I am republishing this article I wrote for Bariatric Friendly’s Newsletter in case anyone missed it:
Reactive Hypoglycemia Background
Reactive hypoglycemia (RH), or postprandial hypoglycemia, is defined as low blood sugar following a meal. Typically the blood sugar drops about 2-4 hours after the meal. This is different than other forms of hypoglycemia that may occur in a fasting state or when too much insulin or diabetic medication was taken. Symptoms include shaky, dizzy, light headed, cold sweats, and confusion. You do not have to have diabetes to have RH. In fact, one of the major contributors to RH is weight loss surgery (WLS).
We know that the negative feedback system from the Roux-En-Y (RNY) gastric bypass may induce low blood sugars early post surgery. When someone eats highly concentrated sweets or just slightly over does the more simple carbohydrates, dumping syndrome can occur. There is a low blood sugar reaction that occurs in the later stages of dumping syndrome as food passes quickly through the digestive tract.
Despite the low blood sugar reaction that occurs from dumping syndrome there is a growing concern for those who are developing true RH 2-3 years post WLS. Studies show that the excess weight (pre-surgery) leads to an increase in insulin producing cells in the pancreas, so more insulin is being secreted. There are other hormones that are also heightened due to the re-routing of the intestinal tract with the RNY that also triggers an increase in insulin. In addition, the surgery is known to improve insulin sensitivity, meaning the cells are taken out of the blood more efficiently. So not only are WLS patients over producing insulin, it is being cleared from the blood at a much more rapid rate, leaving the “perfect” combination for RH.
So what do we do to prevent this unwanted issue from happen? Below are a few tips that can help maintain a steady blood sugar level and prevent RH from occurring:
- Interval eat! Several small meals and snacks throughout the day, every 2-3 hours while you are awake can help maintain blood sugar levels, in addition to reducing cravings for sweeter foods.
- Eat a well-balanced meals and snacks. Include lean protein sources and high-fiber foods (whole grains, fruit and vegetables).
- Avoid sugary foods, especially on an empty stomach. These sweet foods and trigger an over secretion of insulin, causing he blood sugar to drop rapidly.
- Avoid drinking alcohol, especially those with sugary mixers. Alcohol inhibits the liver’s mechanism in regulating blood sugar levels and can cause low blood sugar.
The following are steps you can take if you have a RH episode:
- Ever heard of the rule of 15? Take 15g of carbohydrates every 15 minutes until the blood sugar normalizes. This is usually in the form of 1/2c juice. Wait…but all that sugar even after WLS? Yes, even the American Society of Metabolic and Bariatric Surgery (ASMBS) recommend consuming 1/2 glass of juice (NOT the Light ones).
- Avoid choosing chocolate as a sugar source because it has a slower absorption due to the fat in it.
- Eat a balanced snack or small meal after the symptoms are gone to prevent the blood sugar from dropping again.