Treatment of Hyperinsulinemic Hypoglycemia After Gastric Bypass

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Hyper-insulinemic hypo-glycemia is an important late complication of gastric bypass surgery that is increasingly recognized in patients who have undergone Roux-en-Y gastric bypass. It is a condition characterized by shortage of glucose in the brain (neuroglycopenia) and abnormal elevated insulin concentrations experienced mainly after eating a meal.


Hyperinsulinemic hypoglycemia is caused by unregulated secretion of insulin by the pancreatic beta-cels. The obesrved postprandial hyperglycemia is caused from the rapid digestion and absorption of ingested carbohydrates. This is a common phenomenon in gastric bypass patients and is related to the dumping syndrome—the result of food passing too quickly from the stomach to the small intestine.


Post-gastric bypass hyperinsulinemic hypoglycemia causes confusion, lightheadedness and loss of consciousness after a carbohydrate-rich meal.


Although the treatment of the disorder remains elusive, a number of studies have investigated the following three approaches

  • Low carb diet
  • Pharmacotherapy
  • Surgical Removal of Pancreas

Low Carb Diet

Since the symptoms of hyperinsulinemic hypoglycemia are exacerbated by carbohydrate consumption, low carb diet has been investigated as treatment of the condition.

A recent study described the effect of high and low carbohydrate meals on plasma glucose in 3 patients diagnosed with hyperinsulinemic hypoglycemia 15 to 37 months after Roux-en-Y gastric bypass.

Although the fasting glucose levels of these patients were within the normal range (70-99mg/dL), when they consumed a high carb meal all three developed hypoglycemia with plasma glucose reaching as low as 28 mg/dL, 2 hours after eating. The high carb meals consisted of orange juice, milk, bread, toast or donuts.

In contrast, when the patients ate a low carbohydrate meal, they exhibited no hypoglycemia, and the change in their glucose and serum insulin levels was minimal. The low carb meals included black coffee, eggs, meat, and cheese.

The authors concluded:

Our data suggest that a low carbohydrate diet may be effective treatment for this disorder, and we have recommended such a diet to all our patients.

A similar and more recent study confirmed these results. Fourteen patients who had reported episodes consistent with hyperinsulinemic hypoglycemia were given a meal high in carbohydrates on one day and low in carbohydrates on another day. Both meals were equivalent in calories (410 calories).

Within 30 minutes following the high carb meal, the patients became hyperglycemic and hyperinsulinemic. At 2 hours, glucose levels reached an all time low and subsequently returned to normal levels.

Interestingly, after the low-carb meal, insulin increased only modestly and plasma glucose changed very little.

Todd Andrew Kellogg, MD, who spearheaded the project, commented:

The hyperinsulinemic hypoglycemia noted in some patients after RYGB … can be significantly improved through dietary intervention.


Medication has been successfully used in a few cases for treatment of hyperinsulinemic hypoglycemia. A 2009 study by Dr Spanakis, reports on the successful management of post-gastric bypass hyperinsulinemic hypoglycemia with Diazoxide. The subject was a 52-year-old woman who had undergone gastric bypass surgery 4 years ago.

Diazoxide has been successfully used in the treatment of a similar condition in infants and children.

Patients taking other medications after a gastric bypass procedure should express extreme caution as some may cause potential harm. For instance, patients with diabetes may commonly use medications such as Januvia. In fact, has just recently focused the health spotlight on the cases of pancreatic cancer Januvia has been causing, which some diabetic patients fear. Glyburide, a common diabetes medication taken orally, is also worrisome to doctors as it can completely alter a diabetic person’s blood sugar.

Removal of Pancreas

Partial pancreatectomy has been used to control the symptoms of hyperinsulinemic hypoglycemia. In such cases, some patients benefited from partial pancreatectomy while others experienced recurrent hypoglycemia that required total removal of their pancreas.

In general, studies do not support the use of pancreatectomy as a treatment for hyperinsulinemic hypoglycemia because pancreatectomy causes diabetes.

Dr Spanakis, explains that although there is a growing tendency to treat hyperinsulinemic hypoglycemic patients with pancreatic resection, it is often unsuccessful resulting in total pancreatic removal. “The end result of this approach is to cause iatrogenic diabetes, necessitating lifelong treatment with insulin”


Hypoglycemia after eating a meal is being increasingly recognized in post-gastric bypass patients. While the etiology of this condition is not entirely understood, ongoing research suggests that approaches to treatment should involve a low-carbohydrate diet rather than pancreatectomy.

I hear you!!! That horrible

I hear you!!! That horrible sugar craving is a symptom of hypoglycemia. You only need a SMALL amount of glucose (15 grams) bring it back up, but those cravings make you feel like you need to eat 10 times that amount. It's so hard to control. Unfortunately once you're in that state there is nothing you can do. Try hard NOT to get that low. Watch your BG levels constantly. My endo tells me to eat a small snack when I get down to 100 and make it a goal to keep it above that level. It is an all day/night job with our condition. High protein, low carb (whole grain, veggies, limited fruits) at meals to keep BG swings milder. My dietitian limits my carb intake at meals to 30 grams and only 15 grams at snacktimes. Use your BG monitor and watch your rise and fall post meal and you will find which foods to avoid. The higher the rise the lower you'll fall. For example, 15 grams = a small apple or 1/2 banana for a snack. ALWAYS combine a carb with a protein like cheese or nuts to minimize the rise/fall. 30 grams of carbs = 1 cup whole grain pasta - which is not a lot. Never go over that or you will pay dearly with a severe low. It is not worth it. A knowledgable dietitian/diabetes educator can be so helpful since they will be familiar with the effects of carbs on BG levels. I hope this helps. Hang in there!


Sarah-your deficencies all cause body pain and fatigue as well as the reactive hypo. Hopefully your are taking pres vitamins and after a couple of months it will get some better. I eat every hour starting with breakfast till bedtime. I use a digital kitchen timer-carry it everywhere I go. Here's a sample of what I eat- it took a good two weeks to tell a difference and a week for the sugar cravings to go away.

2 eggs
2 slices of bacon

chicken patty and side salad-reg dressing-less carbs or
1 crunch taco or
chicken caesar salad or
deli lunchmeat and cheese-make sure you eat enough to get at least 2-3 protein servings

any kind of meat
salad or veggies

Every hour I eat one of the following
tbsp of peanut butter
2 string cheeses
100 cal pack of almonds
1/2 pk of peanuts-

None of following-bread,potatoes,corn(except for tortilla-only one at a time),rice,pasta,sweets of any kind, anyting else that is considered a carb or starch.

I also cut out all caffiene-sugar substitues and sugar achols.
When I bottom out I eat two glucose tablets and protein

Hope this helps

Finally I am hearing from

Finally I am hearing from others that are having the same symptoms as I have. I am 5 and 1/2 years post RnY Gastric bypass. I had experienced the dunmping and had learned to stay away from sweets. Within the last 6 months I have felt different and I am having as what is being described to me as hyperinsulinemic hypoglycemia. I went to my PCP yesterday and all she told me was to go on a low carb diet. I am hoping she will refer me to an endocrinologist and someone that can help me with my diet. I am going today to get a blood glucose monitor and glucose tablets to start monitoring it more carefully. If anyone knows of a Dr in the Tulsa area that deal with post gastric bypass problems please let me know...


I felt the same way. I've been to an endo and nutr- not much help-endo did test to be sure that it was caused by the r-n-y and it was. I eat high protien/low low carb-every hour-carry a timer with me at all times to semi-control. Still haven't figured out how to clean house-go to the store without bottoming out. The way I figured out what I have so far is the internet. You tube has some good info- pull up reactivehypoglycemia and ryn gastric bypass. I'm in Louisiana so no help with the drs

have a good day

I think my diagnosis is

I think my diagnosis is Hyperinsulic Hypoglycemia with Nesidioblastosis. Most of the time my endocrinologist just says my pancreas doesn't work right anymore. I am 5 years post RNY and lost 100 pounds. Three years ago I began suffering from intractable migraines and after much work, narrowed the triggers down to highs and lows in blood sugar. I think I could handle this disorder if it weren't for the pain caused by the rapid dilation of my blood vessels when my blood sugar changes rapidly. I eat so little now; I can't eat more than 5 slow carbs in a meal without getting hyperglycemic. I am underweight, malnourished, anemic and have ulcers from taking NSAIDs in the past for the migraines. Eating is very painful and I swallow a lidocaine/maalox cocktail, plus carafate, before small soft meals to get and keep food down.

My endocrinologist has prescrbided Humalog, 1 to 8carb ratio, so that I can eat more and become better nourished. I can't get the timing right and don't use it. When I inject, my sugar still goes up 70 points within minutes and then comes back down rapidly, giving me a headache. Has anyone else had any luck with Humalog?

I am trying to increase my food and protein intake so that I will be in better health for ulcer surgery, as I have had them for two years now without healing. I am seriously considering a takedown of the gastric bypass. I think that having a normal delivery system would help with the hyperglycemia. Has anyone with talked to their doctor about a takedown?  

Yeah, actually a take down is

Yeah, actually a take down is the preferred treatment at this point. I have been working with doctors at Hopkins who are researching our condition and are saying that a take down is the best treatment at this point. They are having some success with conversion to a gastric sleeve for those who worry about weight regain. Also some surgeons are converting to a band saying that slowing down the passage of food helps their patients. I, for one, don't care to have a foreign body inside of me. I am seriously considering the takedown to gastric sleeve. They say there are NO LONG TERM STUDIES out there to back up any of these treatments though. For those who are afraid of more surgery, there are some surgeons who have claimed success with their patients on an Atkins-style diet. I have tried that and it does help some...and I stress some. Boy, does it ever give me indigestion. I have resisted the take down option for 1 1/2 yrs now but I think I am ready to give it a try.

I was on long term disability for two years and just went to my soc sec disability hearing and had no problem getting approval. At least now I will have medicare and my medical expenses won't be as astronomical. I hate being disabled but I know I couldn't function at work in this condition. I think I am more worried about my depression and anxiety than anything else right now. This has taken over my life. My endo has told me I shouldn't drive anymore. She decided not to take away my license right now but strongly advised me not to use it. I just bawled. I feel like my arm has been cut off. I am careful always checking my glucose before I drive and carrying fast acting glucose, etc. She feels I am too much of a risk anyway. This sucks so much.

take down

You are right- this does suck so very much. I wish there was a way we could be sure that anyone considering the surgery could talk to us.I am going back to work on Sept 1st- I am good as I'm going to get so might as well see what happens. I'm an off mgr so I don't think its going to turn out well- at home I don't have to multi-task or answer questions. i'm really scared. I'm going back to my surg tom to talk about the sleeve-band etc--Its been 10 yrs since I had my original surgery and I'm afraid of the complications of reversing.
I've e-mailed all the tv talk shows to try to make this public knowledge-of course no one has responded. What I am running across now is that I am dropping below 50 with no symptoms-at one point I could tell once I went below 100. Hope all goes well with whatever you decide to do and thanks so much for posting-----all of our post help each other- the post is how I figured out an eating plan to follow.

Hypoglycemia, Chronic Fatigue Syndrome, Vitamin D, B12, & Iron

I am 9 Years post gastric bypass. I was 363 pounds and was having back issues and broken bones. The pain was awful and my orthpedic surgeon recommended Gastric Bypass surgery and refered me for the surgery. I had the surgery in February 2002 and 13 months later I had lost more than 200 pounds. I could not stop losing weight and so my gastric surgeon did an exploratory surgery to see if he could find anything when all of the scopes and tests showed nothing significant. While he was in there he removed my Gall Bladder, which showed no abnormal pathology. Then he referred me to Mayo Clinic in Rochester MN for further evaluation. The doctors there discovered that the bypass surgery the original surgeon did was not a RnY but a mini-loop. They recommended that I have another revision surgery to abate the weight loss. My husband had just taken a new job on the west coast and was already there. I just couldn't face another major surgery alone. Mayo referred me to a good surgeon in Califonia. It took me nearly a year to convince the surgeon in California to take my case. He was concerned that the errors of the previous surgeon would result in a law suit later on. After at least half a dozen visits with the Dr. he finally agreed to take my case. Subsequntly, I went into the hospital and underwent surgery to try to repair a the previous gastric bypass. It took three surgeries and a 6 week hospital stay to get me stable enough to go home. It took a long time to recover because my body had no extra resources to draw upon. I gradually got better and I felt good for about a year and a half, was working full time. Went back to college to finally finish a Bachelors degree and then......Everthing went topsy-turvy. I started experiencing and new and different kind of fatigue. It was profound. Some days it took everything I had just to walk to the kitchen to get my day started. More referrals to doctors who blamed it on non-existant psychosematic issues. I was not depressed at the time. I was referred to numerous specialists as more symptoms started surfacing. Joint and bone pain resulted in a rheumatology consult which showed nothing abnormal. Back to my general a different rheumatologist who then sent me to an endocrinologist. The endocrinologist discovered numerous issues with in depth blood tests.
1. Severe Vitamin D deficiency 2. Vitamin B-12 deficiency, 3. Iron deficiency anemia and 4. an extremely elevated parathyroid hormone level. All of these things contribute to extreme fatigue, bone pain as a result of osteopenia and micro-fractures which are part of the inability to absorb vitamin D(absortpion happens in the small intestine which was redically shortened in my original gastric surgery) muscle pain also as a result from malabsorption issues. This resulted in additional diagnosis of Fibromialgia. Elevated PTH(parathyroid) due to lack of vitamin D uptake. Also resulting in bone pain and malabsorption. Iron deficiency anemia - similar pain and fatigue the result. The latest diagnosis which I discovered when my doctor put me on anti-depressants is the hypoglycemia. We originally thought it was a side effect of the antidepressants. It persisted after being off of anti-depressants for more than a month. Unfortunately the hypoglycemia just keeps getting worse. I found out today that the doctor suspects that is is Hyperinsulinemic hypoglycemia with nesidioblastosis. I am incredibly frustrated with continuing ISSUES from the gastric bypass. I have only mentioned the major issues I have had that we can directly attribute to the gastric bypass. Who would have imagined so MANY bad things as a result of a "life saving" surgery. Morbid Obesity was going to kill me.....I never imagined that my life would be reduced to being severely disabled and having one grim diagnosis after another surface as a result. When does it end? Count me in on any support group that results and email me if any of you want to compare notes.


e-mail or send me your e-mail

I can feel you

I just read what you had to say. Even though I was not as big as you my story is a little different but the out come is so the same. I had my surgery in 2005 and from the moment I had it nothing but complications. I didn't take me nothing to have mine. I wasn't even a 100 pounds over weight I had uncontrolled diabetes and the military told me don't you want to "save" your life. I had not been big before the diabetes came on and so I listened to the doctors recommendation and a month later had the surgery without any counseling or classes ( I was so young and a scared mom just not wanting to die) and so foolish.. I had my surgery and immediety the problems started. We found out the pouch was made too small disaster from the get go, but a about 6 months later we were out of the military and I was the VA problems I didn't get fallowed by anybody and let me tell you it's hard to get appointments with the right doctors threw them. About a year ago I learned that I was suppose to be on a ton of vitamins. I had no clue know body ever told me that and I had no post opt fallow up until I was in the hospital for impacted bowls because they had me on pain meds around the clock.. I think the scary part came this April when the put me in the hospital under critical care and I thought I was going to die because my anemia had reached an all time low to the point I couldn't breath or walk and they had to do blood transfusions. I am deficient in almost all vitamins and not from lack of taking them I take 31 a day but from the lack of being able absorb them. I am also allergic to iron we found that out durring my spring stay. And the most current was I know am on monitoring my glucose because of sever drops. I feel like I can win for losing. But the saddest thing to it all. Is my original diabetes and weight gain was induced by a medication I had been put on for depression I later found out. There are lots of law suits for it. I have thought of joining them. But I haven't because the money won't give me back my life. All I can say is I have learned so much. I feel that I can't trust a doctor at all. I do not talk about my story ever it is really emotionally to painful for me but I stumbled across this site today and felt maybe somebody could relate and understand me. I feel the surgery that was suppose to save my life has shortened it.

Wow! What a story! If only we

Wow! What a story! If only we could go back in time! I know it has shortened my life too. I participated in a research study at Hopkins a couple of years ago and after hearing the things they learned from the study I asked the dr why don't they stop doing the roux-n-y GB until they can figure out how to prevent this awful complication. He said that will NEVER happen because only a small number of folks get this complication and it is a huge business. So the "few" of us who don't matter get to die younger because these greedy surgeons want to capitalize on the hot obesity market no matter who they kill or maim in the process. That is my two cents on the matter. Depression is another serious complication that goes right along with this condition that we get to deal with. I have yet to find a med that has helped me with that. Nothing works. I am going to see a new dr at Hopkins who is trying some new meds next week. I am soooo hopeful that there is something I haven't already tried. Hang in there!!!!

I just read the other blogs

I just read the other blogs on this subject- my cousin found this website for me- thank God!!! I am 10yrs post op bypass and having major problems. I am going on short term disability because I can't do my job anymore. Most days I feel like a zombie trying to function.

This makes so much sense.

This makes so much sense. I'm crying as I read this. My best friend found me totally out of it last Friday. She made me eat which probably saved my life. Her friend is a nurse so when she explained my symptoms her friend said it was probably low blood sugar. That made sense to me since I had been highly anxious the previous two days and had barely eaten anything and when I did it was high in carbs. Since then I've been goggling this.

So far since my surgery (7 yrs ago), I'm b-12 deficient, severely anemic, been diagnosed with ptsd and depression (one stint in the mental hospital), too tired to work (on disability since Feb...I'm a paralegal), i can't eat anything without getting dumping syndrome, I'm probably 5-10 lbs underweight, now probably this.

Even my psychiatrist is frustrated because I'm hypersensitive to absolutely everything he gives me for my anxiety and depression. If I had it to do over I would never have had gastric bypass. The side affects get worse as the years go on.

Thank you for this information it probably saved my life.

I finally found others with the same problem

I'm in shock- other people that are going thru the same thing as I am. I am 10 yrs post bypass- going on short term disability because I can do my job anymore. I'm seeing an endo-diet is all she comes up with so far with no luck. I literally feel like I am going crazy-this is consuming my life.

My husband has this problem 7

My husband has this problem 7 years post op. He now wears a continuous blood glucose monitor to monitor his swings from below 30 to over 400. We are seeing someone at Mayo and they still cannot come up with a solution.
I am now contacting Joslin Diabetes in Boston for help.

glucose monitor

Beverly,what kind of monitor does he use? Does it beep when he goes low and if so can you set it yourself? Let us know what the Joslin clinic says-hope we all get better.

I'm so glad your friend found

I'm so glad your friend found you. I echo your thoughts...I wish I never had the surgery either. I, too, am underweight now and am still losing very slowly and cannot stop. My dr doesn't know what to do for me. My days feel like an all day graze. I have to eat very frequently to keep my blood sugar up. I never even have the chance to get hungry yet I continue to lose weight. I, too, have been on disability for over two years. My nurse case manager has been trying to pressure my dr into having my driver's license taken away. I already suffer from deep depression as you do. That would just send me over the edge. I am responsible enough to know when I am too impaired to drive and I take all the necessary precautions. I also wear a continuous glucose monitor so I feel I am safe behind the wheel. I am going to fight this. Hang in there. All I can suggest is get a good support system. Endocrinologist, Dietitian, family trained to resusitate you if necessary, and if you are close to a research hospital (Johns Hopkins, Mayo, Joslin, for example) they have a lot of resources for education and help. Keep in touch. We need each other. No one else understands.


Everyone on this blog ... here is my message in trying to help each of us. Helen/Karen/Bonnie/Jade/Linda/Janet/Shannon/ Mosie/Jadeland/Jade/Theresa what is happening to you is extremely dangerous, you need to consult with your doctor ASAP!!

If you don't get results keep on searching until you find a doctor who understands and is willing to help you. I have found a doctor who has been helping me if you want you can contact him I will put his contact information below, it truly scares me that we are ALL struggling this on our OWN. The medical community has failed us big time!!!

I am beyond angry and somewhat negitive that these issues were NOT presented nor even mentioned prior to my having the Rn'Y gastric bypass. It is my firm point of view that I didn't have all the information about the complications pre, during or post the Rn'Y gastric bypass therefore my NOT having this information prior, during and or post to consent to even have the Rn"Y gastric bypass surgery, was NOT and is NOT an act of informed consent even though we had to all sign the same paperwork pre - surgical procedure.

It's been years of struggling with NO real help from my primary care doctors and or endocronologists. It's the same every single time they take blood, run a few tests that all come back "normal" the majority of the time, because they are running the wrong tests!!! If I ONLY KNEW then what I KNOW NOW ... There would be NO WAY in HELL or HIGH WATER would I have EVER had the Rn'Y gastric bypass surgery. But I was told I would keep on gaining weight until I died from obesity complications.

The ONLY reason I had gastric bypass was both my father and eldest sister were/are super-morbid's and I didn't want to become a super-morbid myself. I saw how devestating and debilitating it was and is for them. My father died 2001 of complications of his obesity, my eldest sister is currently dying of complications of obesity she has been a super morbid for the majority of her life she is 56 ... the complications are diabetes, renal failure and the list goes on.
PLEASE contact your doctor and or Contact:

Dr. Christopher Foley M.D., Minnesota Natural Medicine, 3640 Talmage Circle #208, Vadnais Heights, MN 55110 Phone: 651-484-5567 Fax: 1 - 651-344-4400.
Post gastric bypass illness/or surgically caused disease is a full time job 24x7x365. I've struggled with this since 2003 and ONLY recently for the first time, I realized I am not ALONE and that this has a name. The day I first wrote in this blog I knew ... and have come to grips within my own understanding - like you ... my OWN that there is something dramatically wrong - that traditional medicine will not and has not been addressing via my health care plan as related to my Rn'y gastric bypass not for my lack of trying but for their refusal to recognize this for what it is and provide ongoing help and or medical support post the Rn'Y gastric bypass.

I lost the quality of my life but now I fear I am slowly dying as well from the complications. (Do you feel the same way?) That one day I will pass out and or not wake up ... I struggle daily trying to keep ahead of the issues with the low blood sugars and a host of "other" ongoing problems with malnutrition, anemia, chronic dehydration and other significant and debilitating problems including depression ... and a sense of hopelessness. Normal people in my life don't understand how hard this really is ... You don't get a break from it. Now I am actually developing a fear of eating ... OMG, as I don't want to experience the super low blood sugar crashing, which can also happen all on it's own ... even with not eating carbohydrates depending on my physical activity, I've crashed. I have to carry glucose tabs with me Dex 4 you can get it at Walgreens, table sugar, fruit is not "glucose" do some homework. This is a very fine rope we walk and extreme balancing act ... indeed to just maintain as best we can.

Each of us has described and share in a significantly tough road ahead with a rebound illness and or some type of surgically caused disease process post gastric bypass. With each of us suffering in varying degree's including excessive and unrelenting fatigue and depression at least for me. (Even though no one really likes to talk about that part and or any of the other normal functions of life that have been destroyed and are just plain gone at this point. Your partners also need to be educated as to why you feel the way you feel and so they can learn to cope and assist where need be. It's terrifying to me when I find myself alone and my blood sugars are dropping too low aka: crashing. I immediately call a friend and tell them exactly what is happening and if I lose conciousness they call 911. If you are driving get off the road go to a safe place - tell people what is happening to you. I've end up at Walgreens a few times because glucose is available and the pharmacy staff are trained to some degree and understand and can possibly assist you if need be. If I am out walking I take glucose with me or food nuts, high protein bars with 1g or 2g's of sugar at max. Carbohydrates if you eat them try to stay as low as possible ... for me carbohydrates anything over 8-10g at a time are problematic and can cause major problems with tossing me into a cycle of ongoing crashingly low blood sugars. You have to develope a plan ...that works for you and do the homework to save your OWN life. That is my conclusion.

Again I have been seaching for answers for years and feel Dr. Christopher Foley M.D. has significantly helped me in the last few weeks with proper care, testing and supplements.

My part is to stay away from carbohydrates (Which helps but does not resolve the low blood sugars and or "other" medical issues.) I follow the plan of prescribed specfic supplements that have started to finally deal with my unique malabsorbtion of nutriants issues(which are specfic to each person) that the main stream medical community doesn't understand nor have proper training for these issues. With my having some form of hyperinsulmatic hypoglycemia, anemia, chronic dehydration and the "other" chemical imbalances that has also caused my severe depression and un-relenting fatigue. I am fully challenged daily ... no different than a person with COPD or Cancer ... but I the main stream medical HMO's do not recognize the disaster coming to haunt them with all the people who have had these gastric surgeries. I know 3 people who have died so far ... due to complications of gastric bypass surgery.

I am sure many of you also have no idea what a normal day is anymore ... just like me normal was gone immediately after my Rn'Y gastric bypass surgery. Like you I didn't know what was happening to me, but I felt it ... I had no way to actually describe and transcend what I felt into a meaningful, valid and organized concern to report to the doctor as he would always say "I was doing fine" ... when I wasn't doing fine. I never did get any approperiate medical help/support and or follow up care to deal with this ongoing nightmare.

If you are still reading this PLEASE find a internal medicine doctor in your area, that you trust. If need be print out this entire blog if you have too, and hand it to the doctor - but make it clearly understood that this is NOT in your head that this is a "illness and or some kind of surgically caused disease" post gastric bypass.

CARBOHYDRATES are significantly problematic ... avoid them as much as possible (I know it's hard, but feeling better is worth not eating carbohydrates.) Carbohydrates cause the severe blood sugar spikes both high and then comes the severely low rebounding. Which also cause significant metabolic reactions - that your internal medician doctor can explain much better than me. However, this constant reactive glucose spiking can also cause the body to actually re-gain the weight you've lost as the bodies chemical mal-functioning due to the gastric bypass is "out of order".

I can't stress enough to each and everyone of you ... Please see a doctor that understands the chemistry post gastric bypass surgery. I've provided you a doctors name use it or call your own ... but please get some help and support with the severe blood sugar lows as this is terribly dangerous even deadly. Helen please do it today. I am sincerely hoping we can all help each other through this nightmare and back so some kind of normal health ... each of you are in my prayers. God Bless, Jeanne

Blog on hyperinsulmatic hypoglycemia

I hope you will still respond to this. I just ran across this site and I see you posted a long long time ago. But I really think I am suffering from this. I for some reason monitored my own blood sugars on my own due to nothing helping my energy, even after many infusions since I get anemic from the gastric bypass. I take b12 sublingual now since I am taking a break from the shots. I have the memory loss going on, I am thinking its stress or depression but the anti depressents arent working and long story short last night my blood sugar was high then today so low I thought I did it wrong, it was only 8.5. But with my ferritin being low alot I thought I read somewhere that the blood glucose monitor would not be accurate. God I hope that is the case. I am making a full physical appointment but I also keep a close eye on my labs but it has never been mentioned to me that any glucose was too high or low? Wow, I just am wondering how you are doing now. And did a low carb diet help keep you level? So you could feel alert again? I have seriously put on 10 pounds in 3 weeks and it feels like water weight. I am sooooo wondering what it is with me. I am 43 so I expect alot of hormonal crap too, lol.
Please let me know if you have found out more I am interested in getting healthy again.
God Bless!


low carb diet-low blood sugar-gastric bypass

Hey Jeanne,


Your blog has given me so much info.  Will you please post a sample day of what you eat?  I'm am off work on short term disability due to the same problem.  I'm having trouble developing an eating plan.  If I can't get this figured out I'm out of a job. I'm going to call your doctor and see if he recommends anyone in my area- I live in Bossier City Louisiana.  My endo says diet only-no meds- which would be fine if that would even semi-work.  Once you made changes to your diet how long did it take to see the results?

What kind of brand of protein bars do you eat?  Thank you for taking the time to help. I would like to e-mail you if that ok.




low carb diet-low blood sugar-gastric bypass

Hey Jeanne,


Your blog has given me so much info.  Will you please post a sample day of what you eat?  I'm am off work on short term disability due to the same problem.  I'm having trouble developing an eating plan.  If I can't get this figured out I'm out of a job. I'm going to call your doctor and see if he recommends anyone in my area- I live in Bossier City Louisiana.  My endo says diet only-no meds- which would be fine if that would even semi-work.  Once you made changes to your diet how long did it take to see the results?

What kind of brand of protein bars do you eat?  Thank you for taking the time to help. I would like to e-mail you if that ok.




Medical Failure

I too understand fully what you are talking about. In 2000 I weighed 419lbs and was told I needed this life saving procedure. I had the gastric bypass and have every day since been wishing i had not. I was only 21 years old at the time of surgery and since have had debilitating B12 deficiency(my hair is falling out and i get severe migraines), I have had to have several iron infusions from being severely anemic, and now I have severe hypoglycemia every time I eat. I have also had to have my gall bladder removed exactly one year post op. The sad part about this all is I still weigh 350lbs. The surgery did not work. I have had endoscopes and my stomach is still super small so they have no answer as to why my body will not give up the weight. My surgeon told me after four years I will never loose the weight and there is nothing more he can do for me. I now no longer have insurance because i cannot work and I have to suffer without help because I cannot see a Dr. I fear my son will have to grow up without a mother because I chose to have a surgery that was supposed to help me. I tell everyone who is considering this surgery to run and find a different option.

Hyperinsulinemic Hypoglycemia

Wow! At least I have a name for what is going on with me. I had gastric bypass in Aug. 2007. I have experienced dumping on many occasions. It was within the last few months that I realized that what I was going through had to be more than just ‘dumping’. I started checking my blood sugar when I would have an episode and noticed that my sugar level was dropping. It would go as low as 35. Every time my body would crave toast with peanut butter and a glass of non-fat milk. Which sounds weird to me since toast is a carbohydrate. Last night I had an episode in which I couldn’t wake up. My cat kept licking me and I would come to myself to know that something was wrong, but couldn’t move or open my eyes. I also couldn’t stay awake. I knew I needed help and it really scared me since I had no way to let anyone know. When I finally came to myself, and I don’t know how much time had passed, I was soak and wet. It looked like someone had poured a bucket of water over me or had just taken a shower and didn’t dry off. I had to lay in bed, awake by now, before I had the strength to let someone know that I needed help. It really scared me! Again, I felt I had to have my toast and peanut butter. I can deal with episodes, but what do you do when you are alone? It always comes on so fast and is inconsistent with what I eat. I’m to a point that I’m scared to eat.

You are SO fortunate you were

You are SO fortunate you were able to recover without help. I also live alone and I use a continuous glucose monitor. It has saved my life. It is expensive but can be approved by health insurance with a letter, records, etc from your doc. If you haven't done so already, seek out the help of an endocrinologist. Most PCPs know little about this condition. There are drugs that can be taken pre-meal that are helpful too such as Acarbose. It is normal to crave carbs during lows, but pure sugar works much faster than toast and peanut butter. 1/2 cup orange juice works great. Carry glucose tablets on you at all times. Four of them is usually all you need. The cravings can be so intense it can be so easy to eat too much. In most cases all that is needed is 15 grams of carb. Wait 15 min and recheck BG level. Once it is above 80, eat a sandwich or something with protein and carb. My doc has me wear a bracelet and carry a glucagon kit in my purse in case I ever collapse. I feel for you and hope things get better for you.

post bypass surgery and seizures

about 20 months after bypass surgery I had my first partial seizure. I went through all the tests, EEG, MRI and there seemed to be no cause. I have since had 3 more seizures, and they have raised my anti-seizure medication. I decided to do some research on the internet and discovered that seizures from low blood sugar seem to be a complication of the WLS. If someone had mentioned that to me BEFORE surgery, I would have opted for the Lap Band. I will continue with the anti-seizure medications and now pay particular attention to my blood sugar, as well as change diet to low carbs. Thank God for the internet, because my doctors haven't seemed to put this together yet.

Post Gastric Bypass Hyperinsulinemic Hypoglycemia

I am 2 years out from gastric bypass, my weight loss was 123#, which I truly believe saved my life. About 1 year out I started getting dizzy, confused and craved sweets. It got so bad I finally went to see my Dr. I told him I thought it was my blood sugar, but I didn't know if it was high or low. After multiple test he confirmed I had reactive hypoglycemia.

My endocrinologist confirmed and wants me to go on Acarbose to control the hypoglycemia which was induced by the bypass.

My question: Is reactive hypoglycemia and hyperinsulinemic hypoglycemia the same thing.
And: is Acarbose appropriate for this treatment?

Yes it is the same thing.

Yes it is the same thing. Reactive hypo is low blood sugar induced by eating. When eating carbs, the intestine converts them to glucose and releases it into your blood. The pancreas releases insulin to prevent the blood sugar from going too high. With those of us who have had GB surgery, the food we eat enters the small intestine without being properly digested in the stomach. It leaves the stomach too quickly resulting in a sharp rise in blood sugar. The pancreas reacts by releasing an abnormally high amount of insulin which eventually causes low blood sugar. Acarbose slows the absorption of carbs so that we don't get as sharp a rise in blood sugar resulting in a lower insulin release. If you eat processed carbs such as white rice, white potatoes, pasta that is not whole grain, chips, sweets, etc., it doesn't work as well and most of the time you will still experience lows. I have been on Acarbose for over a year and it helps but does not totally prevent lows. Having this condition for an extended period of time will sometimes cause an enlargement of the insulin producing islet cells in the pancreas causing Nesidioblastosis. I waited for over a year before I sought help because I thought it was just dumping syndrome. When I passed out behind the wheel I finally sought help. But waiting so long caused Nesidioblastosis and I am now disabled and have suffered brain damage. I can't stress enough to get help as soon as possible and enlist the help of a reg dietician who can develop an eating plan that will help significantly. There is no known optimal treatment for Nesidioblastosis unfortunately. Just follow your Endo's instructions faithfully to deal with it as best you can so it won't progress that far.

gastric bypass

Jade-how did the doctors diagnose the brain damage? Even when I have 3-4 good days in a row the confusion/memory loss and dizziness doesn't go away. I can actually feel the syptoms the minure they start to drop even when they are above 100-

The info everyone has shared means a lot.

The brain damage was

The brain damage was confirmed by an MRI of the brain and EEG. I had those procedures done about a year prior when I first began passing out and having seizures due to hypoglycemia. By comparing them they could see a significant change for the worst IN JUST ONE YEAR. My neurologist said the abnormalities and changes appear to be metabolic in origin which make him very inclined to blame the severe hypoglycemia. Unfortunately, it is irreversible and we are just trying to keep it from getting worse. The memory and confusion are horrible. I have actually driven in my car and forgot where I was going, pulled over, could not remember and turned around and went home. Didn't remember until three hours later when my daughter called me angry because I hadn't did the errand I had promised to do. Forget about multi-tasking. It is impossible anymore. I used to be a bank manager and had many things going on at once. Forget about that now! If my brain tries to process more than one thing, it is just mass confusion and then panic. The decision to have that surgery has totally ruined my life and the worst part is these surgeons know this is a possibility but choose not to divulge that information because they don't want to scare that potential money away.

brain damage

Hey Jade,


Thanks for taking the time to answer me. I cannot multitask anymore which is why I am home on disabilty for 6-8 weeks trying to figure this out.  I just got back from vacation and now will try to see what I can come up with -diet wise- .  I am starting with 2 weeks of no-carbs then will add I kind of carb back at a time(comples carbs) and see how this affects me. I know anything white-potatoes/bread etc will always be a no.  If you don't mind will you post what you eat in a day?  Also, what kind of protien bars do you eat so you can exercise?  Once again thanks so much for sharing.



Sorry it has taken me so long

Sorry it has taken me so long to get back to you. Sounds like you are doing the right thing. White starches are out for sure. Low, low carbs are the best route. You just have to find what works for you and it sounds like that is what you are doing. Adding one thing at a time is the best way to go. Here is a typical example of my menu: I am NOT a meat person so this way of eating really bites as far as I am concerned. LOL. I eat 2 eggs and 2 low-fat sausage links for BF, then yogurt and 1 fruit mid-morning. Lunch: a meat serving (chicken breast, beef patty, shrimp, fish, etc), a salad with fat free dressing. Aftn snack: veggies with hummus and cheese. Dinner: A meat serving again, 2 servings of veggies (sometimes a baked sweet potato which does not cause a sugar spike for me.) Late night snack: cheese, soy milk with Unjury protein powder. This is NOT counting the carbs I have to eat to recover from hypoglycemia which happens everyday. If I am at home I'll use applesauce, juice, glucose tabs or a banana, etc. If I am out, I'll use glucose tabs or a fun-size packet of skittles (my dietitian recommended them because they are simple sugar, exactly 15 g carbs and they don't melt in your car.) This diet gives me indigestion and constipation but it does help reduce the number of and severity of my lows.

When I exercise, I try to go shortly after a meal. It works best for me, otherwise my glucose level will drop like a rock. I carry glucose tabs or skittles and usually take a few as I am walking or I will pass out before my hour is up. It is usually very unstable for a few hours after exercise too. I have gotten away from using protein bars but occasionally I will eat a Kashi crispy type bar. The rest cause a spike and drop.

How is your low carb trial and error going?


In 2002, I had Roux-en-Y gastric bypass surgery, and lost 100 lbs. I no longer have diabetes, but I have acquired the hypoglycemia associated with the surgery. It began two years ago, and I never knew what hit me ... my daughter found me disoriented, sluggish, and barely able to form sentences. I was sent to a specialist who diagnosed the problem, and have been taking a pill called Arcobose at each meal (when I remember). There were times when I would forget and my blood sugars would go as low as 29. A month ago, I had a session with a nutritionist and we worked on a food plan which excluded many of the carbs that have caused the low blood sugars--no more pretzels, popcorn, potatoes, baked chips, etc. No low blood sugars except for the time when I ate popcorn at a movie. My blood sugar went down to 35. Not eating those carbs and keeping on a low carb diet will have to be a habit of mine if I want to keep the blood sugars in the normal range.

OMG - finally a name -- hyperinsulinemic hypoglycemia?

I have seen the RY-Gastric bypass surgeon, gastroentrologists - for the last 7 years without getting any real answers for the numerous medical issues I suffer post RY-Gastric bypass surgery. It was HERE on the internet I finally have a CLUE as to why I have been so ill, why my life has been so devestated. I don't even know what a normal day is anymore with malabsorbtion, anemia, hypoglycemia etc. There may be a name for all of what I've been going through alone my medical issues may be as so many have described as "hyperinsulinemic hypoglycemia"!

I have been testing my blood sugars for the last 4-5 years. I have dropped as low as 24 and go as high as 300 plus. I can not seem to regulate - my blood sugars. I have to eat extremely carefully as I also have dumping syndrome. On my OWN I started to test my blood sugars the first time happened when I was standing in a pharmacy feeling genuinely ill, at the suggestion of the Pharmacy Clerk, I was at 27. I didn't even know what the normal blood sugars should be at that time years ago. I kept on getting ill, faint and felt something was dramatically wrong with me, so testing my blood sugars became a way of life. I adjusted my diet over and over to try to find what works so my blood sugars don't go too high or too low.

I've had numerous tests and I am not diabetic. I am both angry and feel a sense of relief to be able to may be finally able to put a name to the issues I have as possible "hyperinsulinemic hypoglycemia"! I developed numerous medical problems post RY-Gastric bypass malabsorbtion, anemia, dehaydration, abnormal blood sugars too low or high that have devloped since --- 2003 with what I've been going through for years now without real help of my doctors.

Why couldn't they tell me this - I find out via this blog. The gastroentrologist had put me on Metformin, now Acarbose. I have major hypoglycemia issues, anemia, dehaydration, malabsorbtion issues and I am extremely sensitive to sugars, carbs. Recently the doctors discussed removing my pancreas.

Reading this blog has given me more information in 45 minutes than I've had in the last 5 years from my health care providers. I am truly upset yet feel some relief in finding information for what I may have "hyperinsulinemic hypoglycemia" it as a NAME.

I am going to continue to research this - as I haven't had a medically normal day post RY-Gastric bypass, for a surgery the doctor told me was safe. I wish I would have never had the RY-Gastric bypass - the complications are dramatically life altering and non-reversable. I currently have to test my blood sugars 12 plus times a day, given circumstances. Any input, suggestions or advise on what I should be doing would be greatly and sincerely appreciated as to what I need to do next, what tests, etc.


Your Hypoglycemia

Is there any way you can contact me? I am going through the exact same thing and am starting a movement to get this recognized by more and more doctors so I can stop this from happening to another person. I'd love to talk to you about this. Please email me.

Matthew's picture

Janet, I Will Help You Contact Jeanne

Hi Janet,

I am the administrator of this site. I have given your email address to Jeanne so that she will contact you.

medical issues after RNY

After reading these posts and have been to tons of doctors with no answers or help. I would appreciate any information to doctors in Iowa or Illinios that know how to treat people after RNY surgery that are having muliple medical issues.Thank you, Paula DePardo

please could you add me to

please could you add me to the email info. I have been in and out of the TEXAS MEDICAL CENTER and NO ONE can help me. I am 10 years post RNY gastric bypass. as the other lady said you have help me put a name to this is 45mins of reading than ALL my dr.'s in the last 10 years. I have been on insulin for 3 years now and its starting not to help and my endo. just said today last try PRE-COSE (SP)? i do have to say that it DID help i had a high carb meal and my BS only went to 156, when it would have gone to 300+. Now I'm just waiting to see if i go low! BUTPLEASE CAN YOU GIVE MY EMAIL TO JEANNE. I FEEL LIKE IM DYING AND I CANT FIND ANYONE TO HELP ME THAT UNDERSTANDS GASTRIC BYPASS!

post surgery mystery illnesses

Omg this blog has made me cry!!! There's a name for what's wrong with me!! I am an EMT and firefighter its been killing me because I live day in and day out feeling so ill sugar dropping being anemic and sick when I eat! I have passed out a few times thank everything its been at home but people thought I was drinking and I tried to tell them I had not been and that something was medically wrong and couldn't put my finger onit! It has scared me my boyfriend and most of all my daughter who thank everything finds me when I drop out. I don't regret the surgery because I lost 170 lbs but have been feeling my life fall aprt before my eyes since this stuffs been happening. I wanna play outside with my daughter and have my joyful energetic self back! Thank you for posting and I'm glad I never gave up searching for an answer plEase e-mail me as having someone who understands this to talk to will help me so much!

I am 27 and had Gastric

I am 27 and had Gastric Bypass 15 months ago. I would have episodes maybe twice a month with dizzy spells and labored breathing. The past few weeks have gotten severly worse. I test my blood sugars now 3 times a day and it is always severly low. I range between 40 and 70, now this even eating high protein low carb. It is getting tougher for me to function. I keep putting protein in and it's not working. I;m doing everything my nutrionist has told me to do and my physicians and it still does not help. Glucagon made me sick and so did the insulin. But I will stay positive and I'm looking into the partial pancreaotomy. It's scary to know that this might be my only option and it still might not work. It will all work out in the end though.

Matthew's picture

Hi Shannon

Hi Shannon,

Thank you for your comment. I would advise that you consider pancreatectomy as your last option and not necessarily the best. Have you exhaustively investigated all nutrition-based approaches to treatment of hyperinsulinemic hyploglycemia? It appears you have. It is great that you stay positive and I, too, believe it will workout well for you in the end.

hyperinsulinemic hypoglycemia or something else?

I’m 1 year 3 months into learning how to live with gastric bypass surgery. Had surgery in Oct of 2009. By April of 2010 I began to notice I would experience pre syncope after getting up from a sitting position or from a lying down position. My vision narrows to blackness, my limbs get heavy and tingle, my lips tingle, and my breathing gets labored. I loose balance but never had fallen as I hold on to something to steady myself. The strange thing is during these episodes I’m completely aware and even while my vision is completely gone I’m conscious. I don’t pass out just get these symptoms and a few seconds later short of being a little light headed I’m back to normal. A nuisance, but I can live with it. However yesterday, I was craving something sweet and got up from lying down and walked to the frig. Right before I got the frig I completely fainted and fell. I got up I’m assuming 5 seconds or so later with a scraped knee and elbow. I must of hit the side of my head because my jaw was sore and I had bit my tongue from the impact. I woke up and was in a panic because at the time I didn’t know where I was or how I got there. I was shaken up real good as losing consciousness can do that to you. Maybe 10 minutes later I was able recall my events. But it took me that long to figure things out.

I’m not sure if this is a heart issue or a hypoglycemic issue. My doctor is leaning towards hyperinsulinemic hypoglycemia and is now requiring me to monitor my glucose levels and begin an eating journal.

I sure hope I don’t have hyperinsulinemic hypoglycemia…but we’ll see. I’m questioning this diagnosis because the back story is that when I was 20 (a time when I was normal weight) I had pre syncope and fainting issues for roughly three months but then it went away. Fast forward 14 years later, now that I’m normal weight again, I’m having the same issues and I thought it would go away but now I’m 10 months into it and it hasn’t gone away. But now I’m wondering, did I have hyperinsulinemic hypoglycemia pre gastric bypass or something else? It seems when I had the weight on I didn’t have any of these issues. It’s so confusing…

Had a slight episode this morning after getting up from driving. I didn’t faint, but I took my time getting up and when I realized I was light headed I sat back down for a bit. But when I finally did get up, I was in a fog, a daze...someone was joking around and I remember feeling confused and I couldn’t comprehend all the chatter...that’s what it sounded like to me...chatter. It took me a good 15 minutes to get my full awareness. WIERD stuff to me... Now I’m honestly scared, but I’ll do my journal and my glucose readings to see if there’s any validity to a hyperinsulinemic hypoglycemia diagnosis.

I’ll keep you posted.

Gastric Bypass side effects.

I am 3 years out from gastric bypass and am now completely disabled with side effects.
I have orthostatic hypotension which causes, like you, dizziness and sometimes fainting upon rising. The doctors have tried everything but no medications help.
I then became hypoglycemic. I have been hospitalized twice with severe episodes and with no warning I can drop to 40 and need to eat a quick sweet snack then a good carb and protein meal to control this. I am getting use to having this and can usually ward off a bad episode now because I feel it coming on.
Then today I find out that I am severely anemic and need to have iron infusions to treat my lack of red blood cells and iron. This too can lead to weakness, dizziness and other symptoms such as neurological deficits.
I never regretted my decision to have the surgery until now. I love the fact that I have lost 200 pounds but at what cost??? Why aren't we being warned that this can occur????

It sounds like it could

It sounds like it could possibly be orthostatic hypotension. A sudden drop in blood pressure upon rising. Are you on HBP meds? In my experience with hypoglycemia it doesn't get better like you describe without injesting simple carbs like sugar, orange juice, etc to recover. If you pass out from hypoglycemia you will not wake up until you are given IV glucose or glucagon. The craving of sweets IS an early symptom of hypoglycemia though and is usually accompanied by profuse sweating, shaking and overall weakness then if it continues will progress to mental confusion and syncope. Monitoring you glucose levels is definitely a good place to start. I hope all turns out well for you.

Matthew's picture

Hi Mosie

Thank you for sharing your experience. I am sure others who are having similar symptoms will find your posts valuable . I hope you don't have hyperinsulinemic hypoglycemia. Keep us posted.

Post gastric bypass hypoglycemia

I am 4 1/2 years post gastric bypass. Developed severe hypoglycemia with seizures 1 1/2 years out. BG going as low as 25. Had an 85% pancreatectomy 7/09. Began experiencing hypoglycemia again four months later. Low carb diet helps but does not completely prevent lows. I exercise (brisk walks) 4 times weekly. I ALWAYS go low by the end of the walk even when I consume a light snack just prior to exercise. Meals are not the only cause of lows. I am now a T1 diabetic while at the same time hyperinsulinemic. Talk about confusing!!! I now use a CGM that has been a life saver for me. I have documented and significant brain damage due to the severe lows. Cognitive, concentration and the most severe is my short term memory. Debilitating. Now severe depression with anxiety. I have been disabled for 1 1 1/2 years with no hope of recovery. If anyone reads this that knows of any new treatments, I sure would like to hear from you. Please reply to this post. Thanks.

Matthew's picture

Hi Jade

Hello Jade,

Thank you for sharing your experience. I empathize with your situation. So, pancreatectomy did not actually improve the condition, which is inline with clinical data. I am glad continuous glucose monitoring has helped you a lot. I hope other people that read your comment here can offer some insight.

feeling sluggish & tired after I eat

all of a sutton 2 weeks now i feel tired after i eat i can't even stay awake at home to watch tv, nothing in my diet has changed last time i tooked my sugar it was 64 alittle low and i could tell, i need to figure out what's best for me to eat and what's not not...oh i'm 1 yr & 4 months out of gastric bypass surgery.

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