I am a registered nurse. With that comes a great deal of responsibility, not the least of which is properly documenting the condition and care of my patients on a daily basis. My goal here is to document my diagnosis and experiences with Hyperinsulinemic Hypoglycemia after gastric bypass surgery (http://www.ncbi.nlm.nih.gov/pubmed/21671112).
I was 48 years old when I had laparoscopic Roux-en-Y gastric bypass on April 11, 2011 and had been in the throes of peri-menopause for over ten years. I never thought the hot flashes I was having weren't part of that change and I never spoke to anyone of waking up in the middle of the night to eat candy or a protein bar because, frankly, it was kind of embarrassing.
All that changed on August 1, 2014 when I had a 'hot flash' that made me hot, sweaty, disoriented, hands and feet tingling and feeling like I needed to sit down. Find a chair and sit, Mimi, fast. I found a chair and dragged it to my computer near the doorway of one of my patients, who was a type II diabetic. She took one look at me and said 'You need to check your blood sugar'. 'Really?' I said, not quite hearing what she was saying. She was adamant, so I had one of my co-workers bring me one of our glucometers. I checked my fingerstick and the number on the meter was shocking, and dangerously low...55 (normal range for blood sugar is 70-110). I looked at it, thinking, this isn't real and checked it again on the other hand...56. Then I rechecked it again...52. I was incredulous. My charge nurse brought me orange and apple juices, peanut butter and graham crackers to eat and an hour and a half later my blood sugar was up to 140 (normal after a meal). Good enough to go home.
I had a scheduled check up with the Nurse Practitioner (NP) at my Dr's office the following Tuesday, so I brought up what happened. The next day I had fasting labs drawn and a glucometer in my hands with orders to check my blood sugar every morning when I woke up and to stay away from concentrated sweets. Over the next two weeks my morning blood sugars were stable, in the 80's and 90's. I only woke up once in the middle of the night and ate a protein bar.
August 18th was my boyfriend's birthday, so I bought him a little carrot cake, his favorite. I had one small bite and then decided to test myself to see if my blood sugar would drop. I ate two lollipops and within an hour I felt a little dizzy so I checked my blood sugar. It was 33. Again, I didn't believe what my meter was telling me and retested twice getting 35 and 36 respectively. I ran to the kitchen, slapped some peanut butter on a slice of ancient grain bread and choked it down with a cup of almond milk. Not an easy feat with a stomach the size of an egg.
The next morning I had a follow up appointment with the NP and I told her what my 'test' had revealed. She discussed my lab work and my parathyroid level was low so she sent me for a thyroid ultrasound which revealed two nodules that were 'too small to biopsy'. She told me to follow up with the bariatric surgeon's office to find out what I should be eating.
The PA at the bariatric surgeon's office had me do a trial of acarbose, a medication which is supposed to slow the release of carbs into your system after a meal. After a week of feeling like I was stark raving hungry, I called her and we decided it wasn't working.
Everyone seemed to have different ideas about what and how often I should be eating. So many differing ideas that it became both confusing and overwhelming as I progressed from being able to keep my blood sugar stable by not eating to having to shove food into my mouth almost continuously in order to keep my blood sugar high enough to stay alive.
As I sit in the hospital near the end of my most recent bout with hypoglycemia (that required a call to 911 from my car on a local highway on November 26, 2014, after my mom's birthday dinner) I can't help but think a continuous glucose monitoring device would be a life saving tool...
Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery
http://www.nejm.org/doi/full/10.1056/NEJMoa043690#t=article
