and you then have a low sugar moment.  It is very dangerous.  If I were you I would cease eating all sweets.  Protein first then Vegatables.  I would fill my pouch with that and be happy.  I long for the day I have surgery and say goodbye to insulin shots.  Best wishes, hope you get better soon.

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Something in me senses some form of this may be in my future.  Just a gut feeling... I'm going to save this info for future reference. peg, have you had any resolution or further information yet?

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I've been seeing an endocrinologist at U of C for the past 3 months; he told me they're seeing hypoglycemia after bariatric surgery in over 10% of patients who had RNY or duodenal switch. Most cases aren't as extreme as mine and can be controlled with diet and/or meds. On the other hand, my bariatric surgeon said he's done hundreds of surgeries and I'm the first patient he's had with this issue. The doctors are definitely on different pages; the endo thinks I should have my gastric bypass reversed and the bariatric surgeon says absolutely not; my original surgery and subsequent surgery for adhesions both had to be performed as open surgeries; my organs were fused together, he had very hard time doing the bypass in the first place, trying to reverse the bypass would be nearly impossible. I know I have more adhesions, so any abdominal surgery at this point would be very complicated. The other option is removing part or all of my pancreas (pancreatectomy). I don't want any surgery at all! I'm reading that some people go through the reversal surgery and it doesn't help; they end up having the pancreatectomy. At least 15% of the pancreas must be left to produce its enzymes for digestion; if the entire pancreas is removed you become a severe diabetic because you no longer produce insulin. I've had some very scary episodes with blood sugars as low as 21; I get down to the 30's and 40's every day, sometimes multiple times a day. In the meantime, the endo's been trying different meds to raise blood sugars I've been on Prednisone for almost 3 months; over the same time period I hurt my back and hip and got 4 cortisone injections in my spine and hip over a 7 week period; the steroids helped raise the blood sugars, but it was only a short-term solution. For about 3 weeks I've been giving myself injections of Octreotide at night; but still having very low blood sugars every day.

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So glad you posted! 

I am so, soo sorry you're having to deal with this...  I think of you often after reading your earlier post and I really hope they can find an acceptable solution for you soon.  Please keep us updated on how it's going? 

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I'm just hoping this resolves on it's own; may be wishful thinking on my part, but the Endo say's it does happen on rare occasions. I've pretty much made up my mind there's no way I'm letting them reverse my gastric bypass. Despite what's going on right now; I am still glad I had the surgery; I am four years out and very happy with my weight loss... don't want to go back to the person I used to be. I have another appointment with the endo tomorrow to discuss next steps... we shall see.

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Hello again. I haven't been here in a while but I have a really strange observation that I'd like to share. I make a bangin' chili and use quite a bit of chili powder in it. I had some last night and about an hour and a half later I had a seizure. I noticed that this happened the last time I ate my chili too, but not when I've had other people's chili. I do often normally feel my blood sugar drop about an hour after eating and can take a glucose tablet (which by the way I keep with me all the time now) and it nips it in the bud before it results in a seizure. For some reason last night, I didn't go for the tablets in time and had a full blown seizure. It was one where I was in a totally other world. I didn't know where I was or who I was at the time. I was confused and my whole body was soaking wet, even down to my socks. My husband was talking to me and I couldn't answer him. He knows to get my tablets for me and gave me a couple and I came out of it. But it scared the crap out of me, and I kept wondering if the high concentration of chili powder had anything to do with it. I ended up going straight to bed afterward because I just feel totally sleepy after these seizures happen. I feel drained today. I do not put any kind of sugar in my chili. It's mostly meat, beans, veggies and spices. You'd think that something that is so protein packed would not cause this, but this isn't the first time. I love chili but I'm going to try it next time with half the chili powder. It seemed to be way too much anyway and as yummy as it was, I just kept thinking while eating it that it was a bit over the top. Just wondering if anyone else here has had a similar experience, particularly with chili powder. It really never occurred to me that chili powder could be the culprit.

I have been doing a great job keeping my weight down and I've even been trying to include protein shakes and more protein overall in my diet and a lot less sugar, even though I do have a sweet tooth. I still dump and there's no rhyme or reason for it. I cannot eat more than a half a sandwich at a time and will sometimes dump on half a turkey sandwich. Other times I'm fine. It's getting to the point where I don't like to eat at all, but I know I can't survive like that. I can go all day without eating anything but a snack, but I know that isn't good either and I've really been trying to eat right. Yesterday I did not have much to eat all day so maybe that could be the cause too. 

I think that now I understand why I was obese in the first place. My body just doesn't need much food at all to survive. I guess it never did. It must be really inefficient in metabolizing food. I eat very little now and I've learned (finally) to chew everything to practically nothing. I get my blood tested yearly and everything looks good (except for my vitamin D, which I've been on a prescription for), so I must be getting enough nutrition otherwise. 

Peg, I'm particularly interested in how you're doing these days and if you've managed to resolve your low blood sugar problems if you're still around. And I'm with you. I never want to go back to that obese person I was nor is reversing the bypass a solution for me.

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Just had to chime in to mention that I get reactive hypoglycemia after every thanksgiving dinner! :-). I never eat enough turkey, thinking that "a bit of this, a bit of that, it's all healthy..." will be fine, and it never is fine!!!! I get it other times too, in response to making bad food choices, but the Thanksgiving thing is instructive - definitely need to work on that one. 

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