For those who have been reading the blog for awhile will note that I have been struggling with hypoglycemia or lower blood sugar for about two years. I hung in there, sometimes by a thin thread, tied a ever so tight knot on the end and kept hanging on.

Finally, I have had some success.

Here's my experience

In the beginning: I was doing great for about three years. Walking the loop, which is the 2.48 mile walking track in the center of Wrightsville Beach, NC. It's a great place to walk, lots of people who add that sense of community , with a gentle ocean breeze. As you make your way across two bridges over the intracoastal waterway, there are rich, beautiful marshlands and smell of salty ocean air. It winds around through the main street just a block away from the ocean giving that small town atmosphere of small shops and seafood fare. On occasion, the local churches along the route will offer a cooler of iced water and a smile. It just makes you thankful to live at the beach. This walk is as healing to the soul as it is to the body.

At the time I could walk the loop then repeat the top section again, from the History Museum around to the City Office buildings, past the tennis courts and playground through the road beside the Fire Station which added up to about three miles. Some days, I would do it twice in one trip. I had this great idea to sign up for a 1/2 marathon and was just getting ready to train, with a local group for a walk at one of my long-dreamed of destinations at Kiawah Island, SC. 

And then it happened, for several days in a row, I couldn't make it around even half-way. My blood sugar dropped dramatically and I was in trouble. Being unprepared it threw me "for a loop" alright. It was a pretty scary adventure, I had no food with me, no money to purchase any food, although I passed by several restaurants and a local grocery. I spotted several police cars, but I really couldn't justify asking for help. I kept looking at people faces as they passed, wondering if I should ask for help. I was trying to decide if anyone cared enough to sacrifice there walk to help someone who was about to hit the curb. I was confused and close to fainting. I finally made it to my car, drove to the first fast food restaurant just over the bridge and ordered a burger. It was a close call and it started to happen everyday from then on. My walks ended and with it my dream of walking in the marathon and getting to visit my long awaited retreat at Kiawah.

My mission from that point was to figure out what to do next. I made an appointment with my surgeon and talked with several dietians, an endocrinologist and over the course of the next year and a half, did everything I was told and knew to do to bring it under control.

The situation got worse and worse as time went on, despite my best efforts. I ended up at the local eating disorder clinic with a great nutritional counselor who really helped me with some limited success. After several weeks, she realized it was more about a chemical imbalance instead of what I was eating. She recommended a specialist in the area who had experience dealing with hypoglycemia and gastric bypass surgery patients. Although, I say I had "limited" success, it keep me out of the emergency room and on my feet, which was a huge success, I learned about how to eat for hypoglycemia and how my new altered body works, which was priceless, but it wasn't enough to correct the imbalance. 

It took me 5 months to get an appointment with Dr. Parker. He did several tests and prescribed a drug (Acarbose) that would slow down the rate at which my body absorbed carbohydrates. After several months on the medication and several adjustments in dosage, I am finally seeing relief.  I am not 100 percent, but feeling so much better.

Finding Solutions

Walking:Recently I've even started back with my walking routine, which is major because there for a while I couldn't even do light housework without lowering my blood sugar drastically. And several weeks ago, I even walked the loop. It was an emotional event...I was so excited. Although I think that trip was a little pre-mature, I am walking everyday now. Usually about 20 to 30 minutes at a time is best and after each meal. Walking has leveled out my blood sugar and it feels so good just to be able to walk again. I try to walk about 200 to 300 calories off a day (see HMR chart on left sidebar under links to discover how many calories you burn for your weight, per minute).

Counting carbohydrates: I still have to count my carbs very closely, but not quite as close as I did before the medication. I still stay with the 15 to 20 range per meal, I just don't have to be so exact. I am really hoping it continues to work. But for now, I'm learning how to get things back to a more "normal" life, or as normal as it gets for life after bariatric surgery!

I keep my sugar intake to below 9, the lower the better. 

Eating more often: I do eat more often. Breakfast is the most important meal of the day. If I don't eat correctly for breakfast it can throw my whole day off. 

When I walk I make sure I've eaten well; protein and complex carbs, high fiber. Then I make sure I get rehydrated and eat a healthy, high fiber snack. High fiber is one of the important elements, because it takes longer for your body to digest.

I also eat an afternoon meal. Because my meals are small, getting that afternoon meal in is important. It keeps me from getting too hungry before dinner, it stabilized my blood sugar and insures that I have proper calorie intake and protein. 

Dinner, then a light snack before bedtime. 

An emotional battle: I really understand how frustrating it can be to struggle with problems that there seemingly has no solution, but I was determined to find an answer. It was a little disheartening to have to go on prescription medication again. That was one of my biggest goals of having surgery. I began to feel all those "hopeless" feeling return and all those all "tapes" playing again in my head about how things never change and it was always going to be hopeless. 

Medication: I have had to go on medication, and it has greatly helped. Although it's not just about the medication alone. I worked really hard at finding a solution. I think that is the thing that makes the difference. You just can't give up to defeat. Even though there were times when I wanted to throw in the towel, even have the surgery reversed...I'm glad I didn't. 

I also went back on thyroid medication, which also offered some relief.

Gastric Bypass Surgery does carry risk, this one I was unaware of in the beginning...there is so much the professional don't know about what happens to our bodies when it's altered. But it was my decision. Losing the weight has given me my life back, allowed me to do things I would never do. I have to remind myself that I had high blood pressure, diabetes, high cholesterol and other life threatening diseases that treatened to shorten my life. Even with the little or actually "very big" hiccup of hypoglycemia, I can say that I'm glad I had the surgery, I'm glad I lost all the weight, I'm glad I put in the effort of dietary changes.

Was it easy, NO...it was hard. Was it hopeful at the time...NO, not at all. 

But I am making it through...and it has made me stronger and wiser...so for now...I'm back to doing the things I want and need to do. 

Below on earlier posts, are the trial and errors I went through to find a solution. It was a long hard road, but my prayer is that if it will help someone else have an easier road I'll share with you all the information I can. You have to work at finding a solution that works for you, but I'll share some things that I found that work for me. So stay tuned and let me hear from you...

Got to go....time for my morning walk...and oh...next I've scheduled for myself, a message....oh, yeah...life is good!

Thanks for your support and help

 A huge, gigantic, and extra-ordinary hug and  "thank you" to Chaundra Klien at the Chrysalis Center for her help finding my carbohydrate balance and to Dr. Parker and his wonderfully helpful staff at Hanover Medical Specialist. Chaundra and Dr. Parker listened to my needs, trusted me in that I was diligent in my eating and worked with me to find a solution that worked for me.  They didn't just hand me a generic answer.  That was a tremendous and emotional support as well as physical. I have the utmost respect for professionals who really have a the heart to listen "between the lines". Healing is not just about the physical, but is also ministers to the emotional needs of the whole person. 

Limiting your carbohydrate, fiber and sugar intake can be the key to help manage hypoglycemia.  

I have been struggling to bring my battle with blood sugars in control for about a year and a half now. With the help of a nutritional counselor, I have had some success. However, my hypoglycemia, although better with diet has resorted in me having to have a little help from medication. Both of these things, diet and medication have been instrumental in improving my symptoms.  

If you have hypoglycemia, you may have to use trial and error to find your limits, however, not all carbs are created equal.

Carbohydrates provide the body with fuel it needs for physical activity and for proper organ function, and they are an important part of balanced and healthy diet.  However, some kinds of carbohydrates are better than others, especially if you are struggling with blood sugar levels and insulin. 

The best sources of carbohydrates— such as whole grains, vegetables, and low sugar fruits and beans—promote good health by delivering vitamins, minerals, fiber, and a host of important phytonutrients. My rule is the closer to nature I can get the better.  Eliminating all refined sugars and processed foods, along with artificial sweeteners. 

Easily digested carbohydrates from white bread, white rice, pastries, and other highly processed foods contribute to weight gain, interfere with weight loss, promote diabetes and heart disease, and wreck havoc with insulin levels.

If you had diabetes before weight loss, you know the importance of getting the right amount of carbs to regulate your insulin. So it is with hypoglycemia, finding the right balance that is right for you is the key. Most hypoglycemic diets recommend that you have about 15 carbs per meal, and eat several small meals each day. 

To make this a little easier, here is a small list of carbohydrates amounts. 

These foods contain about 15 grams of carbs.  It's important to check each food item you eat to learn how many carbs a certain food contains.  For example...whole wheat bread may contain around 15, but very dense bread may contain more. The more fiber a food contains the slower it digest, keeping you fuller longer and keeping your blood more stable.  

Grains and Breads and Starchy Veggies

1 slice bread (whole grain preferred)

1/4 bagel

1/2 english muffin

1/2 hamburger or hot dog bun (whole grain works best)

1 6-inch tortilla (whole grain works best)

4–6 crackers (whole grain works best)

1/2 cup cooked cereal

3/4 cup dry cereal (higher fiber works best)

1/3 cup spaghetti, macaroni, or other pasta

1/3 cup cooked rice

1/3 cup cooked beans or peas

1/2 cup corn

1/2 cup lima beans

1/3 cup rice 

1 small potato

1/2 cup sweet potato

1 cup winter squash

3 cups popped popcorn

Fruit

1 small fresh fruit

1/2 cup canned fruit in natural, unsweetened juice

1/4 cup raisins, prunes, other dried fruit

1/2 cup fruit juice

Milk

1 cup milk

1 cup plain yogurt

1/3 cup fruit-flavored, low-fat yogurt 

My experience 

• I have found that fruit doesn't work well for me. I can eat low sugar fruit such as apples, berries and peaches. 
• Foods such as cheese isn't substaintial enough for a meal with fruit, unless I add an egg.
• Liquid protein drinks don't hold my sugar steady any longer, I must eat solid food. 
• Eating 5 smaller meals during the day.
• 15 carbs per meal, keeping sugars under 10.
• Eating protein first.
• High fiber foods work better...sweet potatoes, whole grain breads, and beans.
• No cereals, or carbohydrates on an empty stomach without protein. 
• No sugary yogurts, or other soft calorie foods (that leave the stomach too fast: such as milk, or yogurt.)
•  Exercise or do more strenuous activities sooner after eating a meal, rather than further out.

I have been doing a lot of calculating and counting, and measuring...these days!  

...and once again...

I have discovered a simple, yet somewhat complicated solution...for balancing my hypoglycemia and returning to weight loss maintenance. 

Simple, because my carb counts (seem to be) the villain to my issue....and complicated because it depends on which carbs I eat and what and when I eat them. 

But mostly, it's been returning to the guidelines and rules I was given in the beginning...with a few tweaks...

The story:  The first several years after weight loss and surgery, I followed the 5, 10, 15 guideline.  Over time even though I was adhering to this guideline, I have discovered that I can't eat the same things I did before.

One thing I'm wondering, if having my gall bladder out a few months before I starting having this difficulty has any relation to how my body processes carbs. Don't know...but either way, it's out now and I must learn to live without it and manage my hypoglycemia.   

And, since I was being careful with measuring, my carb count had gone either under too much or a little above the 15 to 20 count.  Even not eating enough carbs could drop my blood sugar.  Before, even though I followed the guideline, a once in a while stray did not cause a problem. 

The moral of the story: guard what passes between the lips !  

Here are a few things that have helped me manage my weight and hypoglycemia, so far. 

1. Eat adequate protein and eat it first.

2. Eat carbohydrates, in whole food form, little to no processed food. Keep the counts with in the 15 to 20 grams of carbs per meal.  No white processed foods.  (This count is a good "guideline", however for me personally dealing with sensitivity to carbs, it is a must).  

3. Eat 5 to 6 meals a day, not just "snacks", but meals. Eating adequate meal volume keeps hunger away and blood sugars stable.

4. Keep food in the pouch for as along as possible, I don't drink after eating a meal for at least 60 to 90 minutes. Then slowly begin drinking...when I can tolerate liquids and my pouch is empty...I drink like crazy until the next meal. Hydration is crutial...64 fluid ounces a day! You will know by the "fullness" level whether your pouch is empty or not.  Liquids should be non caloric.  

5. Move, move, move. I know, I know, exercise is a "bad" word, but increasing activity and exercise is a huge key to maintaining healthy weight. It can be as simple as having fun, parking further from the store front, playing with the kids in the park, swimming, bike riding, a leisurely stroll around the block...just get moving! 

6. Solid food, as soon as you pass your weight loss phase, give up liquid protein supplements for real food, stick to real solid food and keep it in your pouch for as long a possible.   

You'll get the hang of it in no time at all...I believe in you...believe in yourself...yes, you can...you have many more miles to go!

Hypoglycemia after weight loss surgery is tricky to manage. But if mine can be controlled by diet, I'm determined to figure it out.  At least how to steady my blood sugars enough with the right foods not to gain weight and better yet go more than 2 or 2 1/2 hours without having to eat.  

Eating this often is frustrating and high in calories. 

Just eating doesn't help, but eating the right combinations does seem to help, at least for now.

Today, was a good day...It started off a little concerning because by readings were a little lower than normal, but then again...I don't always take them every morning.

Today's Breakfast included:

• 1 whole egg omelet
• 1/4 cup mozzarella cheese
• 1 tablespoons salsa 
• 1 tablespoon almond butter
• 1/4 apple 

I felt like this was a little over-kill.  I was tempted just to eat the egg omelet and not eat the almond butter. Next time I might try to leave it off.  But today I was really trying to test what would happen with the extra fat. It worked! 

I awoke at 7:45, ate breakfast at 8:15 and no morning snack...which now that I think about it, I could have moved the apple and almond butter to "snack".  But it was a morning on the road so I needed some security. Not passing out while driving is somewhat important.  Maybe the higher fat content helped carry me a little longer.  At any rate, this is a winning combination.  

I made it till lunch, and lunch was not until 12:30-12:45.  WOW.  Now before a few months ago, I would have said, no big deal, I always made it till lunch time without a snack, but not anymore...with this last "bout" of lows I feel like this was a major milestone.  A WOW moment. That's over 4 hours...I would have been pleased with three!

I just hope it holds true in the days to come...yes, we can, we have many more "meals" to go!

Some of the information I have gathered about having hypoglycemia after gastric bypass has made me feel better, if that makes any sense at all.

Although at this point, I am still struggling with my blood sugar drops, I thought it was something I was doing "wrong".

After I started having problems with low blood sugars in the spring of 2009, (at three years out from surgery) I really thought it was something I was "doing" or "eating wrong".  I have since found out that may not be the case.  Or let's say that if I was eating wrong, it was working...at least no hypogycemia.  

I had lost 165 pounds, I had a small gain,  but not significgant, but it was a struggle to keep it steady.  After losing, I went for about two years maintaining my weight and eating by the "rules"  or guidelines I was given. Having a few sparatic sugar drops but mostly doing very well.  

Looking back over the last few years, I have considered the medical information known and reported on hypoglycemia as a result of gastric bypass.  Since the problems seem to start several years after surgery, it seems to be it's more about how my body now reacts to what I eat.  I've had to re-vamp my diet.  Try to find out what will work and what doesn't.  

At one point I did try APA alpha lipoic acid.  It did seem to help in the beginning, even though I'm still taking it, it's not "seeming" to make a difference.   

Some foods that I could eat a year ago or even several months ago, I can't eat now and expect to go more than 2 hours. Now I have to eat more often. 

"When" and "what" I eat more directly affect my exercise and activity level or how soon after a meal I can be more aggressive or conservation.

After doing some experiments with my diet, I can now see that no matter how "good" I stick to my origional post-op rules, it will only last a short time or a maxium of two hours without a drop in my blood sugar. I have also discovered thus far, there are several foods or meals that I can eat that carry me a little longer than others.  

In this post I will be listing the foods that I have found that help carry me a little further than others.  This list will be extended from time to time as I discover how, or if, my hypoglycemia can be managed by diet.

Remember, I am just now discovering the in's and out's of this issue and the things that help me may not help you.  This list may change, but at this point, I'm praying for the best...At this point, I can tell that some foods I ate before, I can no longer eat without serious repercussions. One list that I found online, suggested to avoid beans, beans just happen to be one of the few foods that I have found thus far that carry me a full three hours.  Unless this changes, one of my staples is beans.  Go figure!

Check back often as this list hopefully will grow.

Successful foods or meals

• foods high in fiber
• black beans or chili beans with hamburger or chicken
• chili with beans
• salmon
• sweet potatoes 
• eggs
• chicken
• apples with peanut, almond, or nut butters (especially when mealtime will be delayed)
• nuts and seeds

Successful in-betweens

• peanut, almond, or nut butter with apple
• Extend Bars
• drinking fluids between meals but the longer out the better, at least an hour or more, never with food or meals

Foods that don't work well alone

• shellfish unless accompanied with another denser protein, such as veal, chicken, or fish.
• Yogurt (even high protein brands) unless I eat it with a heavier or denser protein such as egg or turkey