[DocSanae]

Since a "what is dumping?" Q came up in another thread, I am posting the explanation here, instead of the original thread, so anyone interested can read this outright, instead of discovering it only after reading a seemingly unrelated thread.

Many of you experiecne "dumping" post op with certain foods.
The symptoms are often abdominal pain, vomiting, feeling of nausea, weakness, dizziness, cold sweat, and palpitation among others.

Now, dumping is not unique to WLS patients. Actually it can happen to any person who has had gastroenterostomy--operation that removes part of one's stomach and reroutes the gut, be it because of repetitive or perforated ulcer, cancer, or as with you, WLS. (Okay, so you may say, hey, the stomach is not removed with WLS, but the pouch is separated from the rest of the stomach, resulting in a psuedo-stomach removal.)

This happens because food is passed directly from the stomach to the intestines all of a sudden--hence the term, "dumping" instead of being slowly passed through the stomach and the duodenum, while the rest of your digestive system prepares for the onslaught of nutrients that must be absorbed. The symptoms are actually a result of hypovolemia (reduction of blood volume), due to the difference in osmotic pressure that transfers the water of the plasma into the intestines. In other words, it is a form of hypovolemic shock, albeit low grade.

Another event that produces similar symptoms and is often confused with dumping, is hypoglycemia--low blood glucose. True hypoglycemia is defined as low blood glucose, 50mg/dl or under, with symptoms. However, reactive hypoglycemia occurs when there is a sudden drop in blood sugar level, even if the endpoint of the drop is higher than the medical definition along with the same symptoms as true hypoglycemia. This is also often seen in post-gastroenterostomy patients--and it can happen to WLS patients. The post-op reactive hypoglycemia takes place because carbs that are absorbed speedily raises the blood glucose level, which in turn induces the excretion of insulin to lower the glucose level, resulting in a sudden drop, and hypoglycemic symptoms.

Dumping can be avoided to a certain extent by avoiding foods that seem to cause it with regularity (what these are differs with the person) and chewing throughly, and eating slowly, so that food passes through slowly.
Reactive hypoglycemia can be avoided to a certain extent by avoiding food that contains easliy absorbed carbs--liquid sugar, high carb content foods, among others.
However, in both cases, it is going to be an ongoing learning experince, trial and error for all.

Just remember, your body is trying to teach you what is good for you!

[jilarie1]

hey doc! It's me again 3 years out girl, i have finished with my iron sucrolose drips, and here i am lookin' through the posts and I have this hypoglycemia reaction too. Once my blood suger was as low as 27, they were about to call me an ambulance my regular non wls doctor kept telling them to give me sugar(like a regular stomached person) and there it went down down down, now i have it pretty much under control, no straight sweets at all! I have gotten soooo much info from this sight. thanks! Jilarie

[tshuart]

I had an unusal reaction last night. Since I have found that eating sugar no longer gives me
diarrhea (though I tasted only small amounts), I decided to try a piece of my son's birthday cake (with ice cream). While it is true that I did not have diarrhea, I got sick anyway -- with fast heart palpatations and a feeling that I had tolay down and shut out the world. This lasted two hours, with my heart slowing back to normal during the last half-hour. Needless to say, I will be avoiding that part of birthday celebrations from now on.

Terry

[momrobare]

So what do they do for hypoglycemia if you can't eat any sugar or sweets? Hook you up to an IV and administer glucose?

I have diabetes type 2 and my blood sugar falling after WLS scares me. I hate it when it happens now (I'd rather it rise...the symptoms aren't so drastic though the final outcome ...loss of limbs, kidney failure etc...is!

And if the symptoms for dumping are the same as for hyperglycermia, how do you tell them apart?

[DocSanae]

Originally Posted by momrobare

So what do they do for hypoglycemia if you can't eat any sugar or sweets?

Bypass post op dumping/hypoglycemia is different from those induced by medication in that, when the body tries to bring the blood level up in reaction to the drop, there's nothing to inhibit the reaction--in other words, there isn't medication in the blood stream that works to reduce the glucose level--so your body will be able to bring up the blood sugar level before it becomes damaging or life threatening. Also, post op, your diabetes meds will be reduced, if not be able to come off it completely.
The best way to deal with post op dumping/hypoglycemia is to space the meals and snacks at such a timing that you don't get it. If you do get it, then getting protein in together with some carbs is the best way. Like, peanut butter and apple.
If you have a glucose monitor, then monitoring your blood sugar when you feel icky will tell you if it's hypoglycemia.

[RCPLady]

Thank you, DocSanae! You are so helpful! I'm new in this community and I'm pretty new in the whole GBS family altogether.

Sugar has proven so far to be so hurtful to me that I'm getting paranoid about every bite of food I take! It seems like sugar is everywhere! Even things I never thought would have it, it's there!

I suffered post-operative complications resulting in two subsequent trips to the hospital, so getting used to normal food is coming a bit late for me. Some foods I was told would be a problem, such as rice, are no problem. Others that I thought wouldn't bother me are really causing me difficulty. When I've had the Dumping, I've had it bad. Sometimes, my heart palpitates so hard it feels like it'll pound right out of my chest.

Sorry for the digression. I just haven't had many to talk to about all this. I just accidentally found this community today by accident while Googling sushi rice recipes. I'm so grateful you all are here!

Thanks again for your help!

[DocSanae]

There's been a lot of discussion on reactive hypoglycemia, so here are links to a couple of them.
http://www.renewedreflections.com/fo...oglycemia.html
http://www.renewedreflections.com/fo...oglycemia.html

In the first thread, I've written my theory on what's going on, and am copying that here.

1) The basics
First, to rehash some basic stuff. The βcells in the Langerhans island of the pancreas produces a hormone called insulin. Insulin is instrumental in moving glucose out of the blood stream into the cells of various organs. When there is not enough insulin, or, there is insulin resistance, glucose is left out in the *field* causing hyperglycemia—high blood sugar (glucose) and when specific criteria are met, then the diagnosis of diabetes mellitus is made.
Too much insulin in comparison to the amount of glucose that needs to be *removed* from the blood stream results in hypoglycemia—low blood sugar (glucose) that causes a variety of symptoms.

There is a test that is utilized in diagnosing diabetes called the (75g) oral glucose tolerance test, often referred to as the 75g OGTT. With this test, the examinee drinks water with 75 grams of glucose dissolved in it after fasting overnight. The person’s fasting blood sugar is checked before drinking the glucose, then blood samples are taken 1 hour and 2 hours later to check the glucose level. Often, insulin level is checked along with the glucose level, though this isn’t required for diagnosis.
With healthy people, glucose and insulin levels rise simultaneously, and neither glucose nor insulin gets that high.
The typical reactions for pre-diabetics still in the early stages, especially if overweight, is, the insulin rise is either simultaneous, or a little bit delayed, but the peak amount is much higher. This reaction would be the result of insulin resistance. Glucose in blood, insulin needed to shoo it into the cells, but due to some of the insulin being *blocked* the blood glucose level remains high, so the pancreas secretes more insulin to control the glucose level.
With diabetics, the peak is delayed, and the total secretion also is low.
If your diabetes was serious enough for your pancreas to become permanently unable to produce enough insulin to control the glucose level, you may need a very low dose of insulin for the rest of your life, even if you are type 2 diabetic and even after weight loss.

2) My Theory
All of the above are known facts.
Now comes my theory.

As I wrote, it’s known that when there is excess weight, there is *over* production of insulin in comparison to the glucose level.
So, if you’ve been overweight/obese for a long time, over that time, the conditioning level of how much insulin to release at which glucose level, may be changed. In other words, it will become the norm for the pancreas to secrete more insulin than is appropriate for the glucose level, all the time, because the amount it needed to counteract the resistance. Plus, pre op, you would have been eating 3,4 times, probably even more, carbohydrates than you can with a small pouch. That also sets the pancreas up for needing to secrete a large amount to meet your needs.
Once you’ve had surgery, your intake is drastically reduced. However, because of the changed route, your glucose level rises quickly. The pancreas reacts, and secretes the amount of insulin that it’s conditioned to release at that glucose count. However, with the insulin resistance resolved, the amount is actually more than needed to bring the glucose level down to what’s normal. So, the glucose level gets lower, low enough that symptoms of hypoglycemia develop. This overproduction may be temporary—eventually, your brain and body will get it that you no longer need the amount of insulin you previously did, and will recondition to release the appropriate amount, putting a stop to hypoglycemia, or making it not bad enough for symptoms to develop. However, with some people, the reconditioning may not be enough—the pancreas may still continue to secrete in excess, only to a lesser extent so the episodes are less severe, and in other cases, the pancreas may be too far*gone* to be able to recondition, in which case the person may get serious hypoglycemia, often, and over extended time.

This is the theory I have. There may be other ongoing issues that trigger, or exacerbate the symptoms, but I am thinking that this possibly could be at the root of the issue.

I am wondering if someone will formulate a study to test this theory.

[DocSanae]

Here's a link to the article that LadyLisa linked in to her thread.
Print it out and show it to your dr if you're having reactive hypoglycemia issues.
NEJM -- Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery

LadyLisa's update thread.
http://www.renewedreflections.com/fo...tml#post253532

[mommashart]

Dumping syndrome and hypoglycemia greatly increases when pregnant!!! Atleast it did for me and a couple of girlfriends.

[kiwi-leelee77]

This is quite interesting. As didnt have an issue with diabetes etc pre-op, im new to all this stuff.
I dont dump in the common way since wls, at the start I did, but not with the runs or anything like that, so I really didnt classify it as dumping.
However, If I dont have something to eat when my body deems it is time, I start to get a fluttering shake in my tum. If I have something like a bit of choc or a biscuit, the fluttering wont go any further. If I dont have a sweet thing quickly, then I get the shakes real bad, I sweat badly, I get tunnel vision, my hearing seems to go muffled and I have to sit down, strip off as much as possible, and have a towel handy as the sweat is really bad (like night sweats where people wake up drenched). If I have something a bit too late, it takes more of it too halt the symptoms. This can sometimes happen in the middle of the night, which is unpleasant as then I have to lay on a towel as the sheets are soaked and im too far gone to do anything than lay on a towel and ride it out. which it does, usually takes 30mins or so though.

I tried to tell my Dr's nurse, but they said I was dumping and I said, but how can you dump if you havent eaten anything for 3 hours or more?
Nope, its dumping I was assured. hrmmmm
Thanks for the info Doc, it has been very helpful. Thought it would be a good idea to have it seen again for those recently joined up.
Again, thanks Doc, your answers and info are invaluable to us and allows us to go see a dr armed with some good info or ideas about what might be going on.