Three years after gastric bypass surgery, things were going well for me. I was maintaining my 160 pound weight loss and training for a half marathon. But then it all came to a screeching halt when my blood sugar started plummeting without warning. 

The next several years were a nightmare. Trying to find a solution sent me to four doctors and several nutritionist seeking answers to an seemingly incurable problem. No matter how "on track" my diet was, there was no rhyme or reason to my low insulin levels.

According to articles written in Haelio, (written by Dawn Belt Davis, MD, PhD) Postprandial hypoglycemia is one of the long-term risk of RNY gastric bypass surgery. The prevalence still remains unknown, however, Haelio endocrinology reports that as more and more people have RNY for obesity, endocrinologist will undoubtedly be seeing more patients with hypoglycemia. They report that:

"Hypoglycemia typically does not present until 2 to 3 years after gastric bypass surgery. These hypoglycemic episodes are characterized by low blood sugars that occur 2 to 3 hours after a meal. Fasting hypoglycemia is typically not seen. The etiology seems to be excessive insulin secretion in response to the meal. It is well documented that patients are more insulin sensitive after gastric bypass surgery, but the pathophysiology of these specific patients who develop hypoglycemia remains unclear. It is hypothesized that it may be related to elevations in the incretin hormones glucagon-like peptide 1 and gastric inhibitory polypeptide, and their ability to stimulate additional insulin secretion. It has also been debated whether increased beta-cell mass may lead to excessive insulin secretion." 

The effect on the lives of patients can be devastating and severe. Without information and education about hypoglyemia, patients can become trapped in a vicious cycle of high and low insulin levels. Symptoms can develop rapidly and seemingly without cause or warning. Some patients can have loss of consciousness and experience seizures, which may result in motor vehicle accidents. Many patients go undiagnosed for extended periods of time, as there is limited awareness of this disorder in the medical community and the initial episodes are often mild with subtle symptoms. 

This is exactly what happened to me. For six years I fought the battle of hypoglycemia with no control over my blood sugar levels. Until I was properly diagnosed, doctors who inquired about my insulin levels said I was just fine. 

But I wasn't fine. I was very, very sick.

Finally, I was referred to an endocrinology who diagnosed me with severe case of Reactive hypoglycemia (also known as post-surgical or postprandial hypoglycemia). 

First I discovered that even though my thyroid numbers were almost normal, I had suspected for years that I had a thyroid issue. I found that going on thyroid medication help improve my hypoglycemia. Afterwards I was placed on a prescription medication, Arcobose, to help with carbohydrate absorption. I found some relief, but I was still very sick. My life was ruled by unpredictable rises and falls in blood sugar levels. I was unable to exercise or control my weight. 

In June of 2014, I made an appointment to see Dr. Walter Pories. Dr. Pories is a re-nowned surgeon in the field of bariatrics and is currently doing research and trials on the cause and cure of post-surgical hypoglycemia. After listening to my story, he explained the "medical and scientific" reasons behind my problem and offered a solution.

He suggested that I replace my vitamin routine with 2 Silver Centrum for Women. That's all. Just 2 multi-vitamins (with iron) everyday. No supplemental calcium or vitamin B12. I was shocked that this solution could be that simple. We are told that calcium and B12 are a must after RNY. I'm not suggesting you go off calcium and vitamins without checking with your doctor, but if you are having low blood sugar issues, and under a doctors care, you might want to try it. It seemed like such a "crazy" thing to do, it took me a few weeks to stop taking my calcium.

He suggested that it might take up to a year to see any results. However, I began to see result in just a few weeks. After seven months my blood sugar was significantly stabilized and was able to eat a healthy and normal diet and discontinue my Acarbose. My leg cramps dissipated greatly. I was able to add Vitamin D back into my routine several months later for joint pain. It did take a year to see significant results, and several years to find better control of my blood sugar levels. But I did it!

If you are suffering from post surgical hypoglycemia, there is a solution.

First-line treatment is education. I suggest that you should document your daily diet routine and discover what things set off your hypoglycemic episodes. Keep detail records of what you eat, amounts, and what times you eat. Also record amounts of food intake and avoid high-glycemic-index carbohydrates and limited portions of any slowly digested carbohydrates.

Along with making sure that I eat protein first and low carbohydrate meals, I have eliminated most wheat products from my diet altogether. I have also eliminated refined sugars and added raw honey to my diet. In small amount, honey is digested slower than refined sugars and can help eliminate drops in blood sugar levels and give you a safe energy supplement. (a teaspoon or less).

I eat several small meals a day. If I am active, I don't go longer than 3 hours without eating a protein snack. Always eat any carbohydrate food with protein. I also totally avoid foods that leave the stomach faster than normal—soft foods such as yogurt, protein shakes and other predigested or liquid calories, including ice cream, milk, jello, or high calorie drinks, or fruit juices etc.) Remember if you are suffering from postprandial hypoglycemia you are probably 2 to 3 years out from surgery - past the weight loss phase and should no longer be eating these foods anyway.) Any sugar that leaves your stomach is undigested and dumped straight into your intestines—which will cause hypoglycemia and dumping. 

I also avoid strenuous exercise or lifting, such activities such as mopping floors and lifting heavy groceries can induce an episode. I can walk and do low-impact palates. 

Blood sugar levels are also affected by emotional stress or getting to hot, such as weather or even a shower, spa, or sauna. Extreme hot or cold affects the way your body uses insulin. 

Acarbose (Precose, Bayer Pharmaceuticals) is often successful in patients with relatively mild disease to reduce carbohydrate absorption. However, even though it helped me for awhile, the side effects were unpleasant and affected my social life. I am thankful that I could eliminate it after a few years.

In severe patients who do not respond to these initial therapies, the addition of medications to antagonize insulin activity or minimize insulin secretion can be helpful. Calcium-channel blockers, octreotide or diazoxide are other options that can be tried. In the most severe patients, partial pancreatectomy has been performed; unfortunately, it has not been successful at reversing the hypoglycemic episode and it is unknown if reversal of the gastric bypass is a successful strategy.

Having personally experienced postprandial hypoglycemia, I recommend that you see your endocrinologist (preferably one who has experience in working with gastric bypass patients or at the very least proactive in helping you find a solution that works for you. 

I highly recommended that you get regular follow-ups including blood work, as well as consult with your primary care doctor or surgeon before changing your vitamin routine, or before discontinuing any prescription medication, vitamins or calcium supplements. I also have my bone density monitored. It is crucial to continue monitoring your overall health and be proactive in finding a solution that works for you. There is hope if you are willing to find it. 

Yes, you can. You have many more miles to go!