What Is Reactive Hypoglycemia?

reactive hypoglycemia

How RH makes me feel

Over the past two months, I’ve begun experiencing one of the dreaded after-effects of gastric bypass surgery: reactive hypoglycemia. Most people who are familiar with gastric bypass know about dumping syndrome, but reactive hypoglycemia can be just as painful and uncomfortable.

Reactive Hypoglycemia (RH) is a condition indicating recurrent episodes of hypoglycemia in people who do not have diabetes. Scientists and nutritionists think that RH is a consequence of excessive insulin release triggered by intake of carbohydrates, but the insulin release continues past the digestion phase, and and beyond the disposal of the glucose derived from the meal. According to the NIH, a blood glucose level below 70mg/dL at the time of symptoms, followed by relief after eating, confirms a diagnosis for reactive hypoglycemia.

Reactive Hypoglycemia symptoms include:

  • Double vision or blurry vision
  • Unclear thinking
  • Sleeping Trouble
  • heart palpitation or fibrillation
  • fatigue, depression
  • dizziness, lightheadedness, confusion
  • sweating
  • headaches, tremors, flushing
  • nervousness, irritability, panic attack
  • increased appetite, craving sweets
  • numbness/coldness in the extremities

In severe untreated cases, coma can be a result from RH. It’s serious stuff.

How do you treat RH? By eating. The quickest way to feel better is to eat something that will get your blood sugar up quickly, so sugars and carbohydrates seems to work the best. But having protein and fat will help sustain you so you don’t have another RH episode.

Now, I leave a disclaimer that this is NOT to be taken as medical advice, but I’m sharing what I’ve come up with after tracking my RH episodes and talking to my doctor. I will often have peanut butter and crackers, or some popcorn. Fruit juice usually makes me dump, but a sip or two seems to help me get out of an RH episode. I’ll admit, sometimes I’ll eat junk food when I sense the first symptoms of RH, and being timely is much more important than choosing the exact perfect thing to eat.

I had my first experience with RH in November in England. I was meeting up with a friend in Liverpool one morning, and the restaurant we planned to eat at wasn’t open yet. I nibbled on some turkey jerky, then we walked around Albert Dock for a few hours, then I went to the Beatles Story museum. As soon as I got back in the car, I started getting confused, shaky, weak, and had blurred vision. I knew it was because I hadn’t eaten and I actually blacked out for a few seconds. Eating made me feel better very quickly.
The next RH episode was on Thanksgiving. I had a fairly surgery-friendly dinner (turkey, salad, veggies, sf jello) with one exception – I had a little bit of mashed potatoes and gravy. I’ve been having powdered mashed potatoes for a few months, but mashed real potatoes took me over the edge. I went into dumping mode for about 20 minutes. As soon as the dumping subsided, I laid down and fell asleep immediately. When I woke up, I felt disoriented, my arms and legs were completely numb, and had double vision. When I tried to stand up, I collapsed and started shaking uncontrollably. I got on BBGC and left a message with my symptoms, and everyone agreed it was an RH episode.

I started tracking the symptoms through the next 10 or so episodes, and I realized that there were two common items : I had done a rigorous workout within the past 24 hours, and it had been more than 3 hours since I’d eaten anything. To date, I’ve completely passed out 3 times from RH. Every Sunday in the 3rd hour of church, I’d have RH symptoms, so I began packing crackers, granola bars, and other portable items to eat between classes.

I met with my doctor, showed him my log of RH episodes, and he agreed that it was something I needed to take very proactive control over. His main advice to me, which is not what is part of the typical gastric bypass diet, is to eat more carbs. Eat something a little carby with every meal. Eat carbs and protein before and after working out. Stop exercise at the first sign of fatigue. Be intuitive and listen to my body’s signals.

My weight loss has been slow the past 2 months, but my body is shrinking. I’m down a dress size, but only about 5 pounds from the beginning of January. I’m exercising hard, my muscles are getting more lean and toned, and I am enjoying an active lifestyle. My body is no longer in ketosis, but I’m okay with that. I’d rather have energy, exercise, and eat more carbs, than be lethargic with a carb and exercise restriction.

Now, if I can only get this reactive hypoglycemia under control!

I Want To Be Sedated

Today I was sedated with Propofol, the drug that killed Michael Jackson. After the procedure, the PA said to avoid moonwalking for the rest of the day.

As I’ve mentioned in several other posts, I’ve been having a difficult time with keeping liquids and solids down the last 10 days. I’ve been having some pretty violent vomiting, which can cause scarring on my surgical anastamosis (where the stomach pouch and small intestine come together.) At my 4-week post-op visit, Dr Smith told me that I probably had a stricture, and would need to have an endoscopy to see if I needed to be dilated. Unfortunately, the soonest I could get an appointment was Thursday (today), so I’ve had a tough few days. Monday night I was in the ER to get hydrated, and I’ve still been having a tough time getting enough fluids.

This morning I had to be at St. Marks at 7:30am for registration. Once all the paperwork was order, I was taken into endoscopy. I got in my gown, was hooked up to IV fluids and monitors, and had an EKG. I was asked the most comprehensive health history questionnaire imaginable. I’m allergic to fentanyl, which is commonly used in endoscopic procedures, so they said they would be using a different drug on me.

Once all the pre-procedure stuff was taken care of, the took me into the endoscopy procedure room. They put me on oxygen by nasal cannula, and the tech told me about the functions of the endoscope. The actual scope was smaller than I expected, much to my relief.  Within the black cable (which is hanging down in the from the machine on the right), there are functions to insufflate (blow air) and suction, as well as the camera.

They called Dr. Simper (one of Dr. Smith’s colleagues), who would be giving me the procedure. He reviewed all the risks and benefits of the procedures, then I signed consent forms. They started an IV push of Propofol, and everything got fuzzy until I fell asleep.

The procedure took less than a half hour. The endoscopy showed that I indeed had a stricture. A normal anastamosis is supposed to be 10-15mm. Mine was 4.5mm. This is like the difference between the diameter of a dime versus a pencil. No wonder I had such a hard time keeping things down! They successfully dilated me, and said I should be having immediate relief.

As I woke up from the sedation, I felt so loopy. I was jabbering about how colorful my dreams were, and how the wallpaper border of the room looked like it was moving like a conveyor belt. They told me that I was coming off of Propofol, which was one of the drugs that killed Michael Jackson. I was told to take it easy for the day, and to avoid any moonwalking for the rest of the day. I was advised to have clear liquids for the rest of the day and to avoid any “activities that require good judgement.” 

I was given some apple juice with Sprite to drink, so they could see if I could keep it down. I was excited that I was able to drink and keep the drink down without discomfort. After finishing more IV fluids, they released me. I spent most of the day sleeping, which wasn’t hard because I was still so groggy from the sedation. I sipped on broth and juice, and had some sugar-free popcicles. After being on clear liquids so much this week, I’m VERY excited to go back to soft foods tomorrow. Bring on the cottage cheese and yogurt!

But enough about Michael Jackson, endoscopic procedures, and liquid diets…how about The Ramones?

I Have Pneumonia – Post-Op Day 5

Today was really rough. I knew it would be from the moment that I woke up.

I had a headache more severe than I’d ever experienced, with blurred vision and vertigo. I wake up with a headache fairly often, usually when my CPAP mask hasn’t sealed very well in the night, depriving me of oxygen. But I also had extreme discomfort in my chest, particularly on my lower left side. There was a lot of tightness and shortness of breath too.

I knew I wouldn’t last very long feeling the way I did, so I popped a Lortab and tried to get comfortable and let the pain subside. By about 8am, it wasn’t getting any better, so I called the surgeon on call. It took almost an hour for Dr. McKinley to get back to me, and we discussed my symptoms. He said that my problems could be a variety of conditions, but I’d need lab work, radiology and a full evaluation to know for sure. He advised me to go to the St Marks emergency room right away.

The next few hours were a series of pokes and prods. I first got an IV in my right arm, but it wouldn’t advance in correctly. But it was enough to get my blood drawn and start me on fluids and main medication. I had a chest x-ray, then went to radiology for CT scans. I had to drink some nasty contrast fluid, which was basically radioactive Crystal Light. But because they were doing tests that needed a larger gauge IV, they sent me back to the ER for a new IV.

Little did I know they’d be doing an IV in my NECK! The nurse felt around, and the best vein option was in external jugular, calling it very “juicy.” I went back to CT, drank the radioactive Crystal Light again, and was hooked up to this witch doctory apparatus full of radioactive liquid. Through the CT, they did a chest and abdominal series, then a pulmonary series to rule out an embolism. During they pulmonary series, they pushed in the clear liquid into my neck vein, and it felt like my body was in an oven, inside and out. It was such a crazy and uncomfortable feeling, feeling like I was melting from the inside out.

After several more hours of waiting as doctors and radiologists evaluated my tests, it was determined that I have pneumonia. There is an irritated “solid infiltrate” in my lower left lung, which is likely causing all the chest pain and shortness of breath. After almost 90 minutes beyond my diagnosis, I was finally discharged. The whole process at the ER was about 7 hours.

I picked up my prescriptions, including a generous refill of Lortab elixir, went home and got in my jammies. After being required to fast from food and drink for the day, I was quite ravenous. I fudged my eating guidelines a bit through the evening, trying to get in adequate nutrition. I also added in a new food to my semi-solid food regimen – hummus! Oh, how I’ve missed hummus. It’s just a little strange to eat it straight off the plate with no veggies or crackers, but I gobbled up all 2 tablespoons.

Today’s food diary:

  • 1/4 cup egg whites with melted cheese
  • 3 oz soft serve ice cream
  • 2 tablespoons hummus
  • 2 oz Simply Apple juice
  • 1 wedge of light Laughing Cow cheese
  • 1 sugar-free popcicle