[medicamanda]

Hey guys, I have another question (told you I would be posting on here alot)

Last shift at work, I was with a partner who had gastric bypass around a year and a half ago. While we were at lunch, she was telling me that she had experienced a few instances of her blood sugar dropping, and having the typical symptoms that go along with it. For lunch she had a small piece of fried chicken, corn, yams, and sweet tea. (Yes, I am very aware of how ill advised most of that is, but this was her choice of food, not mine)

About an hour later, we were back at the station when she came in asking if anyone had any sugar. When I asked her why, she said she had checked her glucose level, and it was 48. She was feeling shaky, nauseated, and was diaphoretic (sweaty). She drank some mountain dew and took a few bites of a honey bun, which failed to raise her level. I started an IV on her and gave her some D50, which is basically sugar water going straight into your veins. Her glucose level came up immediately, but she still felt bad for a while. She had rapid respirations, nausea, weakness, and tingling in her hands and face. Normally when you administer D50 to a hypoglycemic patient, they feel better almost immediately.

I was confused as to why her glucose was so low after eating a meal so high in carbs, so being the nerd I am, I got on the internet and started researching, and learned about the high prevalence of reactive hypoglycemia in gastric bypass patients. I understand why it happened, but I have a few questions about it. I'm hoping the doc or someone else in the healthcare field can help me understand.

First, will D50 cause you to have dumping syndrome just like ingesting sugar would? And if so, what would the proper treatment be for someone who is suffering from reactive hypoglycemia? Normally, if a patient is alert we would either treat with oral glucose or have them eat something like a peanut and jelly sandwich, for both the quick sugar from the jelly, and the complex carbs from the peanut butter, but that seems illogical for a GB patient due to the liklihood (sp?) of that inducing a dumping episode.

Second, is it something some people are just predisposed to, or is it just likely to happen from any high carb meal?

Sorry for all of the questions, I'm just trying to figure this out.

Thanks,

Amanda

[SummerBreeze]

I have had it and its not fun type in reactive hypoglycemia in our search box we have discussed it alot...I think you will find all your answers there...hugs, Annie~

[not quite Barbie]

I'm curious to see what Doc has to say. There are a lot of threads about reactive hypoglycemia on this site, and I've had it happen a few times myself. Most recently, I ate a donut with icing, I knew I was going to dump from it, but I wanted it anyway and chose to eat it. About an hour later I got the sweats, shaky, fuzzy brained feeling and ate a piece of candy to help me out until I could get a good high protein/complex carb meal in me. That was enough to fix it for me.

I would worry that 25G of D50 would be too much and cause a follow on drop in blood sugar = a vicious cycle, which it sounds like that's what happened with her since she presented with dumping symptoms after getting the D50.

I don't think it's something we are predisposed to, I think it can happen to anyone who has the dumping syndrome (not every GBYer does).

[medicamanda]

I have read a lot of the posts on here about it, and I think I have a pretty good grasp on the signs/symptoms of it, and how to prevent it. My biggest question is about the immediate treatment once it has occured.

It definately does seem like a vicious cycle. Even as I was giving the D50, I questioned myself whether it would cause her to dump, but I honestly didn't (and still don't) know what the best treatment option would have been. Her glucose did immediately go up after the D50, so when she still felt bad, it led me to think that the D50 caused dumping. The two seem to have some similar characteristics. I just would like to know how to treat it correctly for future reference.

Thanks for the responses so far. Once I have a question about something it drives me crazy until I can figure out the answer, lol.

Amanda

[BreeChick]

Quite a few of us have this issue the further we get out. Obviously your partner is trying to 'self treat' thinking you treat it like 'normal' hypoglycaemia which is most certainly NOT.

It takes a LOT of work to handle and the BEST way is to eat high protein solid protein every 3hrs (some need 2hrs others 4) with low carb.

Do a search on here for the term reactive hypoglycemia and you'll find some of Doc Sanae's medically based responses.This issue is very much which over time can require surgery to try and fix.

The high sugar drinks and high sugar carbs only CAUSE those very low drops. I pray to God she is NOT your driver?? This can and has caused blackouts in posties. Blackout/faints without ANY warning whatsoever.

NREMT-B. former PHTLS instructor, Confined Space Specialist & Moulage Artist for the RRMS team for the State of Oklahoma

[medicamanda]

I was working an extra shift, so she isn't my usual partner, but she is actually a former student of mine. I taught her EMT Basic class, and I was and am concerned for her. I sent her a message earlier telling her to do some research on reactive hypoglycemia, and when we stopped by her station to restock our truck she showed me a stack of papers she had printed out. So I am happy that she is trying to gain knowledge about this.

Bree, you have my admiration for being confined spaces certified. I am WAY too claustrophobic for that. Lol, I have had to suck it up and go in some houses with horrible odors (I won't specify from what) because I can't stand to even put a SCBA mask on.

[Sfmini]

I had Reactive Hypoglycemia back in the 80's and went to an endo doc for testing and advice. What he told me was that it is such a vicious cycle, your sugar tanks so you crave sugar, your sugar comes up, but then crashes.
His rules were simple, no fruit, sugar, alcohol, or milk, at least until I was stable.
If my sugar did crash, I was to eat protein like peanuts, meat, eggs. He also promised I would never be diabetic. That was a lie.
I now know that is part of the process and became diabetic.
Now, no more diabetes, and I know if I have a hypoglycemic episode, at least I know what to do.

[DocSanae]

Here's the best thread on this board to go through.
http://www.renewedreflections.com/fo...oglycemia.html
I have my theory on the why in this thread.

As for the D50, yes, it probably was too much so she went into a cycle of up-down-up-down. Even when you administer glucose to raise the level, you're going to have to wait out on some of this, let the body recover the balance naturally. The best thing to do for bypass patients is to have the person eat something with both carbs and protein. Something like peanut butter and a couple of crackers, cheese and crackers, apple with PB, things like that.

Keep in mind that the normal situation where you see a hypoglycemic patient is someone who is on an agent that lowers the glucose in one way or another, from insulin to medication that aren't meant to drop the sugar level but does as a side effect. With these cases, quick and continuous administration of glucose until the effect of the medication wears off; or the glucose level has risen enough so it is sufficient until the effect of the medication wears off, in which case, you can/should stop administering additional glucose to avoid hyperglycemia.

With dumping/hypoglycemia due to the *natural* reaction to high blood sugar, you have an ongoing metabolism reacting to the initial high blood sugar that easily kicks in again when the sugar level rises again after only a short low interval.
The *natural* reaction to low blood sugar is to release the glycogen in the liver and raise the blood sugar level, so this takes time, but so long as you aren't taking any meds to decrease blood sugar, even if you lose consciousness, the blood sugar level will rise again without much adverse effects unless your hit your head or something when you lose consciousness. If you're at home and feel sleepy or lightheaded, just going to bed and sleeping it off/riding it out is fine.

[medicamanda]

Doc, thank you so much for your response, it was exactly what I was looking for. It helps knowing this not only for what happened the other day, but also for any future GB patients I may come across, or even for myself in the future if it were to happen to me. It is our standard course of treatment here for any patient whose BGL is below 60 to administer D50. We don't even carry oral glucose on our trucks anymore. It is eye opening to know that for a person who has had GB that this can do more harm than good.

[BreeChick]

I am SO glad she is studying up on this! It is much more serious than 'reg' hypoglycaemia. Good luck on anyone on the bus listening to you on NOT using iv glucose to treat a crash in a wls patient.

(I love!! Confined space work!! The challenge of the puzzle of "how?"I miss that work the most! I did a full year at a facility where all we did was confined space....amazingly I hate crowds but love confined space go figure!)