Saturday, January 5, 2013

Bariatric Betty starts 2013 with Reactive Hypoglycemia

Scary.  That's how I can sum up my first (and hopefully last) experience with Reactive Hypoglycemia.  Reactive Hypoglycemia occurs 1 - 2 hours after a meal and is when your blood sugar plummets.  It's a complication some post-bariatric patients get about a year out from surgery, and apparently I am part of that group.  Non-WLS people can have experience R.H. by eating very high carb unbalanced meals, or by diabetics injecting themselves with too much insulin.  Studies have shown that starting 6 months post-op the pancreas of WLS patients (particularly the gastric bypass patients like myself) have a big increase in insulin reactivity.  One study I read said that the reactivity increases 20 times normal (duadenal switch and gastric sleeve WLS patients had a 6 time increase).   It's part of the same mechanism that reverses our diabetes with surgery, but in overdrive.

So, what happened?  Last night I made homemade black bean soup from a bariatric-friendly recipe, and had a bowl with some cheese sprinkled on top for dinner.  I also ate 1/4 of one serving of a baguette, a rare grain "treat".  I had eaten the black bean soup acouple times before as part of a meal - eating 1/4 of a serving along with 3/4 serving of my favorite lentils/onions/ greek yogurt/ cheddar cheese dinner.  Then about 1 1/2 hours later I went to the gym and hopped on the treadmill, because I hadn't gotten my 10,000 steps in for the day yet and it was TOO COLD to go walking outside.

Looking back, my first clue that something was wrong was that about 20 minutes into the walk I realized I was sweating.  Sweating?  From walking?  Ridiculous - I jog 5ks now, why would walking for 20 minutes make me break out in a sweat?  I decided that the gym must have bumped up the thermostat, and since I was on the top floor I was just getting an extra dose of heat.  I was trying reading while I was walking and I started having trouble reading at about the same time.  Of course, that wasn't how I was thinking of it then - I thought "Wow, suddenly the light reflecting off the screen of my Kindle is making it hard to see the words" and "Huh, I'm losing the thread of this chapter - maybe I shouldn't try reading while walking, I'll just turn it off and watch the TV.  Then I started feeling a little clumsy and irritable.  My brain started to signal "Hey, maybe you've done enough" at about 27 minute, but I thought "Nah, just 3 more minutes..."  By the time the 30 minutes was up I was definitely not feeling great. I felt light-headed, sweaty, and when the machine tried to add an additional 5 minutes of cool down walking I got mad.  I got mad at a treadmill.  Yeah, they should list that among symptoms - if you start to fume at inanimate objects, you might want to check yourself for hypoglycemia. 

Compare this to how I usually feel after a 35 minute jog - warm but not sweaty, sharp, and pleased with myself.

So I went down the stairs carefully because I felt a little dizzy.  "Must have not had enough water..." I thought.  So I drank some and headed into the basketball courts where my kids were playing.  I saw my one son, but didn't see my other son.  Then I realized that the other son was standing next to where my first son was sitting - weird, how did I miss that?  My younger son wanted to stay, so I went to sit down.  Then my older son said he wanted to get home and I agreed.  By this time I had decided that I must not have had enough protein that day.  I had only logged my breakfast so far (15 grams of protein), and had a Quest bar for lunch (20 grams) and I knew that the black bean soup wasn't as protein dense as lentils... yeah, that must be it, I was low on protein.

For my non-WLS readers, most adults only need about 45 grams of protein a day.  Post-bariatric surgery we aim for 60 - 80 grams.  Our bodies metabolise things quite differently, and having to live on great reduced calories requires a large protein load to reassure our bodies that we are not - in fact - starving after having been shipwrecked on a deserted island (in which case our bodies would start to consume it's own muscle tissue in addition to fat, BAD). 

So I called my husband as I started the drive home, explained I was low on protein and not feeling great, that my 12 y.o. was complaining of being lightheaded as well (meanwhile he started telling me from the backseat that he wasn't lightheaded and never said that). My younger son backed me up saying that my older son HAD said he was light-headed, but at this point I realized that I wasn't even sure what he had said any more, because I was feeling confused and irritable.  I SHOULD have realized "That means you shouldn't be driving, dummy!" but I didn't.  Luckily we got home safe and sound.  My hubby was waiting in the driveway with some cheese for me.  I ate half of it and started making some popcorn for my son.  I finished the cheese, had 2 cups of popcorn and went online to log the rest of my food for the day. 

Wow!  I hadn't realized that the disparity between the protein in black beans and lentils were so huge.  I always try to eat between 20-23 grams of protein in a meal, and apparently even with the cheese on top, I had only had 11 grams.  I ate another 1 1/2 ounces of cheese to bring me up to 60 for the day.  My overall calories had been low, too.  Good thing I had eaten some popcorn (I had no idea how good until this morning).  OK, everything looked better.  I signed off and went into the other room to sit with my family while they watched TV.  Within 15 minutes I fell sound asleep.  My husband woke me up and walked me upstairs to bed.  I had horrible dreams about feeling confused and thinking I was having a TIA (mini-stroke).  It wasn't that far off.  My brain was being glucose deprived. 

This morning I woke up feeling much better and something clicked.  Reactive Hypoglycemia.  I went online and reviewed studies and articles until I was sure.  It wasn't just lower protein, it was lower protein mixed with higher carbs (although not enough to make me dump) and then working out (even though it was low intensity) two hours afterwords - which is right about when my blood sugar plummetted.  I rushed through the low level and landed in moderate hypoglycemia and luckily had the popcorn and cheese before it got to severe (which includes seizures, unconsciousness, and potentially death).  If I hadn't eaten the popcorn it might have been worse.

To treat hypoglycemia you eat a small amount of carbs paired with protein (in my case, cheese and popcorn).  Non-WLS people might drink juice or eat a small amount of candy to boost up their blood sugar short term until the protein kicks in, but in gastric bypass patient that will cause a potential dump and a larger blood sugar crash shortly after, putting them in greater danger.  In non-WLS someone might have hypoglycemic symptoms after not eating at all for a long time, or about 1-2 hours after eating a huge amount of carbs (like 120 grams) and no/ low protein.  I ate about 30 grams of carbs, but only 11 grams of protein and BAM!  Lessons learned... whew. 

A big thank you to all my WLS friends who have written and talked about their experiences with R.H. - it was remembering your experiences that helped all of this make sense his morning. 

One fun/ funny experience to share - I was on Zappos' Facebook page and saw joint contest with Delivering Happiness and where you shared a 15 second video of what or who inspires you for a chance to win a $500 Zappos gift card.  SWEET. I need new waterproof snowboots, and had been wrestling with whether or not I can afford some nice heck - that could be several pieces of new clothing!  So, I made the video about how my Weight Loss Support Group inspires me and posted it, checking the box that said "only you" can view this on your timeline.  Imagine my surprise when my friends started commenting on it!  Great comments, too - saying I was cute, adorable, and my favorite "HHHHOTTT!"  What a great reminder that in our internet world, just because it says something will not be seen doesn't make it TRUE!  I'm so grateful for the support of my family and friends, and grateful that the thing that inspired me wasn't embarrassing or "private" in any way.   Here's hoping I win the gift card!

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