Hypoglycemia After Bariatric Surgery- What You SHOULD know

Medically Reviewed by Katelyn J. Mock, US-Registered Dietician (R.D.)

Question – I am non-diabetic but have had low blood sugar after bariatric surgery. What should I do?

There are many reasons why a person feels light-headed and dizzy after bariatric surgery. One such reason is hypoglycemia. Hypoglycemia is a possibility after both gastric sleeve and gastric bypass surgery.

• Hypoglycemia or low blood sugar is a complication of gastric bypass or any other bariatric surgery, including mini gastric bypass surgery or gastric balloon.
• According to the Cleveland Clinic Journal of Medicine, post-gastric bypass hypoglycemia (PGBH) should initially be treated with a diet rich in fiber and protein but low in carbohydrates.
• It further states that if the problem persists, medication such as “acarbose or a calcium channel blocker and octreotide or diazoxide or both” can be taken.

Symptoms of Non-Diabetic Hypoglycemia Post Weight Loss Surgery

It is not necessary to experience any of these symptoms to have hypoglycemia. Such a condition has been termed as Hypoglycemia Unawareness.^[1]Health Line. “Can You Have Hypoglycemia Without Having Diabetes?” 25 July 2018
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Some common symptoms are-

• Headache
• Dizziness
• Blurred Vision
• Extreme Hunger
• Excessive Sweating
• Problem in Concentrating

Severe hypoglycemia patients exhibit symptoms like rapid heartbeat, seizures, nausea, and anxiety. ^[2]American Diabetes Association. “Hypoglycemia (Low Blood Glucose)” 25 July 2018.
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Causes of Hypoglycemia After Bariatric Surgery

Some factors^[3]Diabetes.co.uk, “Diabetes and Hypoglycemia” 26 July 2018.
View in Article that put a person at a greater risk for hypoglycemia are –

• A very high dose of medication (either insulin or hypo-causing tablets)
• Irregular meals
• Too much exercise
• Alcohol
• Deficiencies in counter-regulatory hormones (cortisol, glucagon, and epinephrine)^[4]Marisa E Desimon MD and Ruth S Weinstock PhD. “Non-Diabetic Hypoglycemia” (Last updated in 2017) PMC. Web. 26 July 2017
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Alleviating Hypoglycemia Following Bariatric Surgery

Post-bariatric hypoglycemia can be life-threatening as it can be accompanied by dizziness and seizures, which gives rise to motor vehicle accidents as well.^[5]Goldfine, Allison B., and Mary Elizabeth Patti. “How Common Is Hypoglycemia After Gastric Bypass?” Obesity (Silver Spring, Md.)6 (2016): 1210–1211. PMC. Web. 26 July 2018
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This is why it is necessary to eat right and drink the right amount of fluids. One needs to have a protein-rich balanced diet. (Some post-op stage 3 diet ideas).

Research indicates that post-gastric bypass hypoglycemia (PGBH) specifically occurs postprandially after 6 months of the surgery.^[6]Lee, Clare J. et al. “Risk of Post-Gastric Bypass Surgery Hypoglycemia in Nondiabetic Individuals: A Single Center Experience.” Obesity (Silver Spring, Md.)6 (2016): 1342–1348. PMC. Web. 26 July 2018.
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• Mild hypoglycemia can be treated by taking glucose orally or by consuming foods that contain carbohydrates. For instance, juice, candy or a small meal.^[7]Evert, Alison B. “Treatment of Mild Hypoglycemia.” Diabetes Spectrum: A Publication of the American Diabetes Association1 (2014): 58–62. PMC. Web. 26 July 2018.
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• Try drinking about one-third of a cup of juice.
• Have a protein + glucose stabilizer bar.
• If you are more than 1 week out from bariatric surgery, you can have some puréed fruit, yogurt with a little sweetener, or mashed potatoes.
• For those of you who are long out, 1/2 a piece of fruit and 1 oz of cheese or 1 tbs of nut butter is a great snack to have.
• Eat something with at least 15 gm of carbohydrates every 3 hours to help prevent hypoglycemia.
• Good choices are fruit, Greek yogurt, 3-6 whole-grain crackers, oatmeal, roasted potatoes, brown rice, dried fruit, or whole-grain bread (if you can tolerate it).

This Post Addresses

• What are the symptoms of non-diabetic hypoglycemia following weight loss surgery?
• What should I eat after bariatric surgery in case of low blood sugar?
• Symptoms of hypoglycemic attack post gastric bypass
• Can you have low blood sugar and not be diabetic?

References

1. Health Line. “Can You Have Hypoglycemia Without Having Diabetes?” 25 July 2018
2. American Diabetes Association. “Hypoglycemia (Low Blood Glucose)” 25 July 2018.
3. Diabetes.co.uk, “Diabetes and Hypoglycemia” 26 July 2018.
4. Marisa E Desimon MD and Ruth S Weinstock PhD. “Non-Diabetic Hypoglycemia” (Last updated in 2017) PMC. Web. 26 July 2017
5. Goldfine, Allison B., and Mary Elizabeth Patti. “How Common Is Hypoglycemia After Gastric Bypass?” Obesity (Silver Spring, Md.)6 (2016): 1210–1211. PMC. Web. 26 July 2018.
6. Lee, Clare J. et al. “Risk of Post-Gastric Bypass Surgery Hypoglycemia in Nondiabetic Individuals: A Single Center Experience.” Obesity (Silver Spring, Md.)6 (2016): 1342–1348. PMC. Web. 26 July 2018.
7. Evert, Alison B. “Treatment of Mild Hypoglycemia.” Diabetes Spectrum: A Publication of the American Diabetes Association1 (2014): 58–62. PMC. Web. 26 July 2018.

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Have a protein + glucose stabilizer bar.
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For those of you that are long out, 1/2 a piece of fruit and 1 oz of cheese or 1 tbs of nut butter is a great snack to have.
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