Posts categorized "Reactive Hypoglycemia" Feed

White rice raises risk of type 2 diabetes

Super!  Although, we knew this, didn't we?

Scientific American -

White rice joins the growing list of refined carbohydrates with links to increased risks for diabetes, according to a new large study that quantified odds for consumers of white rice—as well as brown rice.
  White_Rice_100_Grade_B

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How to pass out!

Eat about 3/4 serving of instant grits.

I thought I would avoid the carbohydrate coma by adding protein and fat, but, it was a big fat fail.  I ate the grits with crumbled bacon bits and light butter at 11am, and had to lay down and was out of it until about 2pm.  

Good times.

Yes, I know better, yes, I have eaten this same food at least 5-10 times before with the same result, but I thought THIS TIME IT WOULD BE DIFFERENT!  THIS TIME!  BACON WOULD MAKE IT ALL BETTER!  HA.  My body says FUCK THE BACON, I WILL SHOW YOU!

Newbies, close your eyes:  Tell me this, I can eat and ENTIRE BLOCK OF RAMEN NOODLES WITH ZERO RAMIFICATIONS?  But, 1/4 cup of GRITS sends me to bed?   I puffy heart love my WLS!


A Low Blood Sugar Scenario Explained

This sounds eerily FAMILIAR, and although myself and many of my post gastric bypass peers DO NOT HAVE DIABETES, we DO HAVE HYPOGLYCEMIC EVENTS that mimic the following story.  BE PREPARED, AWARE, AND PLEASE DO NOT DRIVE INTO TREES, oncoming traffic, the wrong side of the highway, etc.  I've done enough of those things for you.

(While I have NO idea if hypoglycemia had anything to do with my latest wreck, it could have been the trigger of my seizure.  We will never know.)

  DSC_8502

From Diabetes Health - 

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50 mg.

BananaImage via Wikipedia

...after splitting one half of a homemade banana muffin and adding light cream cheese?

I am at 50 mg blood glucose and wanting to fall on the floor.  (Yes, I dealt with it.  I am waiting to get back to normal.)

But, I "failed" the blood testing after eating a donut.  This stuff really blows sometimes.  This is what I am talking about.  

  • I can't even put together a sentence right now.
  • Confused.
  • Dizzy.
  • Shaking.
  • Nearly fell up the stairs.
  • Couldn't work the glucometer.
  • Sweating now.
  • ...about to be STARVING.
  • Inhaling glucose.
  • Two no sugar added popsicles, I am so sweaty.
  • And a few bites of chicken.

HALF of a banana bread muffin.  HALF. 

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I failed my test.

I failed wait, it's a good result, actually, if that makes any sense for my mixed meal blood testing.   Picture 89
I picked a DEFINITE TRIGGER FOOD - a glazed cake donut - and ate as much of it as I felt comfortable eating without dropping dead.  Someone on Facebook asked:  "Why would you do that to yourself?"  Um, because, it's a DEFINITE TRIGGER FOOD.  I WANTED A REACTION.  I wanted my blood sugar to DROP DRAMATICALLY LOW.   I don't make a habit of eating donuts, even if I post about that kind of thing, often.  (It's usually just to piss you off.)

  Homer-donut
 My blood sugar went from 80 > *ate a donut* > 193 > 67.   IN THREE FREAKING HOURS.  That's it?  That's all you have?

I drop to the 30's when I eat cereal.  I am less than impressed with my body today.  The cut-off for this test is 55 mg. of blood glucose.  I never dropped that low, CRAZY!

The endocrinologist suggested that it's possible that a single food, a single time, while sitting and not doing anything isn't enough.  Had I been home, cleaning house, out walking, or had eaten in a pattern, I'd likely have DROPPED INTO A COMA.  (My words.)  

I often drop on much less, much, much quicker.  

This was the longest three hours of my life.  At least this time, I did not shit my pants, or have a seizure. 

I guess it wasn't a total fail.  (I mean, I passed.  My body did the RIGHT THING.)  LOL.

The treatment is the same, regardless, since I still have a serious problem.  Dietary controls and medication.  I am not seeking further pancreas testing at this time, it doesn't look like I am dealing with an insulinoma that would be removed surgically.

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Hyperinsulinemic Hypoglycemia Following Gastric Bypass - Testing

by Mary-Elizabeth Patti, MD 
via Joslin Diabetes Center, Boston, MA

(I captured the slides from a PPT presentation, there's lots of juicy information in there.)

I am headed to Tufts for a Mixed Meal blood lab on Wednesday.  

This means, I have to eat something that I know will trigger me into a low.  

That's easy as pie.  Err, not pie, but likely two frozen waffles, or a cup of Kashi, or a half stick donut from Dunkin' Donuts.  Those are known assailants.  The endocrinologist wants to prove that I will drop under 50-55 mg after a "mixed meal."

You may recall I did this EXACT TEST a few years ago, with a liquid meal, and I did not get very hypoglycemic, though I got horrifically sick to my stomach and had partial complex seizures.  (Which were undiagnosed at the time, because I thought it was "hypoglycemia.")

(But, I am glad to do it again, to prove that it still happens, it's OBVIOUSLY A PROBLEM, and that it could very well be the cause of why MM has had several car accidents and countless seizures even if MD's believe that hypoglycemia is the trigger of anything.  That's just MY theory 'cause I live in this body.  But, to be frank, it makes me a little sick to think that, "What if I was right?  What if I find out that these seizures ARE because of the blood sugar, and nobody listened to me?"   

I'm over here swallowing 11 anti-seizure pills, and the neurologist twice has suggested brain surgery.  Yeah, you didn't know about that.

One hour after 1/2 c Kashi and 4 oz sugar free pudding. Thumbs up.

PS.  You know, I am reading back into my archives, looking for those trigger meals?  With the photos, and I realized, I don't test much.  I am so medicated, that I rarely "feel" lows until I am cuckoo.  

I don't eat poorly enough to GET that low, either, but I'm not pricking my finger, because when I feel out of it, I'm OUT OF IT.

PPSS.  Or whatever.  I pricked myself now- because - I am a little edgy and pacy - one of my early signs that I should probably test because I am either going down or will have a seizure.  Three strips later, and three error messages?  LOL.  Nevermind.

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Climbs out of a coma with a question.

 Nowihazsugar128638019866427462
 It's a few days into spring vacation.  The kids have had sleepover guests, and although last night it went "well," today my daughter wanted to make "something" with her girl friends. 

She found all the ingredients for simple sugar cookies and went at it. Although, I must admit, we were out of vanilla, and we subbed some flavor drops. ;)  I did attempt to talk them into doing something else -- but they like to cook -- and I couldn't think of anything else to make that they'd do alone and without a huge mess.

I am now coming out of a full-blown COMA.  Not a dumping, not a little queasy, a FUCKING COMA. 

I sat down in a chair, and my eyes shut.  I laid on a blanket on the floor.   I tried to "sleep."  I got jumped on.  "Sssh!  My mama's dot a bewwy ache!"

Frankly, if there weren't two additional kids in my house right now?  I would go to bed.  <I saved the post and came back to it later.>

Many things, I can tolerate.  I cannot tolerate BUTTER SUGAR COOKIES.  Why did I has cookies? Because, they were there, and there were warm.  I ate two and I died.  

I always have a warm cookie from the oven if someone else makes them.*  

And, if it's MACAROONS?  I'll take some home, if it's BAKLAVA?  I'll pay for it, like, I mean, how much DO YOU WANT FOR IT?  

READ THAT AGAIN, I AM A WARM COOKIE EATING WLS FAILURE.  (That's your next blog post.) *Unless, of course, they are raisin, because WTF raisins?  EWW!

MM never makes them much of anything on her own fruition.  It's just not worth the effort anymore for ME to make cookies, because I would lick the spoon and pass out in the oven.  I can't even make macaroni and cheese without getting sick.  I will eat some cheese while I am grating it and then, two bites of pasta, and I'm in the chair while it bakes, waiting for death.

Eating is simply a game sometimes.  I have had much, much stronger poison than two pissy little cookies. The reactions really ARE amazing when they are SO DRAMATIC.  

PS.  Someone asked on my Hypo after WLS group:  

"Why do you keep junk food in your house if you are prone to eating it and subsequently getting sick or gaining weight? I read this type of comment a lot and honestly don't understand why you do this to yourself. Just don't buy it."

Um.  Well.  I live with five other people.  

My short answer was basically that I cannot be The Parent to my Spouse, who tends to be the one who buys ANY/ALL "junk" food.  That's it.  I don't need the fights.  

I have spent YEARS throwing shit away, and I still do.  

Thankfully, he has cut it down to a less frequent practice.  But, when stressed, he will come home with food. He works in a bank inside a grocery store:  and is surrounded by food ALL DAY LONG.  

 1244303943grocery_bag1
 
The other day, we got a letter from the IRS.  

"Hi Mr. + Mrs. MM, There Was A Mistake, You Owe Us Many Dollars."  

He came home with two bags of Goldfish Crackers, one empty, a cornbread, a coffee, and a donut.  I have no control over him, his shopping and his habits.  

"Why do I keep it in my home?"  

I don't.  I haven't.  I try not to, at least.  I try not to spend my grocery dollars on food that might keep me running to the cabinet.  

Because of this?  There IS a short list of foods that I truly WILL. NOT. BUY.  and on it are things like, potato chips.  I cannot be trusted.  I will eat them.  They will eat me right back.  Other things?  Ice cream. 

"But, OMG YOUR KIDS?!  THEY DON'T GET ICE CREAM!?"  Nope.  Sorry.  Not in my house.  Believe me.  They're not missing out.  We are all still overweight, without ice cream, potato chips, Cheetos, Fritos, packaged cookies, sugary cereals, etc.  

And, you know what?  Playing food popo has backfired quite a bit in the last seven years.  Just saying.

And, because of my Extra-Special-Guts?  I can have the same reaction from a POTATO or PLATE OF LETTUCE as you might expect from a bowl of ice cream!  Even if I keep all the naughty foods out of my house, I may get sick on GOOD, WHOLESOME foods.  

Because Gawd knows I could use more food guilt.

I mean, sure, the answer to happy hypoglycemia may lie in eating nothing but meat and cheese seven days a week or a glucose bag dripped directly into my remnant stomach, but then?  I'd probably buy Cheetos just to lick them.

And, you?





Blood in an elevator.

Long ago and far away, and repeatedly on this blog, I have had to Stop, Drop And Food Journal.  

If you give Beth some sugar? She's going to need an ambulance.

I know food posts are likely The Most Boring Posts To Ever Read, and sometimes (honestly) will scare the bejeezus out of newbies at weight loss surgery (which is part of the reason I fail to share my intake here much anymore) because "Holy shit, you can eat HOW MUCH?"  

One hour after 1/2 c Kashi and 4 oz sugar free pudding. Thumbs up.

In fact -- going back to my OWN archives -- it shocks me how little I ate at times.  I would give my pancreas, and temporal lobe to get that feeling back.  Or, alternatively?  $10,000 for a band on my pouch.

after I eat.

I know it's not out of the range of what is normal for my stage:  other similarly ranged post ops can eat like I can --- many -- much, much worse and in much larger quantities.  But still, seeing my old posts with "half a protein bar," and "half a cup of cottage cheese" makes me want to poke my eyeballs out.  And, before THAT, with the bite(s) of food being enough.  

After dinner.

HA. I have to keep a journal, at least for a bit, for the endocrinologist.  (He's reading. Hi there.)  I have to journal intake and reactions via blood sugar.  I used to do this quite often until I got flustered with the fact that it was pretty constant, and that I couldn't differentiate, and that I sort of live in a consistent state of hypoglycemia or feeling like it's on the way.  Add in the seizures, which have similar or identical symptoms - I gave up.  It is tiring.  Eat, crash, eat to fix, crash, eat, crash, eat...

44.

So, you are likely to see a week or six of food logs with blood sugar readings.  Good times ahead!

Today -

Weight - Yeah, you can shove it.  You're not having that.

  • 6:30am - 10:30am - Coffee + Diet cocoa packets + 2 ounces light soymilk 
  • Blood sugar 10:30am - 91mg
  • 10:30am - 1 cup tofu/wakame in 16 ounces miso broth
  •  Cubed Tofu
  • 12:30pm No sugar added fudgsicle 
  • 1pm - Light mozzarella cheese stick
  • 2:30pm - 2 slices light wheat bread, Boars' Head Roasted Chicken, Mayo (Gave the last three bites to the dog.)
  • 3pm - Coffee + diet cocoa packet, Sugar free Red Bull.  (I'm dying over here.  Body wants to go night night.)
  • 6:30pm - 6 chicken nuggets, some fries
  • 8pm - Coffee


The Pancreas Journey Part Whatever.

I just spoke with the endocrinologist, who got my files from the Joslin Clinic from 2007.  It appears the testing did not point to insulinoma back then, as I did not have a low blood glucose after the mixed meal testing.

It is obvious NOW that during that test, I had at least two seizures  Uh, DUH!?  (Remember -- I whistled and asked for sugar?!)  BUT - NO OFFICIAL LOW GLUCOSE LEVELS.  

And, in the test after THAT, I had another seizure, and NO OFFICIAL LOW GLUCOSE LEVEL.  

So, apparently glucose TESTING triggers me into seizures.  (Um, WTF?)

The endo wants to do it again.  Seizures, FTW.  But this time, I am on double seizure meds, and he says he will have Ativan on tap.

And instead of giving me holy diarrhea with drinking a sugar laced drink -- I can simply eat a meal that is certain to cause a crash and burn.  (Open to suggestions!  But, I think am leaning toward the obvious no-no foods that do it, that "two waffles with sugar-free syrup" meal, or something like it.)  The goal is to see a level of under 55 mg with high insulin levels.  I *should be able to pull that off, considering, it happens constantly?!

For now, he's put me on blood pressure medication.  What?  Apparently: "Theoretically, calcium channel blockers are capable of inhibiting insulin secretion."  

Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose.

Moreira ROMoreira RBMachado NAGonçalves TBCoutinho WF.

Obesity and Eating Disorders Group (GOTA), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione/Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB), Rio de Janeiro, Brazil. rom_br@yahoo.com

Comment in:

Postprandial hypoglycemia is a common complication of bariatric surgery. It is usually caused by late dumping syndrome, but a few other causes have already been described, including insulinoma and noninsulinoma pancreatogenous hypoglycemic syndrome (NIPHS). Considering that NIPHS is a recently described syndrome and is also very rare, therapeutic approaches are still not consensual. We report the case of a 26-year-old woman who was submitted to bariatric surgery and presented episodic postprandial hypoglycemic episodes after 16 months. Fasting C-peptide, insulin, and glucose were normal. Because of the possibility of NIPHS, clinical treatment was initiated with verapamil and acarbose, leading to a significant reduction of hypoglycemic episodes and also their severity. Surgery is the most common approach to NIPHS. However, in cases of mild or moderate symptoms, it is important to consider the possibility of pharmacological treatment. This approach may result, at least for some time, in an amelioration of symptoms without the need of an aggressive procedure.

I will start taking Verapamil at a low dose, which scares me a bit, I mean, it is a blood pressure medication.  So if I stand up and fall back down, you'll know why.File:Recovery position.svg

PS.  I just had a little heart failure going back to my own archives and reading how little I used to eat.  Did I have WLS or something?  WTF?


No fasting.

I spoke with the endocrinologist today -- he says that he did some research over the weekend and decided that the three day inpatient fast is unnecessary -- that some of the original studies of post gastric bypass insulinomas and nesidioblastosis cases were identified with shorter simpler tests.  Some, of which I have already done, at least partially until I had a seizure.  

One, in particular, a mixed meal study.  So, I'm off the hook for the fast -- and perhaps can simply re-take a mixed meal study where an episode of low glucose and high insulin must be recorded after ingesting a carb/protein/fat combination.  If that is positive, then we can simply move on to other testing, perhaps an MRI, and other more invasive tests if necessary.  

The point is, I want to RULE OUT the nesidioblastosis.  

This really isn't ABOUT my damn pancreas, I'm trying to save my brain from further damage if it's related to consistent low blood sugar.

Now, that said, the endo did say that if I test positive for this -- he won't treat it.  They've not dealt with a post gastric bypasser with this condition.  He suggested going back to the Joslin Clinic, and we can manage with medication, diet, etc... or surgery.  Although surgery is hardly helpful ... and can cause further problems.

Clear as mud, I know.  But, it's progress.


How to REVERSE Severe Hyperinsulinemic Hypoglycemia after Gastric Bypass?!

A tube.  

McLaughlin TPeck MHolst JDeacon C.

Stanford University School of Medicine (T.M., M.P.), Department of Medicine, Division of Endocrinology, Stanford, California 94305-5103; and Department of Biomedical Sciences (J.H., C.D.), Panum Institute, DK-2200 Copenhagen, Denmark.

Context: Severe hypoglycemia after Roux-en-Y gastric bypass surgery (RYGB) is an increasingly recognized condition, characterized by neuroglycopenia and inappropriately elevated insulin concentrations that occur primarily in the postprandial state. Both pathophysiology and treatment of this disorder remain elusive, but it has been postulated that hyperplasia and/or hypertrophy of beta-cells due to morbid obesity and/or postsurgical nesidioblastosis may contribute. 

Objective: The objective of this study was to elucidate the pathophysiology of this condition; specifically, we hypothesized that metabolic abnormalities were a function of altered nutrient transit through the gastrointestinal tract rather than anatomical changes to pancreatic beta-cells that would lead to consistently high insulin secretion irrespective of nutrient transit route. 

Design/Setting/Subject/Outcome Measures: We describe a unique case wherein gastrostomy tube (GT) insertion into the remnant stomach reversed neuroglycopenic symptoms. This subject was admitted to a university hospital research center for standardized measurement of glucose, insulin, and incretin hormones including glucagon-like peptide-1, gastric-inhibitory peptide, and glucagon. 

Results: Standardized liquid meal administration via GT vs. oral route demonstrated complete reversal of severe metabolic abnormalities that included hypersecretion of insulin and GLP-1. 

Conclusion: Post-RYGB hyperinsulinemia and hypoglycemia result entirely from altered nutrient delivery rather than generalized hyperfunction of beta-cells due to presurgical hypertrophy/hyperfunction or postsurgical nesidioblastosis. These findings support the use of GT for treatment of severe cases and have implications for surgical manipulations that may reverse/prevent this condition.

PMID: 20133462 [PubMed - as supplied by publisher]


Weight-Loss Surgery and Type 2 Diabetes Is bariatric surgery a shortcut to a "cure"? (Also, Beth's in a magazine!)

I've pasted just the snippet that I'm in - the entire article which is super-informative - is at the link!  Please check it out and subscribe.

Weight-Loss Surgery and Type 2 Diabetes Is bariatric surgery a shortcut to a "cure"? 

Diabetes Forecast Magazine March 2010 -

 V63n03_p46b_1

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A glimpse.

I have a faint recollection of a problem this morning.

This is my brain on normal, right now, I'm all there.

This is my brain on SWOOSH:

 Picture 36
I POSTED THAT to a message board.  POSTED.  

Typically, I just SAY IT out loud and pace around the house during a brain lapse/low blood sugar/seizure (I don't know what it is.)  

I did not have low blood sugar, THAT is the EXACT swooshy broken brain thing my brain DOES every few days.  I have suggested at times that it's due to a rapid DROP in blood sugar, but I can't test it when I am typing or speaking nonsense!


Be Aware of Blood Sugar Post Gastric Bypass - Looking for participants! Go ye of low sugah!

I hate it when I see something like this, that is good and helpful and all that, and I say, "OH, REALLY?"

UC HEALTH LINE: Be Aware of Blood Sugar Post Gastric Bypass

CINCINNATI—People with type 2 diabetes who have gastric bypass surgery often leave the hospital without the need for previously prescribed diabetes medications. 

Researchers and doctors believe this health benefit is related to changes in the body’s circulating hormones—particularly an increase of insulin secretion. Insulin is the hormone that controls the level of glucose (sugar) in the blood. 

Marzieh Salehi, MD, a diabetologist with UC Health University of Cincinnati Physicians whose research is focused on the effect of weight-loss surgery on glucose metabolism, cautions that although there can be huge benefits for diabetic patients who undergo gastric bypass surgery, a group of patients experience severely low levels of blood sugar (hypoglycemia)—especially following a meal and typically several years after surgery. Symptoms of hypoglycemia often aren’t recognized until they become debilitating or life-threatening.

Salehi says that many patients with type 2 diabetes who qualify for gastric bypass surgery rely on anti-diabetic medications like insulin injections to regulate glucose in the body. These same patients often leave the hospital following surgery with normal glucose control without taking any medications. 

“It’s possible,” says Salehi, “that gastric bypass increases gut hormone secretion or nervous system activity, which in turn increases insulin secretion and improves glucose metabolism in a majority of patients after surgery.

“However,” she adds, “there is a population of gastric bypass patients who, following surgery, develop high levels of endogenous insulin secretion, resulting in dangerously low glucose levels, or hypoglycemia. These glucose abnormalities due to too much insulin secretion represent an extreme effect of gastric bypass surgery.”

Salehi, who sees weight-loss surgery patients with glucose abnormalities at the UC Health Diabetes Center, says symptoms of hypoglycemia include shakiness, sweating, dizziness, light-headedness, weakness, confusion and difficulty speaking. More severe symptoms include seizure and cognitive abnormalities. Hypoglycemia can be life-threatening without proper monitoring or treatment. 

“If hypoglycemia goes unnoticed, the body can become accustomed to low sugar and patients can then lose their awareness to low sugar. It is essential to seek help if any of these symptoms develop after gastric bypass surgery.” 


Salehi is currently conducting a National Institutes of Health-sponsored study to determine how glucose metabolism is affected by gastric bypass surgery. For more information, call Leslie Baum, registered nurse and study coordinator, at (513) 558-0201.

To schedule an appointment with the UC Health Diabetes Center, call (513) 475-8200.


Ah-ha.

I have this "Oh shit, I am going down!" feeling where I stop what I am doing and head for softer pastures.  

What does it feel like?  

Ears ringing, trippy in a bad way, visually fucked up.  

I ALWAYS CALL IT A SEIZURE.

Today, I grabbed a glucose meter on the way down.  Usually I cannot function well enough to prick and bleed.  I did this with a lancer thingie and no holder.  JAB.

 Photo 1
Twelve grams of glucose later I can function enough to type this. 

HOW IS THE SHIT NOT RELATED, huh?  HUH?

Oh, since that will be a comment:  What did you eat?

  • Breakstones' Cottage Cheese 1% 1/2 cup - 90 calories
  • 1/2 serving multigrain cheese puffs - 65 calories

SIXTEEN CARBS.  SIXTEEN.  Insane.  It's not like I ate a FUCKING DONUT.

PS.  Yes, I bought a "Side-Kick."  Review to follow I guess.


This, just within an entry in my "seizures after WLS" survey: 'By the way, my surgeon claimed that he'd never heard of anyone suffering hypoglycemia after WLS.' 

Are you kidding me?


From the "DUH!" Files: Low blood sugar may impair diabetics' driving

Oh, really? Hypoglycemia can mess with your driving? HA. I swear I didn't hit another car before and not really remember it until I tested my blood sugars in the 30-40 range. Nope.  The PCP told me it was impossible.  In fact, told me I was crazy, go see a psych!  

Click to increase -

Picture 41
 

That said, if I were to wait for a 90 blood glucose, I may never drive.  Or never eat.  Whichever came first.  the roads might be safer that way.

 Picture 42