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Rapid gastric emptying: Has anyone had dumping stop and start again?

Posted by suensteve @suensteve17, 6 days ago

Hi. My surgery for stage 4 adenocarcinoma was 2 years and 9 mths ago.
For some time during the 1 to 2 year mark I regularly suffered from rapid gastric emptying to the point where I thought I was having panic attacks. I found them to be very frightening and quite upsetting. I also worried about having one while driving. Thankfully that didn't happen.
Finally they went away until just recently when they started up again. Not quite as severe but same symptoms. I've started carrying glucose tablets in my bag and find that if I take 2 quickly the symptoms ease faster.
Has anyone else had this problem stop and then start again? Any suggestions on how to manage it/cope?
Dealing with this again as well as the ongoing gastroparesis and other issues is depressing. I haven't been able to get on a zoom call in a while due to work commitments.
Sue, NZ

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mrgvw | @mrgvw | 5 days ago

I'd take the time to explain it to you... but AI may be better. Also... stop in on any of our twice-weekly free EC and Esophagectomy Zoom calls. Need the one-touch link?

Yes, there is a connection: type 2 diabetes can be associated with dumping syndrome (DS), and the conditions can influence each other. Constant blood glucose monitoring is not typically the standard diagnostic method for DS, but it may be a useful tool for monitoring glucose fluctuations in complex cases or for managing treatment in everyday life.
Dumping Syndrome and Type 2 Diabetes
Shared Mechanism: While esophagectomy is a primary cause of DS due to rapid gastric emptying, type 2 diabetes (especially in late stages) can also cause rapid gastric emptying and autonomic neuropathy, which can lead to DS symptoms.
Late Dumping and Hypoglycemia: The "late" form of dumping syndrome (occurring 1-3 hours after a meal) is characterized by reactive hypoglycemia. This happens because the rapid influx of carbohydrates into the small intestine causes an excessive release of insulin, which then results in a sharp drop in blood sugar. This mechanism is a key area of interaction with glucose metabolism issues like diabetes.
Diabetes Remission vs. Risk: Interestingly, bariatric surgery (which also causes dumping syndrome) is often associated with the remission of type 2 diabetes. However, studies have also shown that the long-term risk of developing type 2 diabetes after gastric bypass may increase, or that DS patients with persistent T2D may have different pathophysiological mechanisms for hypoglycemia.
Blood Glucose Monitoring
Diagnostic Tools: The gold standard for diagnosing dumping syndrome is the oral glucose tolerance test (OGTT) or a mixed meal tolerance test (MMTT). These are provocative tests performed under medical supervision to measure blood glucose, pulse, and hematocrit levels at specific intervals (typically every 30 minutes for up to 3 hours). Capillary (finger prick) blood glucose measurements are not reliable for diagnosing hypoglycemia associated with DS.
Role of Continuous Glucose Monitoring (CGM): Constant or continuous glucose monitoring (CGM) is an increasingly used tool in research and clinical management.
Not for Primary Diagnosis: CGM is not recommended as the primary diagnostic test for DS because it can have false positives and does not capture other key markers like pulse rate or hematocrit changes.
Useful for Management: CGM can be very useful for monitoring glucose fluctuations in everyday life, detecting asymptomatic hypoglycemia, and helping patients and clinicians tailor dietary modifications and treatment plans.
In summary, a patient post-esophagectomy with DS symptoms (especially late dumping) should be evaluated for abnormal glucose fluctuations, and while constant monitoring isn't the primary diagnostic test, it can be an important part of long-term management and symptom control.

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suensteve | @suensteve17 | 4 days ago
In reply to @mrgvw "I'd take the time to explain it to you... but AI may be better. Also... stop..." + (show)
Profile picture for mrgvw @mrgvw

I'd take the time to explain it to you... but AI may be better. Also... stop in on any of our twice-weekly free EC and Esophagectomy Zoom calls. Need the one-touch link?

Yes, there is a connection: type 2 diabetes can be associated with dumping syndrome (DS), and the conditions can influence each other. Constant blood glucose monitoring is not typically the standard diagnostic method for DS, but it may be a useful tool for monitoring glucose fluctuations in complex cases or for managing treatment in everyday life.
Dumping Syndrome and Type 2 Diabetes
Shared Mechanism: While esophagectomy is a primary cause of DS due to rapid gastric emptying, type 2 diabetes (especially in late stages) can also cause rapid gastric emptying and autonomic neuropathy, which can lead to DS symptoms.
Late Dumping and Hypoglycemia: The "late" form of dumping syndrome (occurring 1-3 hours after a meal) is characterized by reactive hypoglycemia. This happens because the rapid influx of carbohydrates into the small intestine causes an excessive release of insulin, which then results in a sharp drop in blood sugar. This mechanism is a key area of interaction with glucose metabolism issues like diabetes.
Diabetes Remission vs. Risk: Interestingly, bariatric surgery (which also causes dumping syndrome) is often associated with the remission of type 2 diabetes. However, studies have also shown that the long-term risk of developing type 2 diabetes after gastric bypass may increase, or that DS patients with persistent T2D may have different pathophysiological mechanisms for hypoglycemia.
Blood Glucose Monitoring
Diagnostic Tools: The gold standard for diagnosing dumping syndrome is the oral glucose tolerance test (OGTT) or a mixed meal tolerance test (MMTT). These are provocative tests performed under medical supervision to measure blood glucose, pulse, and hematocrit levels at specific intervals (typically every 30 minutes for up to 3 hours). Capillary (finger prick) blood glucose measurements are not reliable for diagnosing hypoglycemia associated with DS.
Role of Continuous Glucose Monitoring (CGM): Constant or continuous glucose monitoring (CGM) is an increasingly used tool in research and clinical management.
Not for Primary Diagnosis: CGM is not recommended as the primary diagnostic test for DS because it can have false positives and does not capture other key markers like pulse rate or hematocrit changes.
Useful for Management: CGM can be very useful for monitoring glucose fluctuations in everyday life, detecting asymptomatic hypoglycemia, and helping patients and clinicians tailor dietary modifications and treatment plans.
In summary, a patient post-esophagectomy with DS symptoms (especially late dumping) should be evaluated for abnormal glucose fluctuations, and while constant monitoring isn't the primary diagnostic test, it can be an important part of long-term management and symptom control.

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No diabetes at all. Just wondering if anyone else has had it go away completely then return again. Any tips for dealing with it when happening?

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seanski | @seanski | 2 days ago

Hi Sue,
I too thought I had past the dumping phase for a while but it snuck back in. Food is not the only trigger for me. If I do any type of moderately strenuous work it will sometimes happen. If I go to an event where there are a lot of people it can sometimes happen. I treat it same way you do, although that sometimes creates a rollercoaster effect that I have to fight all day long. On occasion I use a continuous glucose monitor, it really helps tell a story of what exactly was the cause of the dumping and I can treat it before the glucose gets too low. I would highly recommend trying one of these if you can. I use the Dexcom 7. This one samples every five minutes. I am not diabetic.
A while back I was on a zoom call and was talking about this exact problem. One of the people on the call who is a long time survivor said "things are always changing". I have found this to true.

Sean

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