Nov - Dec 2021

Reactive Hypoglycemia

By Kathy Scott, RN



Have you had a gastric bypass and ever experienced dumping syndrome? If you have then you know the heart racing, sweating, cramping, nausea, and those other symptoms that make you feel like you want to die? Did you also feel light headed as if you may pass out? You may have not only experienced dumping syndrome but also a hypoglycemic episode (low blood sugar) as well. This usually effects gastric bypass patients 2-3 years after surgery and may not be diagnosed due to spontaneous recovery. This can be dangerous for the patient because extremely low blood sugar can cause loss of consciousness (passing out) and/or seizures.


The body’s reaction to carbohydrates can cause the onset of hypoglycemia. Since these episodes are directly related to eating, the reaction usually occurs from 90 minutes to up to 2 hours after a meal. The drop in blood sugar is due to large insulin response to carbohydrates as they are rapidly digested and dumped into the small intestine. This reaction is not usually experienced by a band patient because their anatomy has not been changed. Research thus far indicates that the increase insulin secretion may be due to the body’s failure to adapt to the massive weight loss. In other words, the body is reacting as if no weight loss has occurred. Because of the unaided recovery of the patient, these episodes are rarely diagnosed and can be frustrating for patients. The good news is that most of the time these episodes can be controlled by the combination of foods and an increased frequency of meal consumption.


The best way to combat these symptoms initially is to go back to many of the principles that you observed right after surgery which include small frequent meals (4-6 oz) that consist of a low-fat protein source and a high fiber carbohydrate. Simple carbohydrates such as refined starches should be avoided. By increasing the frequency of meals, every 3-4 hours, blood sugar levels remain more constant thereby decreasing the risk of a hypoglycemic episode. Choosing high fiber foods will also help by slowing the digestion time of the food ingested giving more time for insulin levels to peak and blood sugar levels to stabilize.


Of course, the most important thing to do is follow up with your surgeon and dietitian. If diet changes alone do not combat your reactive hypoglycemia, further testing may be needed to help alleviate these symptoms. Your surgeon may order a glucose tolerance test. After drawing a blood sample for a baseline reading, you are given several  ounces of a simple carbohydrate to drink. Blood is then taken at pre-determined intervals to measure your insulin reaction over time, typically 3 hours. The surgeon may also refer you to an endocrinologist for further evaluation.


Always remember to follow up as prescribed by your surgeon and program. Many times the best way to fight these stumbling blocks in the journey is to identify them before you fall. Be sure as your diet advances, you continue to make appropriate food choices.