Need help-hypoglycemia!!!

[LindaDarnell]

Hi all..Ive researched the site, but not finding quite the answer im looking for. Im hoping someone can help. My husband is abt 4 months from virgin DS. He was a serious diabetic presurgery, but within a week his numbers were in the low to mid 80s most days.

Lately he's been dealing with extremely low sugar levels, around 55 to 60. He'd eat hard candy and it would eventually rise. Over the weekend we noticed it was dropping more often, and taking more sugary f oods to make it rise. Obviously, he doesnt want to start gorging on sugars again. He called his Primary and asked for a referral to an endo..which they are working on. But his sugar dropped to 38...several times today, and he had to drink alot of fruit juice and eat fresh fruit to get it to stabilize . The best our primary could advise was to go the ER if it became too unstable bc it would be 2 weeks before the endo appt.

Obviously he'll go to the ER if this becomes too much for us to manage on our own. I just wanted to get advice from vets who's been through this. Best practices and how to navigate conversations with the endo or any other dr.
Thanks in advance for your help.

 

[KathrynK]

I developed reactive hypoglycemia about year 2 after having DS. I was a diabetic preop, but under good control. The first sign was my hemoglobin A1c, which was 4, meaning I was often in a low blood sugar zone. Then I had a seizure at 3 am and had to be hospitalized. Then I had another, while at a friend's house, in which i destroyed one of her dining room chairs with the seizure since I was waiting for dinner too long. Just went to the ER for that one, but they cut off my favorite dress to get the IV going. (I had seizures prior to DS because of epilepsy, so my threshold was lower, but I hadn't had one in years.)

Candy and fruit juice are exactly the wrong thing to do. His sugars will rise high and then drop like a rock. Peanut butter with a little jelly is what I use when it is really low, the protein in the peanuts levels out the sugar so it is absorbed more slowly. Cheese on a cracker is also ok, a slice of deli ham, a Chicken nugget. It doesn't have to be a lot. He must eat a protein snack every 3 hours around the clock. I eat a snack at 2 am. Always protein based. I had the 24 hour glucose monitoring and it found every night at about 2 am my levels went into the 40s. They offered me a low dose of metformin, which would level out the sugars over the day, if the diet control didn't work. If dinner is late, I nibble on something I have in my purse, because I can't go more than 3 hours. Cheese stick. Beef jerky. Peanut butter cracker package. My hemoglobin A1c is now about 5 and I haven't had another seizure.

While you are waiting for the endo, the first thing is to begin diet control, try to prevent the low sugar with regular eating, and avoid sugar in favor of protein. Never have sugar without balancing with protein. If that doesn't work, you can ask your GP about low dose metformin, which is what my endocrinologist advised as the next step. If that didn't work, they were planning a work up of my pancreas to see if there was something there. If you still have a relationship with his diabetic educator, she may give you some advice.

Getting rid of diabetes was a great thing, and I can live with the hypo episodes now that I know how to prevent them. It is very scary at first. Best of luck.

 

[Clematis]

I agree with ^^^^ I didn't respond earlier because I have lifelong episodes of reactive hypoglycemia, not diabetes. But when I saw he was taking candy and fruit juice my immediate thought was that it would cause another plummet 4-5 hours later. I know the rule for hypoglycemia when one has diabetes is to glucose load with candy etc, but he no longer has diabetes so this is a different animal. If it were me I'd eat protein every couple of hours and stay away from the simple sugars in candy or fruit.

 

[southernlady]

I have reactive hypoglycemia.
First: STOP the pure sugar.
Second:a protein fat and small amount of sugar to raise blood sugars.
Third: Eat often, no less than every three hours but every two is better.

The idea is to keep blood sugars as stable as possible. To do that, small amounts of food are needed often.

 

[LindaDarnell]

I developed reactive hypoglycemia about year 2 after having DS. I was a diabetic preop, but under good control. The first sign was my hemoglobin A1c, which was 4, meaning I was often in a low blood sugar zone. Then I had a seizure at 3 am and had to be hospitalized. Then I had another, while at a friend's house, in which i destroyed one of her dining room chairs with the seizure since I was waiting for dinner too long. Just went to the ER for that one, but they cut off my favorite dress to get the IV going. (I had seizures prior to DS because of epilepsy, so my threshold was lower, but I hadn't had one in years.)

Candy and fruit juice are exactly the wrong thing to do. His sugars will rise high and then drop like a rock. Peanut butter with a little jelly is what I use when it is really low, the protein in the peanuts levels out the sugar so it is absorbed more slowly. Cheese on a cracker is also ok, a slice of deli ham, a Chicken nugget. It doesn't have to be a lot. He must eat a protein snack every 3 hours around the clock. I eat a snack at 2 am. Always protein based. I had the 24 hour glucose monitoring and it found every night at about 2 am my levels went into the 40s. They offered me a low dose of metformin, which would level out the sugars over the day, if the diet control didn't work. If dinner is late, I nibble on something I have in my purse, because I can't go more than 3 hours. Cheese stick. Beef jerky. Peanut butter cracker package. My hemoglobin A1c is now about 5 and I haven't had another seizure.

While you are waiting for the endo, the first thing is to begin diet control, try to prevent the low sugar with regular eating, and avoid sugar in favor of protein. Never have sugar without balancing with protein. If that doesn't work, you can ask your GP about low dose metformin, which is what my endocrinologist advised as the next step. If that didn't work, they were planning a work up of my pancreas to see if there was something there. If you still have a relationship with his diabetic educator, she may give you some advice.

Getting rid of diabetes was a great thing, and I can live with the hypo episodes now that I know how to prevent them. It is very scary at first. Best of luck.

Omgee thank you!! This was exactly the type of info we were looking for! I'd always heard that some diabetics have hypoglycemia after wls, but never quite understood why. We read your post together 630 this morning

He definitely wasnt eating enough protein the past few days. And i knew gobbling down sugary drinks and candy was a bad thing and a slippery slope. Today he definitely got his protein in (of course I made sure) and his sugar levels stayed stable. He only had 6 oz of grape juice. Everything else was protein.
We are trying to learn as much as we can abt hypoglycemia in DS patients, bc chances are the endo will probably understand it from the perspective of RNY.
Again, thank you so much!!!!

 

[LindaDarnell]

Thank you all!!!! Reading your posts gave us a lot of information. His homework today was to learn about reactive hypoglycemia...we are now comparing notes on what we each found. @Clematis you were absolutely spot on abt the plummeting levels bc thats what he experienced all day yesterday. When the primary Dr could only tell him to drink juice and eat jolly ranchers, i knew that was a problem!
The scary but cool thing that we are experiencing with the DS is that the Drs understand very little about it. So the onus is on us to know EVERYTHING bc it's our bodies. They only understand the Sleeve or RNY.

 

[JackieOnLine]

The idea is to keep blood sugars as stable as possible.

this is ideal for everybody, including normies, right?

ETA: this isn't a hijack, I hope

 

[KathrynK]

Linda, You are right that docs don't know enough about DS, or hypoglycemia in general. But, grape juice has another problem in addition to its effects on blood sugar. All forms, and specifically liquid forms of sugar will slow down or stop weight loss. Unfortunately, DS doesn't protect us from sugar calories. I don't know if substitutes might be acceptable, but a friend switched to sugar-free orange soda at breakfast to replace his juice habit. (I don't do sugar substitutes, because of the effects on my sugar levels, but he may be able to. And sugar substitutes have an unfortunate side effect of intestinal gas for me after DS.) It remains a daily challenge to prevent hypo episodes and my husband has learned to drop everything when I tell him I NEED to eat.

 

[Clematis]

Skip the grape juice entirely!!! Even a small glass of orange juice used to send my blood sugars plummeting a couple hours later. I could never drink grape juice for the same reason. All of this is magnified if taken first thing in the morning on an empty stomach. (I sunk to 18 and became unconscious during my last glucose tolerance test when I was pregnant -- who can drink the equivalent of 12 ounces of pancake syrup on an empty stomach??? -- and so I flat out refused to take them after that. Meanwhile whenever my adult son does something stupid I blame it on brain damage from the OGT.) If he absolutely has to have simple sugars, eat it with a meal.