I had a fantastic weekend. I truly did. After living in Texas for 10 years, it’s a travesty that I had never seen Austin or San Antonio until this summer. I did see a bit of Austin a few weeks ago, but that basically amounted to just dinner. This time, Kaitlin and I decided to tackle both cities, with the help of Travis and Jina. More about the fun stuff later.
Dinner on Friday night was at El Chapparal in Helotes, Texas. I do love Mexican food, even if it is high in fat and calories. I generally feel like I can get a good amount of decent protein and thus I justify my food choices without guilt. So on this particular evening, I ate in a manner that is typical of me at three years out, splitting an entree with Kaitlin and having a Shiner Bock, but skipping the rice. Afterward, we went to John T. Floores for the Brandon Rhyder show. We had some time to kill before he was set to come on stage, so we sat out on the patio. All of a sudden, I felt nauseous.
I should backtrack by explaining that I had some gut pain for a couple of hours prior to making it to John T. Floores. I occasionally do experience this, so I took an Ultram before dinner and another after dinner to keep it at bay. At the point at which I felt sick, I assumed that a)I was full and maybe was realizing I ate a couple bites too many and b)the nausea was related to the gut pain.
Within seconds, however, I started seeing spots. I looked up at Kaitlin and Travis (I was seated on a stool) and I saw Travis mouth “Are you okay?” I couldn’t speak. I was able to shake my head no. That’s it.
Kaitlin explains that at this point, I appeared to be having an absence seizure. I have been told before that this is what it looks like when I’m having extreme low blood sugar. I blacked out momentarily and slowly started coming to. I couldn’t shake it off, but I was trying. Kaitlin had a protein bar out of her purse and I had glucose tabs in my own purse. I still wasn’t coherent enough to put them in my mouth.
So, what was happening to me? It’s often talked about in weight loss surgery circles these days, but generally by those who are already suffering from it. It is not discussed frequently enough in pre-op education as one of the common complications of RNY Gastric Bypass. Here’s a great explanation from Kaitlin at The Bypassed Life.
What Is Reactive Hypoglycemia?
Reactive hypoglycemia is low blood sugar that typically occurs one to three hours after eating. Experts speculate that it is the result of an excessive insulin response. The body releases insulin in response to a carbohydrate meal, but the insulin response continues past the digestion of the meal and the disposal of the glucose derived from the meal. Symptoms may include shakiness, lightheadedness, sleepiness, anxiety, or confusion.
The Gastric Bypass Connection
Reactive hypoglycemia is common after gastric bypass surgery because of the lack of a pylorus. Following gastric bypass, food passes through the pouch via the stoma. In many cases, this can occur relatively rapidly, leading to quick absorption of carbohydrates in the small intestine. Under normal circumstances, the pylorus gradually introduces food into the small intestine. Following gastric bypass, the mechanism for moderation is removed, and food is “dumped” into the small intestine. This is the same mechanism behind dumping syndrome.
After what seemed like ages, I came to enough to speak. My guts hurt too bad to eat the protein bar, but Kaitlin made me do it anyway. The glucose tabs I keep handy chew down to nothing and that brought me back to coherent almost immediately. I chugged half of Jina’s water bottle and started feeling present again. So, I was lucky. Kaitlin and Travis both knew what to look for and understood what was happening to me and how to help. But what if I was alone or with people who don’t know how to help? Here’s five things I will never go without again:
1. Medical Alert Bracelet
Recently, I donated to Rob Portinga’s (Former Fat Dudes) Dash From Obesity and I won a prize. WOO! It was a gift certificate to Lauren’s Hope. If you don’t know about Lauren’s Hope, you should definitely go check them out. You can order attractive medical ID bracelets that get the job done, but don’t… uh… cramp your style. This was my second Lauren’s Hope bracelet, and I consider it an investment in my health. They are beautiful and well made. I also just ordered my very first Road ID so that I have one that is more rugged to wear when I am running or whatever other madness I get myself into in the future. Bonus: at $15.99 it is a much more affordable option than Lauren’s Hope if you are on a tight budget. On my Road ID, I also added the line that I wear hearing aids. I typically do not run with them in my ears, so this would alert any medical personnel that they need to speak loudly in order to communicate with me.
My new Lauren's Hope bracelet
I ordered it in pink, of course...
2. ICE (In Case of Emergency) Card
A medical ID tag is entirely too small to contain all the information I might need an EMT to have if I am unable to respond. Also, I need to provide more than one emergency contact since my family lives far away. Having a small ICE card with this information, written neatly and concisely, is like an addendum to the alert bracelet I have on my arm.
3. Glucose Tabs
Because my blood glucose can bottom out at a moment’s notice, it is imperative that I have fast acting glucose tablets in my purse. They chew down to powder and are thus easy to swallow when I am having gut failure or am not 100% alert. I know some people use candy instead of glucose tablets to treat low blood sugar, but to me I regard a tablet as “medication” and won’t be tempted to eat it randomly when I am not sick. When suffering from low blood sugar, chewing 3-4 tablets should bring your levels up to normal within about 15 minutes, but you shouldn’t stop there. Eat a small snack with both protein and carbs immediately to prevent a second blood sugar crash from occurring.
4. Protein Bar
With reactive hypoglycemia, it is important to plan ahead to prevent blood sugar crashes. It is important to eat small, frequent meals throughout the day with a balanced amount of fat, protein, and carbohydrates to keep blood sugar levels stable. Keeping a protein bar handy serves several purposes. First of all, it is a safety net in case life throws you a curve ball and you are unable to eat a planned meal or snack. It also serves as an emergency measure to bring up blood sugar in case of a crash. However, be sure to read the labels on your protein bars. Many of them are no better than candy bars in terms of nutrition. Choose something that contains a balanced amount of protein and carbs. Also be sure to regard them as meal replacements. They can be quite calorie dense and a hindrance to you if you are still in the losing phase or are having difficulty with maintenance.
5. Glucose Monitor
After passing out face first in my bedroom over a year ago, I made sure to get to a doctor. Although that particular instance was related to a fast drop in blood pressure (vasovagal syncope), my doctor and I agreed that it would be good for me to start monitoring my blood sugar. I had suffered milder symptoms prior to this event that I recognized as being blood sugar related. I would get shaky, lightheaded, and cranky. Sure enough, I began catching low blood sugar episodes. I would be in the 40-60 range without even realizing it. Normal fasting blood sugar ranges between 70-99. I do not check my blood sugar daily, but now that I have had two severe crashes in the span of just a few weeks, I have decided to take it upon myself to do multiple checks daily, before and after meals, for a period of time to see if a pattern emerges.
Another note… Because this was my second episode of this severity in the span of a few weeks, I know I need to be extra vigilant in my food choices and that I need to be prepared for any future occurrences. I recognize that I have become lax during the lazy days of summer and my recovery from skin removal. I also need to speak up when I’m not feeling right. I have a tendency to stay quiet and think I can handle it on my own. Asking for help right away can prevent serious injury, so don’t be afraid to speak up! Your friends really do not want you to have a head injury, in spite of any ribbing they may be giving you on a day to day basis!