Diagnosed with Hypoglycemia after bypass surgery: What helps?

In a Bariatric Support group meeting, members were talking about hypoglycemia and I realized it was similar to symptoms I occasionally experience. I plan to discussion with my endocrinologists next month. The episodes do not happen often, once every few month.

First time it happen I was scared to death not knowing what was happening. When followed up with my primary, he never discussed hypoglycemia. I have no history of diabetes, so they just said if happens again, come back and would run more tests. My A1C and fasting blood tests always come back OK. They actually did nero testing to make sure was not stroke related.

I just got a Accu-Chek and few strips from a friend who had extras. Going to randomly take glucose levels so know base line and if and when next episode happens, will take glucose level to see if low. The kind I am using does not require prescription and available at drug stores.

I had Sleeve done in May of ‘23 and have been diagnosed with Reactive Hypoglycemia. This causes your blood sugar to rise and then crash. I have been down on the 40–50’s. The crash usually happens 2-4 hours after I eat. Thankfully mine is well controlled with diet. I have to stay away from 15gm or more of carbs per meal. If I go over that then my blood sugar crashes. A LOT of people with the Bypass have this. Look on the internet for it. Some people said that when their doctors appeal the turn down of insurance for a monitor the insurance approves it, or so they say. My doctor gave me a sample one for free, it was like a 10 day trial, that could maybe help you figure out when your crashes are coming. Worth asking. Hope this gives you some ideas. Good Luck!

Yes, I too have “Post Bariatric Reactive Hypoglycemia” PBRH for short. I had a roux-n-y 20 years ago and hypoglycemia has become a serious problem for me. More research is coming out that this is a much more common problem than originally thought. There is much information out there to learn more, and new treatments possibilities are being studied, some at Mayo. I encourage uou yo research farther. There is so much to say on this subject it is difficult to summarize in this brief forum.

The one thing I do recommend is absolutely get a CGM even if you have to pay out of pocket. It has been a godsend and game changer for me. It helps to predict when the lows are going to occur so you can start treating before you get dangerously low and Blood sugars in the 40’s are considered dangerously low.
I have a Dexcom G6 CGM (for over 2 years now) and I love it because of how you can program the alarms. My endocrinologist was able to make the case to insurance so I am fortunate not to have to pay, but if It wasnt paid for I would definitely pay out of pocket. Fortunately when my Endocrinologist and I were first trying to improve my situation we learned the Libre brand would not cost me more than 75$/month. The alarms are not as fancy as the Dexcom brand but it still works well. I recommend discussing all of this further with your endocrinologist, snd perhaps try to find a Dr who has experience with this problem, although they are hard to find.

I hope this helps to let you know there are many of us out there trying to figure this complication out because frankly, it is a nightmare to live with! Best, Nancy

This Facebook Group is all about PBH/PBRH. You can find a lot of valuable information and support there.

As for the lows you are getting to without feeling symptoms, that is “Hypoglycemia Unawareness” and it’s very dangerous. Your Endo should code the CGM insurance request for this specific diagnosis.

Here is the link to the PBH Group: https://m.facebook.com/groups/794995701320068/

I agree this is miserable. I haven't actually seen the 27 or 28, but I got the "Low out of Range" number last night as I ate a half bottle of Glucose tablets trying to keep my sugar up enough to sleep and not deal with the constant alarms. Are you receiving treatment or testing at Mayo? I've had the Roux-en-Y back in 2017 and just started these symptoms as the end of last year.

@rileylori74
My hypoglycemia is very sporadic and I discussed with endocrinologists at Mayo last week as part of my yearly bariatric surgery recheck. I do not have diabetes and do not wear a monitor, when have spell I do finger prick to test my levels. Like you do, I have supply of something to raise level when happens. He suggested LifeSavers. You do not want to get in situation where have spikes and lows.

Are you diabetic? Have you talked to your provider or an endocrinologists about how to handle or prevent?

Hi. I'm not diabetic. My hypoglycemia has become something I deal with almost every day. Mostly at night. But frequently I get hit in the mornings as well. I feel like I do a pretty good job of watching my diet and it does seem to help, but then it's like sometimes it doesn't matter. If I do something physical outside of my normal activity, I pay for it for a like a week with 10 - 20 alarms of my CGM primarily between 50 & 60 but sometimes in the 40s. I was told by my Endocrinologist at Mayo that it is Hypoglycemia caused by late dumping syndrome. I did the Mixed Meal Test and my glucose hit 45 which documented it was occurring when eating normal food. I'm going in next week for the 72 hour Endocrine test. We are at the stage of evaluation still, but I met with a nutritionist and my endocrinologist has a list of things we are going to try but he doesn't think there is going to be a surgical answer. I'm also meeting with the Gastro team for testing next month.

Hi everyone, sorry I have not updated everyone. Here is a recap and update and hopefully I can answer everyone.
I have my CGM (insurance finally covered) I do see my general surg. team that did my surg. and I see endo. and a dietician and my PCP. I have increased my protein (Pure protein bars are great).
If I do anything "extra" out of my normal routine I get lows, then I have to eat to get my numbers up so I then lose any calories I burned off. I take Acarbose if I know I am going to eat a "bad" food to help off set it (like if I am out to eat or at a function.
I was told by my endo. provider that if it c that they would need to reverse the surg. which I really do not want to do only because of problems and scar tissue build up.
So I continue to watch what I eat and wear my CGM and carry protein bars, glucose shot (the 2 oz bottle you can get at pharmacies) and snacks with me and try keep my protein level up.
Hopefully I answered everyone and thanks for the ideas and tips and hope things work out for everyone. If I missed something please let me know and I will try to stay on top of this.
Have a great weekend

@rileylori74

Thanks for explanation. Sounds like your getting a thorough evaluation of problem. I hope they find a solution.

Please keep us updated.

Your welcome and I will keep you update.

Heidi