I have a friend who is in his early 40's who has Postprandial Hypoglycemia after his Nissen Fundoplication surgery. We are having a VERY hard time finding information on this through so that is how I stumbled onto your video. His blood sugars have been as low as 40 md/dl and even 20 md/dl
@@CarmenA908 Any thing done about it yet? My friend is having no luck as they don't want to do anything and might just send him home with a stomach tube.. :(
Doc you are truly brilliant. I’m only a few weeks post RNY but I’m sticking with low carb low sugar. I had never heard of this condition. Since my father died of a diabetic induced heart failure. I figured taking a proactive approach was key. Bless your heart Doc you are the man. Cheers and Slainte 🇮🇪
This was so helpful, thank you! I have this and didn’t realize it. My CGM showed me in the low 60s this morning….while working it dropped to 53 and I still felt normal. I ate dinner and my numbers spiked 40 points but still in the low 90s.
I'll be 23 years post-Rue-N-Y gastric bypass, June 21,2023. I was 298 lbs the day of surgery, lost 160 lbs, and have kept it off so far. I have many issues, but this one in particular is most problematic at this time. My BS will drop as low as 27, and I lose mental faculties and have drenching sweats. After recovery, I have to sleep for 6-8 hours. This has gotten progressively worse and more frequently happens. My Endocrinologist is going to hospitalize me, induced hypoglycemia, and do multiple tests while I'm in the crisis state. THAT should be fun!
My experience is that endocrine doctors don't often understand the interaction of gastric bypass with food. I recommend for you to get connected with an experienced bariatric team in your area.
@John Pilcher, Bariatric Surgeon Thank you for taking the time to respond. I agree with your assessment. We're both baffled by the fact that the same food can repeatedly cause the hypoglycemia, or, not. It's crazy frustrating.
I am a patient of Dr Jim Valentine who was a long time bariatric surgeon in Idaho for decades before his passing recently. I have just been diagnosed with late dumping with hypoglycemia. I always thought it was normal dumping. I have dealt with it for so long that I have an avoidant eating disorder that I am getting treatment for. We need to educate our bypass patients about blood sugar symptoms.
@@DoctorJP i hope we can educate our GP's to recognize this as well. I had to fight so hard to prove to my GP that it was even happening. I was told, "but it's just dumping syndrome." I have had problems getting them to fight for a CGM. I have had issues trying to get anywhere with it. I feel like I have been gaslit by the medical community that I wasn't as sick as I knew I was getting. It's very difficult to advocate for your health when your claims are getting downplayed. :(
I suffer from a kind of reactive hypoglycemia that is very similar to the one described for the cases of bariatric surgery pacients (but I did not have bariatric surgery, and I’m otherwise in very good health). My blood sugar can drop to as low as 48 mg/dl when I eat carbohydrates with a very high glycemic index and a low total content of carbs. Very ripe bananas are one of the things that trigger the reaction in my case. However, I have discovered that if I exercise vigorously right after I eat the bananas, I suffer no reaction (I.e. I experience no drop in blood sugar). I believe this is because when I exercise the body restricts the increase in insulin production and even stimulates the production of antagonist hormones, like glucagon, to raise glucose levels to the levels that are necessary to supply my cells of the glucose that they need for the exercise, so preventing the blood-glucose levels from dropping.
His description sounds like the explanation I was given about reactive hypoglycemia. I have reactive hypoglycemia, but I’m not a bariatric surgery patient at all. I developed this issue a few years ago, first with sensitivity eating carbs, then fats, then proteins. I was diagnosed with the reactive hypoglycemia first, and then EPI. But I also have symptoms sometimes like postprandial hypotension, and I’ll eat, and then lose consciousness. It can be confusing though because it also matches an issue called d - lactic acidosis, which is related to SIBO. Doctor I had kept testing my gallbladder and nothing was wrong with it. But coincidentally, my pancreas has fatty tissue replacement. A lot of things are still a mystery.
Thank you for this information. I'm 3 years post gastric bypass and the past year have experienced extremely low blood sugar levels...32 or 34. Still seeking treatment to rule out an endocrine tumor. Appreciate your thorough explanation.
I had a gastric sleeve in Aug 2021. I have not been intentionally watchful of my diet and during a cruise at the end of November started eating carbs like sugared and grain based foods, occasional candies and chocolates, and fruits like apples, bananas, and pears. I feel like it is impossible to get back on track, but know that it is necessary. I will eat little amounts and sometimes overindulge to where I cannot keep it down. At first I thought my blood sugar was super high but it was 53. I cannot even remember what I ate, but after an hour I felt worlds better. After watching your video, that makes a LOT of sense. Thank you for posting. I will get back with my bariatric team to get a better eating plan in process. Again.
Thank you for this video. I am 3 years out of gastric bypass and have eaten more carbs and sugar in the past 6 months. I've noticed that I am “hungrier” sooner, but now I believe it is more along the lines of low blood sugar. I will follow your advice of a low carb/low sugar diet with protein and fat. Thank you!
Thank so much for all the information provided here, Doctor! I had my gastric by pass in 2017 and began experiencing Hypoglycemia in 2019. For a long time, my sugar levels were ranging from 53-74 consistently. Eventually I became unaware of my low sugar episodes. This was dangerous as it prevented me from taking timely action. Noticing my hypoglycemic unawareness, I decided to finally make some changes. Unfortunately, finding resourceful and creditable information on how to manage and prevent an episode effectively was extremely difficult. Thus far, I got a CGM- to alert me when sugar level drops below 70, and consistently with your video, I changed my diet to a Complex/Low Carb and Low Sugar diet. I haven't experience a major sugar drop since adapting these dietary changes, but will love to know the proper/recommended method to managing a drop? Is it 15g of carb (for immediate absorption) follow by a small protein meal (to stabilize)?
Carolina, thanks for your question. It sounds like you are doing a good job managing this potentially difficult problem. I agree that a CGM is a fantastic tool that can really provide insight into the effect of various foods on one's blood sugar levels. I can respond to your question in general terms, though I hope you will consult with your bariatric surgeon for actual medical advice in your case. Also, it would be smart to use the CGM to observe the effect of various food interventions in your own life and body. In my experience working with bariatric patients, protein is only slightly slower (maybe 5 minutes slower) in boosting a low blood sugar than carbs are. Convenient proteins could be a protein bar, or nuts. In my patients, carbs seem to cause a temporary blood glucose spike, followed by a crash. Your question about a protein (maintenance) to follow carb treatment is sensible, just that in my experience the carbs are usually not needed.
Talking about bariatric multivitamins. Best to connect with your bariatric team to make sure you're getting the right ones, and that they're having positive impact. Your bariatric team should alos be able to trouble shoot other potential causes of blood sugar fluctuation.
Thank you! I’ve been dealing with this for about a week. Caught it early and got some blood work done and have already mitigated it quite a bit. Trying to learn as much as I can, this sucks!
Yes, it can be a pain. Update from the video; I'm hearing about Continuous Glucose Monitors that are available without a prescription. Can be very useful for finding your triggers.
I had labs drawn this morning after a sugary breakfast from dunkin. My glucose was surprisingly 69. Is this considered reactive hypoglycemia? I did not have gastric bypass surgery, but did have a Meningioma removed February of 2022.
Doctor, it seems the information in your video has answers to my issues. However, I've had these symptoms prior to having a partial colectomy rather than gastric bypass.... I'm becoming skin and bones even though I eat healthily and often. I'll definitely be following your research and comments.
Wow, sorry to hear about your struggles. I hope this information is applicable, and I hope you can get connected with an experienced gastroenterologist and endocrinologist in your area.
I had this when I was on a low carb ketosis diet. I was only eating 20 grams of carbs a day and I’ve never had gastric surgery and I’m not obese, I’m actually underweight. So I’m really confused
I’ve had severe symptoms and been in and out of emergency and hospitals for nearly four years with blackouts ranging from 2hrs-16hrs non-responsive. It has been impossible to diagnose until I seen a naturopath who put me on the keto diet for 12 months to which I responded significantly. However I’m 33 now I’ve been healthy and fit my entire life and had no surgeries that have had anything to do with gastric bypass. Only emergency back surgery but my symptoms started before then. I developed crippling anxiety and deep depression from blacking out in public and missed a lot since 2018. I would just love to know how I managed to develop it originally and is there even a medical procedure or process to determine it because I’ve had the glucose test, blacked out for 6hrs in front of the nurses and they still didn’t think it was diabetes. Professionals have told me to live with it, blamed my make up, disregarded my desperation for help.. It doesn’t matter how strict my diet is I still suffer with shaking, exhaustion and battle with food like it’s my enemy.
Shaking is my problem too, I seen a cardiologist and am now on a blood pressure medication that has stopped the shaking I don’t have high blood pressure but that medication helps with the shakes
Thank you so much doctor for sharing your knowledge with us, it's a great relief for me to be informed about my condition. Despite doing everything rigth, I'm suffering from reactive postprandial hypoglycemia (30 and under blood sugar after eating), I'm trying to work it out with my medical team. But this condition is rare, sometimes I'm the first case for my doctos. I hope to find a solution, it's really exhausting to live with these simptoms everytime I eat, even the right amount and macronutrients. I'm also suffering from low vitamin levels and anemia. After eating I feel dizzy, I can't think right, my heart rate accelerates, it's difficult to breathe, I feel like I'm going to pass out, my hands shake, I feel the urge to eat something, I feel nauseated, sometimes I have to throw up, it's really debilitating and exhausting to feel like this all the time. It interferes with my daily activities, my personal life, my work, my workouts, everything, I really pray this ends, or at least gets better, I hope I do not have to go under surgery to reverse the process, but it's an option if nothing else works. Since my bypass surgery in 2020, I have been experiencing dumping syndrome, nausea, diarrhea, and I always try to eat clean and workout at the gym. I really thank you doctor for your videos, they have helped me to understand what my body is going through, and ask the right questions to my doctors, I also feel like I'm not alone, it's important for me to read the comments section and get to know other people experiences, I'm forever greatful, please know your work is much appreciated and relevant for those like me who suffer this condition. Sorry if any mistake was made in grammar or writing, english is not my native language.
Im having gastric sleeve revision to RNY in a weeks time and your videos are so helpful thank you. A question, if worse case happens for someone who has had a revision, can the RNY be reversed back to sleeve?
That's an interesting question, and the answer depends on your surgeon's plan. Usually, the Sleeve stomach is basically still there so it could theoretically be available to hook the parts back together, but that surgery (additional revision) can be very challenging and pretty risky. NOT to be undertaken lightly. You might also be interested in this video: ua-cam.com/video/jh_Rr9qLjHM/v-deo.html
In your opinion, are the carbs in non-starchy vegetables a concern? I'm 6.5-months po RnY and I've started having some issues with hypoglycemia. About 2.5-3.5 hours after I eat, my blood sugar drops - it's pretty much textbook post-bariatric hypoglycemia. Fear of dumping is keeping me on the fairly straight and narrow, but I do eat lavash bread, low carb tortillas, and beans. I also have been eating fruit, like apples, bananas, peaches, and berries. And I will eat raw carrots and other salad vegetables. I haven't spoken to my surgeon's nutritionist about my blood sugar issues, but I know that she's staunchly anti-low carb.
Thanks for your question Jeanne. It seems to me that several of the foods you mentioned (lavash bread, "low carb" tortillas, and fruits) are very likely to create post-prandial hypoglycemia. For most patients, beans are not a problem. Not sure what you meant about the carbs in non-starchy vegetables, but usually the green and other colored veggies (carrots, bell peppers) are OK. It might be reasonable for you to some planned experimentation: a few days of VERY low carb, then test out various foods in isolation to see how you feel.
Thank you for the video. I am 6-mo post VSG and have had constant hypoglycemia since surgery. I have to drink protein shakes all through the night to avoid altered mental status. This is not fun at all.
Blood sugar 71 1 hour after eating 8 oz steak, buttered corn, tomatoes, avocado, and two pieces of bread. Id say a good balance of macros but i expected maybe 100 to 120 blood sugar. I do not have diabetes I am just checking my numbers to see how Food influences me. I feel like it should have been higher. Can reactive hypoglycemia happen quickly or does it take a few hours. I did not have any surgery or anything so just frequently do 20-40 hours fasts
Thank you for your answer! Since you said low carb diet and vitamins are gonna lower the symptoms, what kind of vitamins are best for reactive hypoglycemia? Have a nice day 👋
Thanks for your question. I'm not aligned with any particular brand of vitamins, though your vitamins should be made for bariatric patients. I recommend for you to follow the guidelines from your bariatric team, and the key thing is to take the vitamins regularly. Best of luck!
Wow this is what my mom is having and can't get anyone to help her. She had gastric bypass in 2006 and is getting worse who can I contact for help. Thanks for your video
I have struggled so much post RNY because my surgeon has poor post surgical support. Thanks for this info. Are than any non-nutritive sweeteners that are safe? Monk fruit and stevia compared to sucralose/nutrasweet My life 25 years after surgery seems to revolve around fear of the next unexplained blood sugar drop. I have successfully kept off 100 lbs. I had hypoglycemia issues pre-surgery. My A1C is great so non -diabetic. I now live in a smaller city where there are few bariatric surgery resources
Thanks for your question. I don't know of any sweetener (real or fake) that is reliably metabolically safe for all patients. In general, I try to coach my patients towards a food plan that has less of the sweet flavor overall. Taking coffee as an example, I recommend for patients to go for the "essence of sweetness" rather than the sweetness of a milkshake. I also think there is significant biologic variability, so if you really need some sweet flavor than you may experiment and observe your body to see which chemical is the least unbalancing in your particular case.
Thanks doctor for your explanation I'd Reactive hypoglycemia 2 months ago, in fact my blood sugar drop between 3 to 5 hours of eating but it still dropping even after 5 hours but slowly, is there any explanation because my doctor did not give me response, and is there any researches in progress related to Reactive hypoglycemia? Thanks in advance
Thanks for your question. I don't think there is a lot of active research, but I do think it sounds worth it for you to visit with an endocrinologist to be sure you don't have a different hormonal or insulin problem.
Thanks for your question. One thing to understand is that there are no essential carbs. At all. Second thing is that any carbs (including healthier ones like millet or quinoa) will have a stronger adverse impact on your blood sugar and your insulin resistance than proteins, green veggies, or natural fats. Yet, in real life people will typically have small servings of carbs and the ones that you mentioned are less disruptive than bread or white rice.
I thought you might be interested to know that this also happens to some patients who have had an esophagectomy for cancer of the esophogus. I am 8 years post surgery for an esophagectomy and have a couple of incidents a week on average. I have been eating a lot of Full fat Greek yoghurt and cheese to try to help to combat it and been told today, by GP that my cholesterol is now too high, so not sure what to do re diet tbh as got to try to combat the hypos and the cholesterol.
I don't have a history of any of these surgeries, but found that following the glucose goddess order of eating (veggies first, then protein/fats, then any carbs or sugar) and correcting vitamin deficiencies has helped. I got micronutrient testing done at AnyLabTestNow without Dr orders.
Hey, my doctor just prescribed me Acrabose. I haven't started it yet. Is it good for hypoglycemia. I eat some carbs but not many. My highs are around 130 my lows upper 60s. I value ur opinion and would love tips on beginning this new medicine.
Acarbose can be useful in blunting sugar swings due to carb intake. In my experience, it usually is not a game changer, and most patients need to be careful with carb intake.
Fasted and then ate a huge meal of carbs today for dinner. Had a damn near panic attack. I had racing thoughts, I started sweating, and eventually had to just hug it out with my significant other and had a glass of orange juice and eventually felt a lot better. This sound like RH?
Is all of the information relevant if you didn’t have a gastric bypass? I’ve been diagnosed with reactive hypoglycemia. They never gave me a reason, just told me I produce too much Insulin
Thanks for your question KD, and it's hard for me to say. I do think the general principles of eating natural low carb food, and taking care of your colon microbiome, could be positive steps while not creating any harm. Best of luck to you!
Same boat as you KD still working to get answers. My doctors theory is because I used to eat horrible and was overweight, my body got used to making alot of insulin. I have lost lots of weight without surgery and changed my diet greatly since then, but it seems like my body still makes a large amount of insulin. I’ve cut lots of carbs from my diet but still keep some. Quinoa has been a helpful staple for me but I’m reevaluating after listening to this. Idk I’ve cut carbs before from my diet and felt worse. Good luck to you. I’m gonna keep experimenting. Definitely the hardest thing I’ve had to deal with.
@@SteamheadBlue it’s literally such a bitch of a thing to deal with. It’s always in the back of my mind. From what I’ve been learning, it’s a very early sign that we are developing pre diabetes. Which makes sense as well. Because if we are producing too much Insulin, eventually our bodies will become insulin resistant. Which is pre and diabetes. If you ever want to talk about it let me know. I’m talking to an endo tomorrow and going to start a keto diet in a few days. I have to do a ton of school work first before I add another thing to worry about haha
Hi, I have glucose crashes everyday, usually within 2 hours of meal. My glucose can fall up to 3.4 and fall is usuall really rapid. I take several glucose measurements in a row in 15 minutes when i start felling symptoms and it droped from 5.4 to 3.4 in onlu around 15 minutes. With all bad known symptoms after taking a candy i was ok, but problem for me is that happens everyday. My endocrinologist thinks that i am all right but i dont think so :(
Hi, I have the sugar crash symptoms and I get hungry every 2 hours. And I don’t eat right away I get lightheaded, shakiness and feels like I’m going to pass. I have checked sugar levels in that moment and they are in the 90s in the normal range. So weird. Doctors can’t still don’t give me a diagnose what is this condition. Any help please?
I'm really sorry but this sounds like it needs a lot more work, in the context of a doctor-patient relationship. If you have not yet met with an Endocrine doctor, I think that might be a good path. Another good bet might be a gastroenterologist. Best wishes.
Thank you for this very informative video. I had gastric bypass surgery 16 years ago. Almost 4 yrs ago I had my first episode of hypoglycemia. I had eaten chicken nuggets about 30 minutes prior to the episode. My family stated that I suddenly went unconscious and started having a grand Mal seizure. I don't remember anything from this incident. The paramedics just told me my blood sugar was 27. I have had multiple episodes of low blood sugar that happen so fast that I don't recognize the symptoms fast enough to prevent a low that causes me to have a seizure. I have changed my diet to low carb and higher fat but I have to be careful about the fat because I am real sensitive and will get dumping syndrome. The only problem I am having is that any type of exercise, even walking will cause my blood sugar to drop too low. I am a nurse and want to go back to work but I am afraid that I will bottom out while working the fast paced field. Is there anything I can do to prevent my sugar from dropping with increased exercise ? Do you know of any support groups for people with this condition? Also what is a safe and effective way to increase my blood sugar when I am low without making my blood sugar bounce up and down. some days I feel like a yo yo going up and down. Thank you in advance.
Sorry to hear about your tough situation. Before I give you any reflections on what works for my patients, I definitely recommend for you to re-connect with your bariatric surgery team. They can help review your diet plan, and you really need your vitamins checked as well. Ideally, they will have a bariatric dietician who can help. If not, it's probably worth the effort to seek out a bariatric dietician in your area. My patients have had trouble when they've gotten advice from endocrinologists, because endocrine specialists mostly believe in the concept of "essential carbs," which is a really counterproductive idea for bariatric surgery patients. My understanding is that carbs are the main cause of hypoglycemia (sugar spikes up then crashes down), not the solution to low blood sugar. Granted that avoiding hypoglycemia is the first goal, if it happens anyway then I advise my patients to boost their blood sugar with protein rather than sugar/carbs. I like natural protein the best (nuts, string cheese, jerky, or something else that can be carried in the purse) because even the artificial sweeteners in protein bars or protein drinks can cause blood sugar swings in those who are sensitive. Best of luck!
@@KiwiBee21 I would definitely check with your doctor because if your blood sugar is low and you could end up unconscious so you need something your system fast and my doctor says simple sugars like apple juice orange juice and so many ounces of that that I have to drink and then test my blood sugar and then follow it up with proteins because if you do a protein it’s gonna take a while for your sugars to rise you need your sugars to go up fast. The best thing to do is change diet so you don’t fall like that anyway and it’s gonna take time to do that I’m sure for some people but be very careful cause your sugar droppings dangerous.
Any suggestions for a flat blood sugar curve 50-90, eating any food causing hypoglycemia within 30-45 minutes of eating? Early insulin response is very strong (hyperinsulimia), never been able to go above 100 blood sugar. Hereditary hyperinsulima hypoglycemia but specific cause is unknown.
Thanks for your question Elena. The science is still developing, but at this point it looks like anything that tastes sweet (real or artificial) is putting some stress on your metabolism and your insulin system. For perfectly healthy people, this type of stress in small doses is tolerable. For people with an obesity imbalance, these metabolic stresses contribute to weight gain.
Dr pilcher I had a gastric bypass with long gastric pouch will I be able to lose the weight I'm asking cos mine is bigger than a boiled egg 🥚 I wondered if you have done this long poch op and if the patients lost weight I've 80lbs to lose any insight would be greatly appreciated. I live in Ireland had my op in Turkey thanks 😊 🙏
I have not had any direct experience with the longer gastric pouch, but the results reported in the literature seem to be the same as the traditional gastric bypass. Best of luck on your journey!
I use sooooo much Splenda. . .please don't tell me I need to give up this too! I feel like I've given up so much already in life. . .this disease/addiction is so very frustrating.
I have been thin my entire life and didn’t have this bypass stuff done!!! I have autoimmune disease and now this hypoglycemia stuff going on. I would love to know what vitamins specifically he is referring to?
Thanks for watching Anitra. The physiology I'm describing may not apply to you. I intentionally don't specify the vitamins because there are a number of valid choices for bariatric patients. Please seek advice from your own doctor about how vitamins might or might not be useful for you.
I get instant reactions (in about a minutes or even seconds) such as pain in my muscles and joints, twitching in my muscles, tingling under my feet and some kind of fuzziness whenever I eat anything carbohydrates or sweet or sugary, including banana and bread, which are the worse. I also get very weak and drowisy that sometimes knocks me off for about an hour. Recently, salt gives me same reactions as well. No Dr has been able to diagnose the problem yet. My blood sugars are high, although I am not diabetic but my sugar levels are almost prediabetic. These symptoms started at a time I was diagnosed as prediatic but my sugar have reduced now, although the symptoms worsen. I am desperately looking for help and warmly welcome any information in this regard.
Sounds like you are not a bariatric patient, but either way I suggest connecting with your primary doctor to get a Continuous Glucose Monitor. This can be amazingly informative.
I have these exact condition but I’m not obese but I was kicked in the stomach by a horse and had to get exploratory surgery and I developed this condition. I went to a doctor twice after, one told me just to eat all the time, another told me I had IBs which I don’t have Gi issues, then another looked for a tumor on my pancreases and I didn’t have one. So I just deal with it with diet, I’ve had it for 20 years.
Thanks for the interesting anecdote. Sounds like maybe you had an injury to your pancreas when the horse kicked you? I wonder what an endocrinologist would find?
@@DoctorJP they looked at my pancreas for a tumor and didn’t find anything unusual. I got a cat scan on it. I also had exploratory surgery so I thought I got dumping syndrome from that surgery? Idk.
I wear a dexcom G7 to monitor my sugar. My RnY was done about 18 years ago. My diagnosis with diabetes was made after my bypass. I had no issues before. Low sugar of 13 and high was 254. Now my lows are still very low and my highs 350... It dips below 40 3/5 times each night. My endo doesn't want to hear it. How do I get him to listen?
I agree that the endocrinologists have a difficult time understanding the interaction of gastric bypass and blood sugar. I recommend for you to reconnect with your bariatric surgeon, or to find an experienced bariatric team in your area.
I have struggled with this for the 17 years since my RNY. Blood glucose drops into the 40s before I feel it, and as low as upper 20s (but I can’t speak at that point).
Technically no, since this about blood sugar level below normal. However, if one has a sudden drop in blood sugar from very high to normal, that might sometimes feel like a low blood sugar.
I have had bariatric surgery 17 yrs ago (2005)... in 2018 I believe I've developed nesidioblastosis. From what you are explaining, I'm sure that's my issue. Dr's have no clue of what is going on. They did tell me I'm hypoglycemia... Do you have a website or email address that I can get in touch with you?
There is also a fake version of this condition, it is called "Idiopathic Postprandial Syndrome (IPS) ". Where your blood sugar is in normal range between 70 to 120 but you feel all hypoglycemia symptoms. A very strange and new issue, all reactive hypoglycemia people should get checked again becasue it is now believed that most of them have IPS. The reason of IPS is unknown but the most cause is not eating 4-5 hours after breakefast. Not feeling hungry can be related to digestive problems, such as reflux, gerd or simply anxiety. However, a normal person should get hungry after 2.5 hours of breakefast. Not after 4 or 5 hours. On the other hand, there are people who dont eat 6-8 hours after breakefast and they dont have any symtomps. So people with IPS problem surely have something wrong but it is unknown, while it is known that IPS is not dangerous as the blood level not going down the limits. However, it makes the life worst. Sadly I am one of them without any surgery and healty body.
I think you're asking if it's a problem for the blood sugar to go from 96 down to 83? The answer to that is no problem. This video is about a situation where a few patients have a much deeper drop in their blood sugar.
Recently I had a lunch of about 1lbs of ground beef and some cheese. 2hrs later I felt dizzy and tired, bgl was 60. Any idea why a meal of protein would cause this? I eat a fairly low carb and high protein diet. I'm a non-diabetic, no gastorc bypass, very active person.
Fair question Nando. Low D is the vitamin that I think of most commonly with distorted glucose metabolism. Occasionally in bariatric surgery patients who don't take vitamins, there can be deficiencies in some other micronutrients that affect glucose such as Chromium or Selenium. Would not expect to see these become abnormal outside of bariatric surgery.
What medication or supplements I can take to keep my blood sugar lev in jornal ranges at night or during the day ? I was pre diabetic and my doctor told me I’m not diabetic anymore after losing 100 pounds with bypass but getting low blood sugar lately.
Yes, this is definitely something to work on. That video link I sent does discuss one medicine, but it's probably more important for you to review this with your bariatric team so they can help you trouble-shoot your food plan and give you some recommendations that fit with your specific situation.
@@leorodz9587 The name of the medicine is acarbose. It really needs to be used in the setting of detailed bariatric education, monitoring, and follow-up. Without that follow up and coaching, the medicine and your gastric bypass are likely to be a waste of time and energy. I wish you the best of luck.
@@leorodz9587 Hi Leo, How’d you get on with your low blood sugar? I was also had a GB surgery and like you I dropped about 100 lbs as well and I am currently with many symptoms of reactive hypoglycemia. I had the bypass overseas too. Did you get any information on the drug?
Thanks for your question. I haven't encountered this situation directly, but my initial thought is that the pre-existing hypoglycemia would cause us to lean towards sleeve or duodenal switch instead of gastric bypass.
Thanks for your question. The data on vitamin patches is scanty, and all the data I've seen indicates the absorption is not as good (or as reliable) as for oral vitamins.
Hi doc , I’m 24 years old, athletic build. I experience reactive hypoglycemia (around 50 md/dl) couple times a week and recently did an insulin test to find out It’s very low. Non fasting insulin test result was 2.29 ( normal is 16-166 uLU/ml) 2 hours after eating a snack. Any suggestions?
Yas me is correct. You could have high insulin levels after meal but normal at other times. My first test was 5 , totally normal. Then my doc suggested testing right after meal and it was 26
Hello doc I had stomach infection for 3 days passing loose stools but recovered using rifaximin but post infection i am having hypoglycemia since days. What can be the reason
Good video! I have been getting tired after I eat basically anything. Just this past year I've been getting so tired after I eat even just eggs I nod out and it's so hard to stay awake when I'm driving after breakfast. I do have that rollercoaster ride sometimes where my body craves something sweet after I eat too many carbs. I'm just tired of the brain fog all day, light headed, not being able to stay awake even after just protein. Help!
Some of the symptoms do sound like low blood sugar but not all the parts of the picture are fitting together. This needs a direct consultation with your bariatric team (option #1) or with an endocrinologist (backup plan). Best of luck.
Please if youve done a RNY to SLEEVE can you let me know how that worked im female but im useing my husband you tube account. My dr wanted to reverse RNYbut i was afraid id put the weight back on so coul you let me know if it will keep my weight down 😢
I see this question along with your other comments. I'm so sorry about your struggles. I have not had many patients converted from gastric bypass to sleeve, but the few that I have done have mostly maintained their weight loss.
Hiii sir goodmrg sir last yr i under gone distal pancretomy wth SPEENETOMY bez insuloma recent I fel post meal hypoglycemia after 3hr plz guide me evn had acarbose tab
Does This reactive hypoglycemia cause sugar crash and diabetic coma?..once I ate 3 sweets after dinner and after some time I started feeling like fainting, unconscious and very sleepy..I don't know what was going on so, I went to sleep and after I woke up again I'm started feeling like sleepy and slep for long time..when ever I eat anything like sugar or potatoes I'm feeling severe fainting and unconscious ..if I eat more sugar the blood sugar levels are coming down and down, how to overcome from this..is there any medication available for this treatment? What should do to avoid this..pls reply 🙏 what is this condition called?..is it dangerous?...
Hello, thanks for your question and yes, low blood sugar is potentially risky. You should review this situation with your primary doctor as soon as practical.
I've checked my sugar levels BEFORE a meal, then after a meal when I begin to feel what I call "SUGAR SHAKES". My before levels are around 110, but are dropping to the 50's after I eat. My whole body shakes UNCONTROLABLY, to the point I feel SICK....like I'm going to pass out or throw up, or something. I have to go lay down for a bit until I stablize. I have NEVER had any stomach surgery either...so what the hell???
I am 54 I have not undergone any surgery I am lean built and I don't have any major health issues but for the past one year I have reactive hypoglycemia.what could be the reason? My other blood picture is normal doctor advise me to take MRI to rule out any tumour but I am postponing it.what is your advice? I am from south india here carbs are the mainstream diet
@@DoctorJP thanks for your reply.i have this condition only after COVID does COVID play any role? I read one news regarding this. A 14 year old boy got this condition after COVID.
I've Been sick for over a year. Dry heaving dizzy 40# weight loss. Hpylori was found and after treatment now I'm really sick. I'm always feeling faint and no weight gain and burning throat and mouth has never stopped.
I went down to 28 and hospital had me on dextrose drip for 3 weeks every time they disconnected me from dextrose drip id plummel down into 30s had to have a push then back on drip that went on for 3 weeks i had to stay in hospital till I San Francisco let them know what it was after every test so i have to either stay on a complex carb or not eat at all 😩 acarbose does not work either 😢 so im going from gastric bypass to sleeve im so afraid of gaining weight
I have hypoglycemia no matter what I eat. I eat healthy meals with fiber, good fat, protein and carbs with low index but it doesnt work. Sugar spike in about 20 min then drop very fast and goes below 70. Where I should find problem?
Agree that can be a terrible problem to have. If you've had bariatric surgery, I suggest reconnecting with your bariatric team. If no prior surgery, best bet will be with an endocrine specialist. Either way, best of luck on your journey.
Thanks for your comment. A sugar crash after bagels makes sense to me. A crash after salads might need a bit more exploration; are we talking about a bunch of big croutons, or some sweetener in the dressing, or fruit along with the green stuff...?
Where is the scientific research supporting your claims about carbs being bad for bariatric patients or artificial sweeteners? Your claims aren't really supported by the literature that I can find.
Thanks for your question. Sorry you were not able to find the literature but here are two recent references that describe the process and treatment of dumping syndrome in bariatric surgery. (Dumping syndrome is the term most commonly used in the literature): www.ncbi.nlm.nih.gov/pmc/articles/PMC10637186/ www.ncbi.nlm.nih.gov/books/NBK470542/ You can use the reference sections to drill down as deeply as you care to go, since this knowledge about the effect of carbs after gastric surgery goes back to the 1960's. About my concerns for artificial sweeteners. There is not yet extensive literature in this regard, and I don't think my video claims such. The concerns expressed in the video about artificial sweeteners comes from my clinical interactions with patients.
Thank you very much for explaining a lot of questions, I have been suffering from this for like 8 months now, and I didn’t see any progress for some reason, my doctor told me that I don’t have to worry because the blood sugar isn’t going to be too low to the point you pass out!! Do you think going to sleep while it’s low like 80 is dangerous? And is it true that it’s not going to drop to a serious point?!
السلام عليكم اخوي ..انا طفلي مسوي عمليه بالمعده والحين دخلت متاهة هبوط السكر مجرد ما ادخل اكل كارب يخفس السكر يشلع ثم ينزل بسرعه الى ٥٠ ..هل حصلت علاج او دكتور حل مشكلتك ياليت تساعدني
I'm so glad that specialist doctors like you exist.
You are very kind
I have a friend who is in his early 40's who has Postprandial Hypoglycemia after his Nissen Fundoplication surgery. We are having a VERY hard time finding information on this through so that is how I stumbled onto your video. His blood sugars have been as low as 40 md/dl and even 20 md/dl
I am having the same issues from the same surgery 😢
@@CarmenA908 Any thing done about it yet? My friend is having no luck as they don't want to do anything and might just send him home with a stomach tube.. :(
Doc you are truly brilliant. I’m only a few weeks post RNY but I’m sticking with low carb low sugar. I had never heard of this condition. Since my father died of a diabetic induced heart failure. I figured taking a proactive approach was key. Bless your heart Doc you are the man. Cheers and Slainte 🇮🇪
Thanks again for watching, and best of luck on your journey!
This was so helpful, thank you! I have this and didn’t realize it. My CGM showed me in the low 60s this morning….while working it dropped to 53 and I still felt normal. I ate dinner and my numbers spiked 40 points but still in the low 90s.
Glad it helped!
This is the best video I’ve seen on this topic. Thank you!
Glad it was helpful!
I'll be 23 years post-Rue-N-Y gastric bypass, June 21,2023. I was 298 lbs the day of surgery, lost 160 lbs, and have kept it off so far. I have many issues, but this one in particular is most problematic at this time. My BS will drop as low as 27, and I lose mental faculties and have drenching sweats. After recovery, I have to sleep for 6-8 hours. This has gotten progressively worse and more frequently happens. My Endocrinologist is going to hospitalize me, induced hypoglycemia, and do multiple tests while I'm in the crisis state. THAT should be fun!
My experience is that endocrine doctors don't often understand the interaction of gastric bypass with food. I recommend for you to get connected with an experienced bariatric team in your area.
@John Pilcher, Bariatric Surgeon Thank you for taking the time to respond. I agree with your assessment. We're both baffled by the fact that the same food can repeatedly cause the hypoglycemia, or, not. It's crazy frustrating.
I am a patient of Dr Jim Valentine who was a long time bariatric surgeon in Idaho for decades before his passing recently. I have just been diagnosed with late dumping with hypoglycemia. I always thought it was normal dumping. I have dealt with it for so long that I have an avoidant eating disorder that I am getting treatment for.
We need to educate our bypass patients about blood sugar symptoms.
Thanks for your feedback. Best of luck to you, and yes we are trying to extend the education!
@@DoctorJP i hope we can educate our GP's to recognize this as well. I had to fight so hard to prove to my GP that it was even happening. I was told, "but it's just dumping syndrome." I have had problems getting them to fight for a CGM. I have had issues trying to get anywhere with it. I feel like I have been gaslit by the medical community that I wasn't as sick as I knew I was getting. It's very difficult to advocate for your health when your claims are getting downplayed. :(
Dr Pilcher, thank you this video answered a lot of questions for me.
Glad it was helpful!
I suffer from a kind of reactive hypoglycemia that is very similar to the one described for the cases of bariatric surgery pacients (but I did not have bariatric surgery, and I’m otherwise in very good health). My blood sugar can drop to as low as 48 mg/dl when I eat carbohydrates with a very high glycemic index and a low total content of carbs. Very ripe bananas are one of the things that trigger the reaction in my case. However, I have discovered that if I exercise vigorously right after I eat the bananas, I suffer no reaction (I.e. I experience no drop in blood sugar). I believe this is because when I exercise the body restricts the increase in insulin production and even stimulates the production of antagonist hormones, like glucagon, to raise glucose levels to the levels that are necessary to supply my cells of the glucose that they need for the exercise, so preventing the blood-glucose levels from dropping.
thanks for your comment
Hi arebolour I'm also phasing same issue. is it diabetic or pre diabetic symptoms? can you please explain thanks
This is excellent knowledge wish I could understand my problem more
His description sounds like the explanation I was given about reactive hypoglycemia. I have reactive hypoglycemia, but I’m not a bariatric surgery patient at all. I developed this issue a few years ago, first with sensitivity eating carbs, then fats, then proteins. I was diagnosed with the reactive hypoglycemia first, and then EPI. But I also have symptoms sometimes like postprandial hypotension, and I’ll eat, and then lose consciousness. It can be confusing though because it also matches an issue called d - lactic acidosis, which is related to SIBO. Doctor I had kept testing my gallbladder and nothing was wrong with it. But coincidentally, my pancreas has fatty tissue replacement.
A lot of things are still a mystery.
Are you diabetic?
Thank you for this information. I'm 3 years post gastric bypass and the past year have experienced extremely low blood sugar levels...32 or 34. Still seeking treatment to rule out an endocrine tumor. Appreciate your thorough explanation.
I'm glad this was useful. Best of luck on getting your blood glucose levels under control!
I had a gastric sleeve in Aug 2021. I have not been intentionally watchful of my diet and during a cruise at the end of November started eating carbs like sugared and grain based foods, occasional candies and chocolates, and fruits like apples, bananas, and pears. I feel like it is impossible to get back on track, but know that it is necessary. I will eat little amounts and sometimes overindulge to where I cannot keep it down. At first I thought my blood sugar was super high but it was 53. I cannot even remember what I ate, but after an hour I felt worlds better. After watching your video, that makes a LOT of sense. Thank you for posting. I will get back with my bariatric team to get a better eating plan in process. Again.
So glad this was helpful, and best of luck on your journey!
Most informative video I’ve seen! Thank you so much for your explanation!
Glad it was helpful!
Thank you for this video. I am 3 years out of gastric bypass and have eaten more carbs and sugar in the past 6 months. I've noticed that I am “hungrier” sooner, but now I believe it is more along the lines of low blood sugar. I will follow your advice of a low carb/low sugar diet with protein and fat. Thank you!
Thanks for watching, and best of luck getting back on track!
I have this. There are no dietitians here in Knoxville so I have been trying to do this on my own. I had my RNY in 2009.
It can be pretty tough. Best of luck on your journey!
Thank so much for all the information provided here, Doctor! I had my gastric by pass in 2017 and began experiencing Hypoglycemia in 2019. For a long time, my sugar levels were ranging from 53-74 consistently. Eventually I became unaware of my low sugar episodes. This was dangerous as it prevented me from taking timely action. Noticing my hypoglycemic unawareness, I decided to finally make some changes. Unfortunately, finding resourceful and creditable information on how to manage and prevent an episode effectively was extremely difficult.
Thus far, I got a CGM- to alert me when sugar level drops below 70, and consistently with your video, I changed my diet to a Complex/Low Carb and Low Sugar diet. I haven't experience a major sugar drop since adapting these dietary changes, but will love to know the proper/recommended method to managing a drop? Is it 15g of carb (for immediate absorption) follow by a small protein meal (to stabilize)?
Carolina, thanks for your question. It sounds like you are doing a good job managing this potentially difficult problem. I agree that a CGM is a fantastic tool that can really provide insight into the effect of various foods on one's blood sugar levels.
I can respond to your question in general terms, though I hope you will consult with your bariatric surgeon for actual medical advice in your case. Also, it would be smart to use the CGM to observe the effect of various food interventions in your own life and body.
In my experience working with bariatric patients, protein is only slightly slower (maybe 5 minutes slower) in boosting a low blood sugar than carbs are. Convenient proteins could be a protein bar, or nuts. In my patients, carbs seem to cause a temporary blood glucose spike, followed by a crash. Your question about a protein (maintenance) to follow carb treatment is sensible, just that in my experience the carbs are usually not needed.
I’m so glad I found this video, it’s been incredibly helpful. Which vitamins are you talking about though?
Talking about bariatric multivitamins. Best to connect with your bariatric team to make sure you're getting the right ones, and that they're having positive impact. Your bariatric team should alos be able to trouble shoot other potential causes of blood sugar fluctuation.
Thank you! I’ve been dealing with this for about a week. Caught it early and got some blood work done and have already mitigated it quite a bit. Trying to learn as much as I can, this sucks!
Yes, it can be a pain. Update from the video; I'm hearing about Continuous Glucose Monitors that are available without a prescription. Can be very useful for finding your triggers.
I had labs drawn this morning after a sugary breakfast from dunkin. My glucose was surprisingly 69. Is this considered reactive hypoglycemia? I did not have gastric bypass surgery, but did have a Meningioma removed February of 2022.
Thankyou. Very informative. I'm having this issue 4 years PO.
Thanks for watching!
Doctor, it seems the information in your video has answers to my issues. However, I've had these symptoms prior to having a partial colectomy rather than gastric bypass.... I'm becoming skin and bones even though I eat healthily and often. I'll definitely be following your research and comments.
Wow, sorry to hear about your struggles. I hope this information is applicable, and I hope you can get connected with an experienced gastroenterologist and endocrinologist in your area.
Thank you for this ,now I know what is happening. I appreciate this video
So glad this was useful!
Wow great video, I'm having this same issue, and haven't taken vitamins in years. GOD bless you 🙂
Glad this was helpful. Best of luck on your journey!
@@DoctorJP but which vitamins should we take?
I had this when I was on a low carb ketosis diet. I was only eating 20 grams of carbs a day and I’ve never had gastric surgery and I’m not obese, I’m actually underweight. So I’m really confused
Agree that would not be expected, but my expertise is in bariatric surgery…
I’ve had severe symptoms and been in and out of emergency and hospitals for nearly four years with blackouts ranging from 2hrs-16hrs non-responsive. It has been impossible to diagnose until I seen a naturopath who put me on the keto diet for 12 months to which I responded significantly.
However I’m 33 now I’ve been healthy and fit my entire life and had no surgeries that have had anything to do with gastric bypass. Only emergency back surgery but my symptoms started before then.
I developed crippling anxiety and deep depression from blacking out in public and missed a lot since 2018. I would just love to know how I managed to develop it originally and is there even a medical procedure or process to determine it because I’ve had the glucose test, blacked out for 6hrs in front of the nurses and they still didn’t think it was diabetes. Professionals have told me to live with it, blamed my make up, disregarded my desperation for help..
It doesn’t matter how strict my diet is I still suffer with shaking, exhaustion and battle with food like it’s my enemy.
Shaking is my problem too, I seen a cardiologist and am now on a blood pressure medication that has stopped the shaking I don’t have high blood pressure but that medication helps with the shakes
I have the exact problem
Thank you so much doctor for sharing your knowledge with us, it's a great relief for me to be informed about my condition. Despite doing everything rigth, I'm suffering from reactive postprandial hypoglycemia (30 and under blood sugar after eating), I'm trying to work it out with my medical team. But this condition is rare, sometimes I'm the first case for my doctos. I hope to find a solution, it's really exhausting to live with these simptoms everytime I eat, even the right amount and macronutrients. I'm also suffering from low vitamin levels and anemia. After eating I feel dizzy, I can't think right, my heart rate accelerates, it's difficult to breathe, I feel like I'm going to pass out, my hands shake, I feel the urge to eat something, I feel nauseated, sometimes I have to throw up, it's really debilitating and exhausting to feel like this all the time. It interferes with my daily activities, my personal life, my work, my workouts, everything, I really pray this ends, or at least gets better, I hope I do not have to go under surgery to reverse the process, but it's an option if nothing else works. Since my bypass surgery in 2020, I have been experiencing dumping syndrome, nausea, diarrhea, and I always try to eat clean and workout at the gym. I really thank you doctor for your videos, they have helped me to understand what my body is going through, and ask the right questions to my doctors, I also feel like I'm not alone, it's important for me to read the comments section and get to know other people experiences, I'm forever greatful, please know your work is much appreciated and relevant for those like me who suffer this condition. Sorry if any mistake was made in grammar or writing, english is not my native language.
I sure hope this information helps you and your doctors resolve this condition. Agree it can be a really difficult and scary problem. Best of luck!
Thank you for this needed information
Thanks for watching Susan, hope you are well!
@@DoctorJP
Yes Sir
Im having gastric sleeve revision to RNY in a weeks time and your videos are so helpful thank you. A question, if worse case happens for someone who has had a revision, can the RNY be reversed back to sleeve?
That's an interesting question, and the answer depends on your surgeon's plan. Usually, the Sleeve stomach is basically still there so it could theoretically be available to hook the parts back together, but that surgery (additional revision) can be very challenging and pretty risky. NOT to be undertaken lightly. You might also be interested in this video: ua-cam.com/video/jh_Rr9qLjHM/v-deo.html
In your opinion, are the carbs in non-starchy vegetables a concern? I'm 6.5-months po RnY and I've started having some issues with hypoglycemia. About 2.5-3.5 hours after I eat, my blood sugar drops - it's pretty much textbook post-bariatric hypoglycemia. Fear of dumping is keeping me on the fairly straight and narrow, but I do eat lavash bread, low carb tortillas, and beans. I also have been eating fruit, like apples, bananas, peaches, and berries. And I will eat raw carrots and other salad vegetables. I haven't spoken to my surgeon's nutritionist about my blood sugar issues, but I know that she's staunchly anti-low carb.
Thanks for your question Jeanne. It seems to me that several of the foods you mentioned (lavash bread, "low carb" tortillas, and fruits) are very likely to create post-prandial hypoglycemia. For most patients, beans are not a problem. Not sure what you meant about the carbs in non-starchy vegetables, but usually the green and other colored veggies (carrots, bell peppers) are OK.
It might be reasonable for you to some planned experimentation: a few days of VERY low carb, then test out various foods in isolation to see how you feel.
Thank you doctor! 😊 very informative
Thanks for watching, and if you're struggling with low blood sugar I sure hope this was useful.
Thank you for the video. I am 6-mo post VSG and have had constant hypoglycemia since surgery. I have to drink protein shakes all through the night to avoid altered mental status. This is not fun at all.
Blood sugar 71 1 hour after eating 8 oz steak, buttered corn, tomatoes, avocado, and two pieces of bread. Id say a good balance of macros but i expected maybe 100 to 120 blood sugar. I do not have diabetes I am just checking my numbers to see how Food influences me. I feel like it should have been higher. Can reactive hypoglycemia happen quickly or does it take a few hours. I did not have any surgery or anything so just frequently do 20-40 hours fasts
Thank you for your answer!
Since you said low carb diet and vitamins are gonna lower the symptoms, what kind of vitamins are best for reactive hypoglycemia?
Have a nice day 👋
Thanks for your question. I'm not aligned with any particular brand of vitamins, though your vitamins should be made for bariatric patients. I recommend for you to follow the guidelines from your bariatric team, and the key thing is to take the vitamins regularly.
Best of luck!
Wow this is what my mom is having and can't get anyone to help her. She had gastric bypass in 2006 and is getting worse who can I contact for help. Thanks for your video
The right team would be an experienced bariatric team in your area. Best of luck for your Mom.
I have struggled so much post RNY because my surgeon has poor post surgical support. Thanks for this info. Are than any non-nutritive sweeteners that are safe? Monk fruit and stevia compared to sucralose/nutrasweet
My life 25 years after surgery seems to revolve around fear of the next unexplained blood sugar drop.
I have successfully kept off 100 lbs. I had hypoglycemia issues pre-surgery. My A1C is great so non -diabetic. I now live in a smaller city where there are few bariatric surgery resources
Thanks for your question. I don't know of any sweetener (real or fake) that is reliably metabolically safe for all patients. In general, I try to coach my patients towards a food plan that has less of the sweet flavor overall. Taking coffee as an example, I recommend for patients to go for the "essence of sweetness" rather than the sweetness of a milkshake. I also think there is significant biologic variability, so if you really need some sweet flavor than you may experiment and observe your body to see which chemical is the least unbalancing in your particular case.
Thanks doctor for your explanation
I'd Reactive hypoglycemia 2 months ago, in fact my blood sugar drop between 3 to 5 hours of eating but it still dropping even after 5 hours but slowly, is there any explanation because my doctor did not give me response, and is there any researches in progress related to Reactive hypoglycemia?
Thanks in advance
Thanks for your question. I don't think there is a lot of active research, but I do think it sounds worth it for you to visit with an endocrinologist to be sure you don't have a different hormonal or insulin problem.
What about carbs such as Millet or quinoa should we avoid those as well?
Thanks for your question. One thing to understand is that there are no essential carbs. At all.
Second thing is that any carbs (including healthier ones like millet or quinoa) will have a stronger adverse impact on your blood sugar and your insulin resistance than proteins, green veggies, or natural fats.
Yet, in real life people will typically have small servings of carbs and the ones that you mentioned are less disruptive than bread or white rice.
@@DoctorJP Thanks for the speedy answer! I stayed away from all carbs today and had only salad and eggs mostly, felt much better so far!
I thought you might be interested to know that this also happens to some patients who have had an esophagectomy for cancer of the esophogus. I am 8 years post surgery for an esophagectomy and have a couple of incidents a week on average. I have been eating a lot of Full fat Greek yoghurt and cheese to try to help to combat it and been told today, by GP that my cholesterol is now too high, so not sure what to do re diet tbh as got to try to combat the hypos and the cholesterol.
I don't have a history of any of these surgeries, but found that following the glucose goddess order of eating (veggies first, then protein/fats, then any carbs or sugar) and correcting vitamin deficiencies has helped. I got micronutrient testing done at AnyLabTestNow without Dr orders.
Hey, my doctor just prescribed me Acrabose. I haven't started it yet. Is it good for hypoglycemia. I eat some carbs but not many. My highs are around 130 my lows upper 60s. I value ur opinion and would love tips on beginning this new medicine.
Acarbose can be useful in blunting sugar swings due to carb intake. In my experience, it usually is not a game changer, and most patients need to be careful with carb intake.
Fasted and then ate a huge meal of carbs today for dinner. Had a damn near panic attack. I had racing thoughts, I started sweating, and eventually had to just hug it out with my significant other and had a glass of orange juice and eventually felt a lot better. This sound like RH?
yep, sounds a lot like the subject of this video
Is all of the information relevant if you didn’t have a gastric bypass?
I’ve been diagnosed with reactive hypoglycemia. They never gave me a reason, just told me I produce too much Insulin
Thanks for your question KD, and it's hard for me to say. I do think the general principles of eating natural low carb food, and taking care of your colon microbiome, could be positive steps while not creating any harm. Best of luck to you!
Same boat as you KD still working to get answers. My doctors theory is because I used to eat horrible and was overweight, my body got used to making alot of insulin. I have lost lots of weight without surgery and changed my diet greatly since then, but it seems like my body still makes a large amount of insulin. I’ve cut lots of carbs from my diet but still keep some. Quinoa has been a helpful staple for me but I’m reevaluating after listening to this. Idk I’ve cut carbs before from my diet and felt worse. Good luck to you. I’m gonna keep experimenting. Definitely the hardest thing I’ve had to deal with.
@@SteamheadBlue it’s literally such a bitch of a thing to deal with. It’s always in the back of my mind.
From what I’ve been learning, it’s a very early sign that we are developing pre diabetes.
Which makes sense as well. Because if we are producing too much Insulin, eventually our bodies will become insulin resistant. Which is pre and diabetes.
If you ever want to talk about it let me know. I’m talking to an endo tomorrow and going to start a keto diet in a few days. I have to do a ton of school work first before I add another thing to worry about haha
Hi,
I have glucose crashes everyday, usually within 2 hours of meal.
My glucose can fall up to 3.4 and fall is usuall really rapid.
I take several glucose measurements in a row in 15 minutes when i start felling symptoms and it droped from 5.4 to 3.4 in onlu around 15 minutes. With all bad known symptoms after taking a candy i was ok, but problem for me is that happens everyday.
My endocrinologist thinks that i am all right but i dont think so :(
I really hope you will work on this with your bariatric team.
You’re awesome …is acarbose otc?
To my knowledge, only by prescription.
Hi, I have the sugar crash symptoms and I get hungry every 2 hours. And I don’t eat right away I get lightheaded, shakiness and feels like I’m going to pass. I have checked sugar levels in that moment and they are in the 90s in the normal range. So weird. Doctors can’t still don’t give me a diagnose what is this condition. Any help please?
I'm really sorry but this sounds like it needs a lot more work, in the context of a doctor-patient relationship. If you have not yet met with an Endocrine doctor, I think that might be a good path. Another good bet might be a gastroenterologist. Best wishes.
Dr berg about keto and hypoglycemia
What's did you find out?
I am facing same
Thank you for this very informative video. I had gastric bypass surgery 16 years ago. Almost 4 yrs ago I had my first episode of hypoglycemia. I had eaten chicken nuggets about 30 minutes prior to the episode. My family stated that I suddenly went unconscious and started having a grand Mal seizure. I don't remember anything from this incident. The paramedics just told me my blood sugar was 27. I have had multiple episodes of low blood sugar that happen so fast that I don't recognize the symptoms fast enough to prevent a low that causes me to have a seizure. I have changed my diet to low carb and higher fat but I have to be careful about the fat because I am real sensitive and will get dumping syndrome. The only problem I am having is that any type of exercise, even walking will cause my blood sugar to drop too low. I am a nurse and want to go back to work but I am afraid that I will bottom out while working the fast paced field. Is there anything I can do to prevent my sugar from dropping with increased exercise ? Do you know of any support groups for people with this condition? Also what is a safe and effective way to increase my blood sugar when I am low without making my blood sugar bounce up and down. some days I feel like a yo yo going up and down. Thank you in advance.
Sorry to hear about your tough situation. Before I give you any reflections on what works for my patients, I definitely recommend for you to re-connect with your bariatric surgery team. They can help review your diet plan, and you really need your vitamins checked as well. Ideally, they will have a bariatric dietician who can help. If not, it's probably worth the effort to seek out a bariatric dietician in your area.
My patients have had trouble when they've gotten advice from endocrinologists, because endocrine specialists mostly believe in the concept of "essential carbs," which is a really counterproductive idea for bariatric surgery patients. My understanding is that carbs are the main cause of hypoglycemia (sugar spikes up then crashes down), not the solution to low blood sugar.
Granted that avoiding hypoglycemia is the first goal, if it happens anyway then I advise my patients to boost their blood sugar with protein rather than sugar/carbs. I like natural protein the best (nuts, string cheese, jerky, or something else that can be carried in the purse) because even the artificial sweeteners in protein bars or protein drinks can cause blood sugar swings in those who are sensitive.
Best of luck!
@@DoctorJP totally actionable steps. Thankyou
@@KiwiBee21 I would definitely check with your doctor because if your blood sugar is low and you could end up unconscious so you need something your system fast and my doctor says simple sugars like apple juice orange juice and so many ounces of that that I have to drink and then test my blood sugar and then follow it up with proteins because if you do a protein it’s gonna take a while for your sugars to rise you need your sugars to go up fast. The best thing to do is change diet so you don’t fall like that anyway and it’s gonna take time to do that I’m sure for some people but be very careful cause your sugar droppings dangerous.
Can this also be a complication from consuming carbs for VSG patients that do not experience dumping syndrome?
Yes
Any suggestions for a flat blood sugar curve 50-90, eating any food causing hypoglycemia within 30-45 minutes of eating? Early insulin response is very strong (hyperinsulimia), never been able to go above 100 blood sugar. Hereditary hyperinsulima hypoglycemia but specific cause is unknown.
Thanks for the video. Is there any artificial sweetener people can take safely?
Thanks for your question Elena. The science is still developing, but at this point it looks like anything that tastes sweet (real or artificial) is putting some stress on your metabolism and your insulin system. For perfectly healthy people, this type of stress in small doses is tolerable. For people with an obesity imbalance, these metabolic stresses contribute to weight gain.
@@DoctorJP thank you for clarifying!
Dr pilcher I had a gastric bypass with long gastric pouch will I be able to lose the weight I'm asking cos mine is bigger than a boiled egg 🥚 I wondered if you have done this long poch op and if the patients lost weight I've 80lbs to lose any insight would be greatly appreciated. I live in Ireland had my op in Turkey thanks 😊 🙏
I have not had any direct experience with the longer gastric pouch, but the results reported in the literature seem to be the same as the traditional gastric bypass. Best of luck on your journey!
@@DoctorJP thanks Doc 👍👍
I use sooooo much Splenda. . .please don't tell me I need to give up this too! I feel like I've given up so much already in life. . .this disease/addiction is so very frustrating.
I know. Some of my patients call me "Dr Killjoy" ;)
I have been thin my entire life and didn’t have this bypass stuff done!!! I have autoimmune disease and now this hypoglycemia stuff going on.
I would love to know what vitamins specifically he is referring to?
Thanks for watching Anitra. The physiology I'm describing may not apply to you. I intentionally don't specify the vitamins because there are a number of valid choices for bariatric patients. Please seek advice from your own doctor about how vitamins might or might not be useful for you.
I get instant reactions (in about a minutes or even seconds) such as pain in my muscles and joints, twitching in my muscles, tingling under my feet and some kind of fuzziness whenever I eat anything carbohydrates or sweet or sugary, including banana and bread, which are the worse. I also get very weak and drowisy that sometimes knocks me off for about an hour. Recently, salt gives me same reactions as well. No Dr has been able to diagnose the problem yet. My blood sugars are high, although I am not diabetic but my sugar levels are almost prediabetic. These symptoms started at a time I was diagnosed as prediatic but my sugar have reduced now, although the symptoms worsen. I am desperately looking for help and warmly welcome any information in this regard.
Sounds like you are not a bariatric patient, but either way I suggest connecting with your primary doctor to get a Continuous Glucose Monitor. This can be amazingly informative.
I have these exact condition but I’m not obese but I was kicked in the stomach by a horse and had to get exploratory surgery and I developed this condition. I went to a doctor twice after, one told me just to eat all the time, another told me I had IBs which I don’t have Gi issues, then another looked for a tumor on my pancreases and I didn’t have one. So I just deal with it with diet, I’ve had it for 20 years.
Thanks for the interesting anecdote. Sounds like maybe you had an injury to your pancreas when the horse kicked you? I wonder what an endocrinologist would find?
@@DoctorJP they looked at my pancreas for a tumor and didn’t find anything unusual. I got a cat scan on it. I also had exploratory surgery so I thought I got dumping syndrome from that surgery? Idk.
I wear a dexcom G7 to monitor my sugar. My RnY was done about 18 years ago. My diagnosis with diabetes was made after my bypass. I had no issues before. Low sugar of 13 and high was 254. Now my lows are still very low and my highs 350... It dips below 40 3/5 times each night. My endo doesn't want to hear it. How do I get him to listen?
I agree that the endocrinologists have a difficult time understanding the interaction of gastric bypass and blood sugar. I recommend for you to reconnect with your bariatric surgeon, or to find an experienced bariatric team in your area.
Does this happen to sleeve patients or just bypass?
It is a bit more likely to happen with Kathryn bypass, but it certainly can take place with sleeve as well.
I have struggled with this for the 17 years since my RNY. Blood glucose drops into the 40s before I feel it, and as low as upper 20s (but I can’t speak at that point).
So sorry you're being affected like this. I hope you're in contact with a nearby bariatric team. I think they can help.
@@DoctorJPI was offered a reversal or acarbose. Took the acarbose for years but stopped because of GI distress. I do my best to manage it with diet.
Can you have this condition with normal glucose level during the symptoms?
Technically no, since this about blood sugar level below normal. However, if one has a sudden drop in blood sugar from very high to normal, that might sometimes feel like a low blood sugar.
@@DoctorJP Does Acarbose work in this case?
I have had bariatric surgery 17 yrs ago (2005)... in 2018 I believe I've developed nesidioblastosis. From what you are explaining, I'm sure that's my issue.
Dr's have no clue of what is going on. They did tell me I'm hypoglycemia... Do you have a website or email address that I can get in touch with you?
Thanks for reaching out on this. I would suggest reaching out to the Mayo Clinic; they have expertise in nesidioblastosis.
@@DoctorJP Thank you.
There is also a fake version of this condition, it is called "Idiopathic Postprandial Syndrome (IPS) ". Where your blood sugar is in normal range between 70 to 120 but you feel all hypoglycemia symptoms. A very strange and new issue, all reactive hypoglycemia people should get checked again becasue it is now believed that most of them have IPS. The reason of IPS is unknown but the most cause is not eating 4-5 hours after breakefast. Not feeling hungry can be related to digestive problems, such as reflux, gerd or simply anxiety. However, a normal person should get hungry after 2.5 hours of breakefast. Not after 4 or 5 hours. On the other hand, there are people who dont eat 6-8 hours after breakefast and they dont have any symtomps. So people with IPS problem surely have something wrong but it is unknown, while it is known that IPS is not dangerous as the blood level not going down the limits. However, it makes the life worst. Sadly I am one of them without any surgery and healty body.
I just spoke about this to my Endocrinologist having symptoms of hypoglycemia but my blood sugar is in normal range.
i have ips as well! just wanted to send you some love because i know from experience how hard it is :(
How do you control shaking episodes?
Depends on what you eat .
Do u find anything helpful? @@dwillbond09
Sugar level decreases from 96 to 83 post eating....
What's the problem?
I think you're asking if it's a problem for the blood sugar to go from 96 down to 83? The answer to that is no problem. This video is about a situation where a few patients have a much deeper drop in their blood sugar.
@@DoctorJP ok thnx
Recently I had a lunch of about 1lbs of ground beef and some cheese. 2hrs later I felt dizzy and tired, bgl was 60. Any idea why a meal of protein would cause this? I eat a fairly low carb and high protein diet. I'm a non-diabetic, no gastorc bypass, very active person.
Sorry, but I'm focusing on bariatric surgery.
Protein can also bring on hypoglycemic episode. The only thing that doesn't up your insulin is fat ( healthy fat is what you need).
1lb of ground beef and some cheese ? Blimey that's a big lunch !
Obrigado
de nada. boa sorte!
Which vitamin do you see is the most common cause of issue? I was very deficient in D but have been taking a supplement for a year now.
Fair question Nando. Low D is the vitamin that I think of most commonly with distorted glucose metabolism. Occasionally in bariatric surgery patients who don't take vitamins, there can be deficiencies in some other micronutrients that affect glucose such as Chromium or Selenium. Would not expect to see these become abnormal outside of bariatric surgery.
What medication or supplements I can take to keep my blood sugar lev in jornal ranges at night or during the day ? I was pre diabetic and my doctor told me I’m not diabetic anymore after losing 100 pounds with bypass but getting low blood sugar lately.
Yes, this is definitely something to work on. That video link I sent does discuss one medicine, but it's probably more important for you to review this with your bariatric team so they can help you trouble-shoot your food plan and give you some recommendations that fit with your specific situation.
@@DoctorJP which medicines is that if you don’t mind, the thing is I had the bypass done overseas since I couldn’t afford it fully in New Jersey .
@@leorodz9587 The name of the medicine is acarbose. It really needs to be used in the setting of detailed bariatric education, monitoring, and follow-up. Without that follow up and coaching, the medicine and your gastric bypass are likely to be a waste of time and energy.
I wish you the best of luck.
@@leorodz9587 Hi Leo, How’d you get on with your low blood sugar? I was also had a GB surgery and like you I dropped about 100 lbs as well and I am currently with many symptoms of reactive hypoglycemia. I had the bypass overseas too. Did you get any information on the drug?
@@user-mk3we3yo7b hello, I don’t get low blood sugar or symptoms anymore everything is normal
In conclusion. U recomend to have loyal carbs diet?
Does keto diet help with this?
Definitely yes, in the sense that a keto diet is low carb.
What if you have something like this and then have gastric bypass?
Thanks for your question. I haven't encountered this situation directly, but my initial thought is that the pre-existing hypoglycemia would cause us to lean towards sleeve or duodenal switch instead of gastric bypass.
Vitamin Patches?... Like Patchmd... Has anyone tried them? Has anyone heard of anyone trying them? I'm nervous to try them...
Thanks for your question. The data on vitamin patches is scanty, and all the data I've seen indicates the absorption is not as good (or as reliable) as for oral vitamins.
Hi doc , I’m 24 years old, athletic build. I experience reactive hypoglycemia (around 50 md/dl) couple times a week and recently did an insulin test to find out It’s very low. Non fasting insulin test result was 2.29 ( normal is 16-166 uLU/ml) 2 hours after eating a snack. Any suggestions?
That sounds like a good start. You'll need to work with your local bariatric team and local bariatric surgeon to go deeper. Best of luck!
Check your insulin when you eat food to see what is it
Yas me is correct. You could have high insulin levels after meal but normal at other times. My first test was 5 , totally normal. Then my doc suggested testing right after meal and it was 26
Sir my bgl dropped from 90(FBS)to 83,is it fine?;And,I'm on IBS medication,is it because of that?
Sorry but this is more of a specific medical question that needs to be addressed with your doctor.
Hello doc
I had stomach infection for 3 days passing loose stools but recovered using rifaximin but post infection i am having hypoglycemia since days. What can be the reason
That sounds pretty tricky, much better for you to have a direct consultation with a gastroenterologist in your area.
Good video! I have been getting tired after I eat basically anything. Just this past year I've been getting so tired after I eat even just eggs I nod out and it's so hard to stay awake when I'm driving after breakfast. I do have that rollercoaster ride sometimes where my body craves something sweet after I eat too many carbs. I'm just tired of the brain fog all day, light headed, not being able to stay awake even after just protein. Help!
Some of the symptoms do sound like low blood sugar but not all the parts of the picture are fitting together. This needs a direct consultation with your bariatric team (option #1) or with an endocrinologist (backup plan).
Best of luck.
Please if youve done a RNY to SLEEVE can you let me know how that worked im female but im useing my husband you tube account. My dr wanted to reverse RNYbut i was afraid id put the weight back on so coul you let me know if it will keep my weight down 😢
I see this question along with your other comments. I'm so sorry about your struggles. I have not had many patients converted from gastric bypass to sleeve, but the few that I have done have mostly maintained their weight loss.
@@DoctorJP thank you so much I appreciate your back feed so much
Hiii sir goodmrg sir last yr i under gone distal pancretomy wth SPEENETOMY bez insuloma recent I fel post meal hypoglycemia after 3hr plz guide me evn had acarbose tab
Really sorry about your situation but your physiology is different than what I am addressing.
@@DoctorJP thnk u sir for ur support
Does This reactive hypoglycemia cause sugar crash and diabetic coma?..once I ate 3 sweets after dinner and after some time I started feeling like fainting, unconscious and very sleepy..I don't know what was going on so, I went to sleep and after I woke up again I'm started feeling like sleepy and slep for long time..when ever I eat anything like sugar or potatoes I'm feeling severe fainting and unconscious ..if I eat more sugar the blood sugar levels are coming down and down, how to overcome from this..is there any medication available for this treatment? What should do to avoid this..pls reply 🙏 what is this condition called?..is it dangerous?...
Hello, thanks for your question and yes, low blood sugar is potentially risky. You should review this situation with your primary doctor as soon as practical.
I've checked my sugar levels BEFORE a meal, then after a meal when I begin to feel what I call "SUGAR SHAKES". My before levels are around 110, but are dropping to the 50's after I eat. My whole body shakes UNCONTROLABLY, to the point I feel SICK....like I'm going to pass out or throw up, or something. I have to go lay down for a bit until I stablize. I have NEVER had any stomach surgery either...so what the hell???
You might benefit from meeting an endocrinology doctor in your local area. Best of luck.
I am 54 I have not undergone any surgery I am lean built and I don't have any major health issues but for the past one year I have reactive hypoglycemia.what could be the reason? My other blood picture is normal doctor advise me to take MRI to rule out any tumour but I am postponing it.what is your advice? I am from south india here carbs are the mainstream diet
There are some other medical conditions that can cause low blood sugar. I recommend for you to visit with an endocrine doctor in your area.
@@DoctorJP thanks for your reply.i have this condition only after COVID does COVID play any role? I read one news regarding this. A 14 year old boy got this condition after COVID.
I've Been sick for over a year. Dry heaving dizzy 40# weight loss. Hpylori was found and after treatment now I'm really sick. I'm always feeling faint and no weight gain and burning throat and mouth has never stopped.
After which treatment?
@@yasme9680 dental. Now allergic to dentures
Can’t believe you are a doctor and this is just such old science. Wow
Blue Zones.
Thanks for watching!
I went down to 28 and hospital had me on dextrose drip for 3 weeks every time they disconnected me from dextrose drip id plummel down into 30s had to have a push then back on drip that went on for 3 weeks i had to stay in hospital till I San Francisco let them know what it was after every test so i have to either stay on a complex carb or not eat at all 😩 acarbose does not work either 😢 so im going from gastric bypass to sleeve im so afraid of gaining weight
I have full blown reactive post prandial and those complex carbs put weight on a person
Have you done a RNY to sleeve
So sorry about this serious struggle, and I wish you the best of luck going forward.
post op Rny 9 months, and yes im getting highs and lows, no more rice for me!!!
Best of luck Lisa!
I got this from doing keto
Sorry to hear that. Kind of unusual...
Can this happen within seconds of eating?
In my experience, it takes at least 10 minutes and usually more like 20-40 minutes.
I have thus.
So sorry about that. I suggest reconnecting with your bariatric team to have further evaluation and probably coaching.
I have hypoglycemia no matter what I eat. I eat healthy meals with fiber, good fat, protein and carbs with low index but it doesnt work. Sugar spike in about 20 min then drop very fast and goes below 70. Where I should find problem?
Agree that can be a terrible problem to have. If you've had bariatric surgery, I suggest reconnecting with your bariatric team. If no prior surgery, best bet will be with an endocrine specialist. Either way, best of luck on your journey.
Should we not have fruit then?
Yes, for most patients the right approach to fruit is to use it as a treat and not as a foundational food.
i have it and i do not have any stomach surgery
So sorry to hear that for you. When this condition happens without bariatric surgery, it's best to see an endocrinologist.
@@DoctorJPOh this is best checked with Endocrinologist? I was thinking it should be a diabetologist
I have this its horrible i have to have revision from RNY to sleeve ive had it for 7 yrs almost died
Is this like having diabetes
.omg i have this !
What a bummer! If you haven't already, please reconnect with your Bariatric Surgeon.
Is this a disease that can't be cured?
I always crash after eating salads or bagels
Thanks for your comment. A sugar crash after bagels makes sense to me. A crash after salads might need a bit more exploration; are we talking about a bunch of big croutons, or some sweetener in the dressing, or fruit along with the green stuff...?
Where is the scientific research supporting your claims about carbs being bad for bariatric patients or artificial sweeteners? Your claims aren't really supported by the literature that I can find.
Thanks for your question. Sorry you were not able to find the literature but here are two recent references that describe the process and treatment of dumping syndrome in bariatric surgery. (Dumping syndrome is the term most commonly used in the literature):
www.ncbi.nlm.nih.gov/pmc/articles/PMC10637186/
www.ncbi.nlm.nih.gov/books/NBK470542/
You can use the reference sections to drill down as deeply as you care to go, since this knowledge about the effect of carbs after gastric surgery goes back to the 1960's.
About my concerns for artificial sweeteners. There is not yet extensive literature in this regard, and I don't think my video claims such. The concerns expressed in the video about artificial sweeteners comes from my clinical interactions with patients.
Thank you very much for explaining a lot of questions, I have been suffering from this for like 8 months now, and I didn’t see any progress for some reason, my doctor told me that I don’t have to worry because the blood sugar isn’t going to be too low to the point you pass out!! Do you think going to sleep while it’s low like 80 is dangerous? And is it true that it’s not going to drop to a serious point?!
I'm glad this is helpful, but please do stay engaged with your doctor. Best of luck!
السلام عليكم اخوي ..انا طفلي مسوي عمليه بالمعده والحين دخلت متاهة هبوط السكر مجرد ما ادخل اكل كارب يخفس السكر يشلع ثم ينزل بسرعه الى ٥٠ ..هل حصلت علاج او دكتور حل مشكلتك ياليت تساعدني