After bariatric surgery, some people can experience low blood sugars after eating a high carbohydrate meal. Although, this is not your typical dumping syndrome caused by high sugar foods that people can experience after having the gastric bypass.

This type of low blood sugar is called reactive hypoglycemia, also known as “late dumping syndrome.” It is only reported to happen in less than 1% of patients, but it is likely being underreported. So if you are experiencing low blood sugars after eating a meal, please let your surgical center know. 

What are the symptoms of reactive hypoglycemia?

• Sweating
• Heart palpitations
• Weakness
• Confusion
• Shakiness
• Passing out
• Low blood sugars between 50-60 mg/dL

When do people begin to experience symptoms of reactive hypoglycemia?

This can begin about 1-2 years or even 4 years after having bariatric surgery, and happens in both Sleeve Gastrectomy and Roux-en-Y Gastric Bypass patients.

So, just because you had the Sleeve, doesn’t mean you can’t experience low blood sugars after your surgery.

How can I try to prevent this from happening?

There are several ways you can modify your diet in an attempt to manage the symptoms. Per the recommendation above, it is always best to meet with a medical professional and registered dietitian to help navigate your symptoms.

Carbohydrate Control

First, it is actually important to control the amount of carbohydrates you consume during the day. Limiting starchy carbohydrates is the first step in trying to minimize low blood sugars caused by reactive hypoglycemia.

Incorporate Protein and Fats With Meals and Snacks

Including protein and healthy fats like avocado, olives, nuts, seeds, and extra virgin olive oil help to slow down digestion and absorption of the nutrients you ate at that meal.

This is helpful if the cause of your low blood sugars has to do with food moving too quickly through your digestive tract.

Avoid Drinking with Meals

Additionally, make sure you are not drinking with your meals. Try to avoid having any fluids for 15 minutes before a meal, nothing with your meal, and wait 30 minutes after you are finished before sipping on your drinks. 

Be Mindful Of High Sugar Drinks

Avoid ALL high sugar drinks. A general rule of thumb is to keep total sugars less than 5 grams of sugar per serving.

I have also found that caffeine has been a contributing factor in some patients to the low blood sugars they have experienced. If you consume coffee or caffeinated drinks every day, try to avoid them for a period of time.

Eat Regularly

Eat every 3-4 hours. This will likely result in having 5-6 small meals daily rather than the 3 meals daily we typically recommend. Eating smaller meals more often during the day will help to stabilize your blood sugars.

Remember to eat slowly and chew each bite very well. It is helpful to take 20 minutes to eat 1 meal, from your first bite to the last bite. 

Are there other treatments that I should ask my doctor about?

If you have tried all of the above ways to manage your low blood sugars through dietary changes, many need to meet with an endocrinologist.

This is a medical professional that specializes in the diagnosis, management and treatment of conditions that have to do with the glands in the body and the hormones that they produce, like insulin. 

Some people may need to take medications to help manage their reactive hypoglycemia, depending on the root cause of the condition for that person.