Posts categorized "Reactive Hypoglycemia" Feed

If you give my spouse a bowl of pasta.

I made pasta and plain homemade sauce for dinner.  Mr. MM ate a small bowl for dinner.  (Can't prove this now, I did not watch him eat.  Normally I do not.  Just understand that he is typically a reactive hypo just like me, not nearly as severe as I seem to have been, but... you never know with RNY do you?!)

So, if you give my spouse a bowl of pasta...

He will watch NCIS, fall into a carb coma, and he will pause it, talk about "conspiracies," and how he just needs some time to think something over. 

He gets up and sits in the other room in front of his computer, but does not use it.  He puts his head in his hands - and starts rambling nonsensical about work and his boss - but brings NCIS into it.  "You know when you think about a problem, and you figure it out?  But then, you forget what you were thinking about?"   Then he puts his head back in his hands.  He tells me not to leave the doorway.  "Wait.  Stand there.  I'll figure it out!"

I think he is serious, for a minute or three, and think he's losing it.  I ask him if something is going wrong at work, does he need help?  I tell him I think we need a doctor.  OMG.  What's the matter?  What happened?  Are you okay?  Did you lose your job?  Wait.

Then I realize, he's got to be hypoglycemic, he's acting like a fucking moron.

He starts to fight me on this.  He's "not low," I force him to jab, it's not that low, his body has started to come back, it's 65 mg. 65 is like, PERFECT!  Back on the job!

PASTA, a small bowl of PASTA!  Why doesn't this happen with all the BAD crap he eats?!


Photo - food blogging success - and a fail!

I'm crashing. 

That last photo post.  I'm shaking.  My blood sugar is currently 60-something and falling.  I ate a sandwich.  Protein + carbs + fat = usually does not do me in.  But tonight it did - perhaps because I had real sugar prior to it in the afternoon?  I don't know.  But, my brain no like this.  BOO ON LOW BLOOD GLUCOSE.  BOO.


Reactive Hypoglycemia Update

A tasty treat!

Weight - 150 lbs.  (This was the weight I was told to get to.  I'm here.  Now what?) 

It's been a long time since wrote about my hypoglycemia.  That may be because I am managing "okay," by eating "okay." 

What?

"If You Give A Beth A ________ (
insert simple carbohydrate or mixed meal) She's Going To Have A Low Blood Sugar."

517AH2E8BWL._SS500_

That goes for many of us post op gastric bypass-ers. 

It's just the way it is, it is just apparently normal, it's just reality.   

If you CHOOSE TO EAT LIKE SHIT - YOU WILL FEEL LIKE SHIT.

Yes, I think it's a choice.  After living with forced freakish guts for nearly five years, what I put in my mouth is my choice.  I can eat anything I want to.

Donuts IN YOUR MOUTH - Donuts in your BLOOD.  (Subsequently, donuts on my ass, too.  My weight chart is public.  Go look at it.)

For some post ops, it happens so frequently and requires the avoidance of simple carbs or mixed meals altogether if we want to live reasonably normal lives.  For an even smaller fraction, it gets so severe even with drastic dietary changes (nesidioblastosis) that these post ops often have surgery to fix it, but this can cause other problems.

Uniquely for ME, I'm already living "abnormally" since I have the additional issue of post RNY seizures- which are still not connected but happened at the same time - so - even if the hypoglycemia was making life hard, whatever, deal. 

Except, it's gotten better since I'm not being such an asshole about carbs.  I won't EAT a "donut."  I mean, sure I WILL, if it's laid out in front of me, but, it's more like eating around the top of it and throwing it away.  I don't purchase junk.  I try to be "good" because if I am not - I pay dearly for it.  My biggest hurdle is that I am married to this:

51ITnIVLOSL._SS400_

That isn't to say that I do not crash anymore - it's just less now than before.  Also, I don't test my blood sugar that often.  I can tell what my glucose is by how I feel.  I don't have symptoms of a low until I am super low, because I am usually at a consistent 70-100 most of the day until I eat.  When I do eat, I spike up over 100-150-200 even if it's something concentrated, and then I crash by 60-90 minutes post intake depending on what the food WAS - it could be as low as 30-50 mg.  Again, if I eat "right" I don't see that drop, I may only drop to 70 mg., and that is fine for me.


e coli licous!

Because, it's just my luck.  I would be the one to get the eColi that is in our water supply:  BECAUSE I DO NOT DRINK WATER, AND NEVER DRINK TOWN WATER.  (What it means to be from Maine, from a tap!)

And, who is the one with the sick stomach tonight?

<----- me.

I am sitting up hoping it's Just A Thing.   Just a passing RNY sort of Thing.

The announcement on the news tonight?  Don't drink it, don't bathe in it, don't do anything in it.

Is there a corpse in our water tank?

Adding this to the fact that one of my children has a flesh eating disease from that water-park they went to?  (Another post to come.)  I am a very happy girl tonight.

Update -  I am not dead.  I was up most of the night - not at all with running to the potty though.   

My blood sugar alarm (CGMS) was, ALARMING.  I did not maintain over 70 mg. at all overnight. 

It beeped, I would shut it off, it would alarm, I would disable it, then, it would vibrate, and I would jump out of the bed.  WTF?!  I cannot possibly eat all night long to persuade the gadget to shut the hell up.

Well, it did go over 70 mg. - it would "shoot" to about 80 mg. and drop back to the 60-75 mg. region.  I have to wonder if that might be something that happens to me if I am getting "sick" or while I am "sick,"  or if the meter is finally showing REALITY, because THIS IS WHAT I WAS COMPLAINING ABOUT.

DSC_0257


I think I may have my first real hypoglycemic event!

Throw the freaking confetti.  I have been waiting for this to happen while on the meter.

Mini-med.

My meter shows that in the last hour, I have gone from of 182 mg > 82 mg.

Now I am 80 mg, and I am sweating and starting to shake.  At this point, I am usually pacing and looking for my meter, fumbling around, usually not finding it.

This machine is 15 minutes behind, so I am probably at 70 mg or so.  I will go prick my finger, just to see, since I am actually symptomatic.

Yeah.  Finger stick is 68 mg.  The CGMS still says higher, at 78 mg, and actually has not alarmed me for a predicted low nor a LOW at all, and I am already in a LOW.  I cannot drive a car in this condition or operate heavy machinery, hell I can barely type.

Poke.


First day with the gadget.

First impression of the CGMS, because this is how I say things? 

I know why my insurance denied coverage for this machine. (Ungrateful bitch I am.)

Sure, it shows patterns, and graphs and Lots Of Useful Information, but, if you are GOING to quickly drop into a dangerously low level of blood glucose? 

YOU WILL NOT KNOW UNTIL 15-20 MINUTES LATER, it's got a delayed reaction time.

And, in my case?  I could already be convulsing on the floor.

Last night, as the machine was telling me that my RATE! WAS! DROPPING! DANGEROUSLY! FAST! 

I had already been eating real food for ten minutes.  I had no symptoms at that point, because I was already treating a low that I did not know I had.  Had I not been eating, and I let it go, by the time it got to a point where it showed me an actual glucose reading, it would have been very, very low. 

The CGMS does not replace a finger-stick.  When you have this gadget in you, the beep indicates you are already fucked up, and have been for about 15-20 minutes or more, and that's just my feeling in my very short experience.

I have hypoglycemia unawareness.  I am unaware of being hypoglycemic.  Yes, this will help me, but an after-warning is probably not what I need. 


My first alarm!

It scared the shit out of me.  After fussing with the meter, and trying to get it set up, it seems to be working right.

I sat down, just a few minutes ago, and the damn thing starts beeping at me.  "FALL RATE!!!"   Repeatedly.  Oh.  I'm crashing again. 

This is going to take some getting used to.  Not the crashing, the responding.  I'm used to the crashing.

Now it's screaming at me, "LOW PREDICTED!!!

(I was eating already, but, it's still telling me I am going down.)


Go-go gadget MM.

What do you do in the hospital?

Good news, seeing as Beth spent a week in the hospital having her head examined for seizures in January of 2008, we hit our deductible$, and this shiny new gadget sent OVERNIGHT after getting very angry on the phone (my appointment is tomorrow) was paid in full, and the pricker + tubing (totally the medical language I know) of which is going to be shoved in my abdomen tomorrow.  It's unfortunate that it took me more than a year to get to THIS point - but it's a START. 

What's next?  I wear this.  I look mighty hot while doing so.  I prove that eating carbs makes you DIE (DRAMA!) if you have a RNY. 

I probably have some testing done to rule out the fact that I also have a seizure disorder - concurrent to this glucose problem - that happens at EXACTLY THE SAME FREAKING TIME - but is not related.  (I know, WHAT?) 

OR, I find out somehow that it is related and I don't feel like a complete asshole for dropping into partial seizures for the last two to three years of my life and thinking it was all simply hypoglycemia, because I HAVE.

Mini-med.

DSC_0009


Medtronic Whine.

Okay.  So.  My CGMS visit is Thursday at The Joslin Clinic.  I have YET TO RECEIVE the CGMS.  I have called Medtronic three or four times now, and emailed, with no response.  The gadget was to arrive nearly two weeks ago by UPS.

I am really getting a complex.  And, can you believe how long this entire process has taken me?

In the are you fucking kidding me file:  I finally got through - she says that again - I need a letter of MEDICAL NECESSITY (Did we not already go over this, again, and again?!) from the doctor, and "Um, you don't have one."


CGMS is on the way. Now how to hold up my pants?

My eight week trial of the continuous glucose monitor is on the way, and should be here via UPS on Friday thanks to a very helpful woman at Medtronic, more helpful than my health insurance happened to be anyway.

Once it arrives, I am to literally "hook up" with an educator to teach me how to shoot myself in the gut and keep the sensors from falling out of my loose skin.  This is something I had not really thought about, my skin and the sensors.  Most of my excess skin is in my abdomen, and that is where the sensors are shown.  I hope they have alternate site placement.

Then,  off to Old Country Buffet

Kidding.

I have been doing really well lately, obviously while watching food intake, carb intake tends to go out the window first and those are what trigger the blood sugar the most. 

Sure, I still have major fluctuations and can't eat many normal foods (Do not give me a potato!) or any mixed meals (duh) I CAN eat a "low calorie and low carb diet" and not die.  But, my brain is still flip-flopping, and I would like to see if blood sugar is at all related to it, because I have been blaming glucose for so very long. 

I self-diagnosed since doctors wouldn't listen to me - and I called myself a "reactive hypoglycemic" a couple years ago. 

The seizures started after that in the form of complex partials, but have not been linked to blood sugar levels.

Do I think the seizure activity is related to my blood glucose levels?  I always have, but it's the what came first thing.  I just don't know.  I may never know. 

But, this trial of the continuous glucose monitor may give us insight - because it will show us a pattern of glucose levels 24/7.   

I will be able to track things for myself in conjunction with the graphs the meter saves:

  • the partial seizures (any blood sugar changes before)
  • any grand mal seizures (any blood sugar changes before)
  • reactive hypoglycemia (when I don't have symptoms, which is the reason for the meter)

I am only alloted an eight week use of the meter.  So, I was only half-joking about the buffet.  I need to sort of trigger events.  Life happens.  So what if I have been "Very Good" for the last so many weeks?  I nearly went comatose a few times in the last few months too, and on some occasions I don't see it coming.  I cannot base my entire future with a broken pancreas on six or eight weeks of being on a diet.

______________________________________________________________________________________

When hyperinsulinemic hypoglycemia persists, continuous glucose monitoring (CGM) can give a more precise picture of the individual's blood sugar pattern. The CGM system is worn continuously for three days. It contains a small catheter that is inserted under the skin to obtain blood glucose readings every five minutes. Results from the monitor should be compared to the patient's food and activity log for those days. Blood glucose that is always low, even during fasting periods, may more likely indicate a diagnosis of insulinoma, while postprandial hypoglycemia is probably reflective of more diffuse islet hyperplasia.

Figure 2
Medtronic CGMS System Gold

An MRI or CT of the pancreas is needed to rule out insulinoma if the patient is still symptomatic after the CGM and dietary changes. There is a case report of a 65-year-old woman who suffered repeated episodes of hypoglycemia after undergoing gastric bypass for continued weight gain. Her symptoms were misdiagnosed as dumping syndrome, and a CT and MRI, which located the tumor, were done only after months of dietary intervention. It is not certain that she had the insulinoma prior to her weight loss surgery, but it seems likely, as an OGTT prior to her operation revealed hypoglycemia. Resection of an insulin-secreting tumor can be curative. In this case, after surgical removal of the insulinoma she became symptom-free and remained so going on two years.9

Figure 3
Patient wearing Medtronic CGMS

Dietary Treatment
Diet should always be addressed first. Often patients will be able to recognize some of the foods that cause them difficulty on their own. Recommendations are to eat a high-fiber diet of three meals plus 1 to 3 snacks daily, to avoid simple sugars (such as juice, soda, and candy), and to include protein with most of the meals. Protein and fat slow down carbohydrate digestion and allow blood sugar to remain more stable. Soluble fibers, such as pectin, guar, and hemicellulose, act by forming a gel in the intestine, delaying gastric emptying and prolonging transit time. Dietary recommendations to prevent reactive hypoglycemia are summarized in Table 1. Hypoglycemic attacks are treated with pretzels, whole grain cereal, or plain graham crackers. It may take 3 to 6 weeks for the diet to take effect, but often dietary changes alone can decrease the incidence and severity of symptoms.

Medical Treatment
A handful of medications have been utilized to treat this condition. Unfortunately there is a scarcity of information available on use of medications for hypoglycemic patients who have undergone weight loss surgery. Medications called a-glucosidase inhibitors, such as acarbose and miglitol, work by decreasing the absorption of carbohydrates from the intestine by inhibiting the a-glucosidase enzyme. This results in a slower and smaller rise in blood sugar. A 78-year-old man experienced unexplained loss of consciousness (LOC) associated with meals seven years after partial gastrectomy due to gastric cancer. After OGTT, his LOC was blamed on late dumping syndrome and he was successfully treated with acarbose. A second study describes six post-gastrectomy patients treated with a-glucosidase inhibitors. The medication improved hypoglycemic symptoms in all patients, but side effects of flatulence and meteorism were problematic for one patient whose dose needed to be lowered.10,11

Diazoxide, somatostatin, and prednisolone are other medications that have been used to treat late dumping. Steroid treatment was successful in one case report of a patient who was suffering from post-prandial hypoglycemia after undergoing total gastrectomy with Roux-en-Y reconstruction for gastric cancer. After being found unconscious, this 51-year-old woman was treated unsuccessfully with both acarbose and diazoxide before successful treatment with prednisolone. She was on the medication for three years until she was successfully weaned. She has remained asymptomatic and off of steroids going on six years.12

Surgical Treatment
There is a role for surgery in cases of nesidioblastosis and insulinoma.6,13 The latter is considered curative, while the former has been shown to be helpful in alleviating hypoglycemia. Selective arterial calcium injections are used to identify areas of hyperplasia. This allows for guided resection of affected areas. However, there is controversy over how much pancreas needs to be removed, due to reports of symptoms returning after subtotal pancreatectomy. It is possible that total pancreatectomy will be necessary in some cases. It should be noted that even reversal of gastric bypass may be an ineffective treatment for this disorder.6,13

Conclusion
The incidence of hyperinsulinemic hypoglycemia following weight loss surgery appears to be low, but since increasing numbers of weight loss operations are being performed around the world, we must be on the forefront when it comes to recognizing and treating the side effects of these life-saving operations. The exact etiology of this troublesome condition has yet to be agreed upon. More research needs to be done to clarify the causes and most effective treatment strategies for this problematic disorder.

Bariatric Times - ISSN: 1044-7946 - Volume 3 - Issue 9 - December 2006 - Pages: 1 - 12


Just, WTF.

Medtronic called me directly last night while I was out walking, so I called back this morning.   I thought to myself, "OMG, they're going to send me the meter and just get this DONE straight from the Medtronic factory, how neat."  I figured they had gotten all the information forwarded along from the insurance and were hooking me up.  Because, the last contact I had with anyone was a random person in New Hampshire via email that asked me for insurance information for coverage of the CGMS and THAT WAS WEEKS AGO?!

I am very confused.  As it seems they are also.

This process is just a little bit more than ridiculous, although I am not sure who is making it so complicated.

I do not know why they are calling me asking me for a letter from my doctor now, "Why do you need a glucose meter?"  I just went through an EXTERNAL APPEAL twice for this machinery.  I got an approval from my health insurer  for a "test run" of the go-go gadgetry and you want to ask me for a letter explainin' why now?

The woman on the phone says, "Well, who did you speak to previously about the meter here at Medtronic?"

"Um, no one, ever? This is the first contact I've had with your company on the phone."

Oh.  She says she'd call back in an hour, because she's covering for someone whom I do have in my email as the Medtronic Representative that I was supposed to be dealing with, and doesn't really know what's going on.

So she just called back.  Apparently, the insurance company did not approve me for ALL of the components of this continuous glucose meter.  They only had codes in/approved me for JUST the transmittal unit, not the other two parts.  (How much sense this makes?)  They gave her a hard time and tried telling her that I "can't have" all of the system.

Now, she's back trying to get the approval codes for the sensors and other bits.  We shall see how long this really takes.

I love hypoglycemia.

"But, wait, you're not even diabetic, Mrs. MM?"


Wait, what?

My insurer called me today - to discuss the appeal.  They wanted to me to understand what this actually meant, and the costs it is going to incur.

Oh yeah.  I hadn't thought much about that.  I really hadn't.   

My co-pays, at 10% for everything I incur, the meter, plus each sensor which is replaced every three days at $300.00?  As she explained, I was only approved for up to six weeks of the system, so, then I would have to re-appeal, because BCBS only covers these meters for persons with diabetes or for 72 hour studies.   It wouldn't be a huge deal if I were to only use the system for a limited time, we could pay the $10.00 a day for a limited time.  But, it would get insane quickly, once the co-pays for the other medical bills starting rolling in.

She asked me about the meter, if I wasn't diabetic, why was I getting one - I explained that it was probably cheaper on Blue Cross Blue Shield than having my pancreas sliced out at this time.  She said she'd never heard of this condition, I explained that I was hoping I did not have it (nesidioblastosis) but if I DID, a continuous glucose monitor would help me feel safe.

She also stated that it seemed odd that I had gotten this far without further testing.  Well, I know.


Medtronic Continuous Glucose Monitoring CAR. (And more!) Dude.

I could use this, car.
Sugarcar
Of course, I'm busy appealing my insurance for the denial of a simple Continuous Glucose Monitor, but THIS?  This is a CAR!  A CAR I MIGHT ONE DAY BE ABLE TO DRIVE!  If my issues are ever linked to blood sugar changes (not currently related - just coincidental that I have seizures AND I am a  reactive hypoglycemic) this kind vehicle is so freaking cool.

Medtronic says:

Medtronic Diabetes unveiled its new M-POWERED concept car at this year's American Diabetes Association (ADA) annual meeting in San Francisco, June 6-10. The M-POWERED concept car would allow a person with a continuous glucose monitor (CGM) device to receive readings of their blood sugar through both audio and visual cues from the car's dashboard.

I assume this means that the car would actually announce to a person like me, maybe in a nice English accent, like the navigation systems in many cars to:

PULL OVER! YOUR BLOOD SUGAR JUST DROPPED FROM 100 to 35!

This would be necessary, because, when my glucose is that low, I can't comprehend much - but a audible sugar level would enough to make me take action.
3534car1
Fun, fun, fun.  Till the hypoglycemic seizure patient crashed her truck and has to walk to the store.  But whatever.

But, wait, there's more -

The CGM car is a concept application of our overall connectivity strategy, and our quest to apply our existing technologies to new platforms," said Steve Sabicer, a spokesman for Medtronic. "Although we don't plan to commercialize the automotive application immediately, we are exploring ways to link our therapy to other products ... like cell phones, bedside monitors and hand-held devices in the next 18 to 24 months."

Source.  http://www.medgadget.com/archives/2008/06/mpowered_car_for_diabetics.html