Dumping/Diabetes

Could someone please explain to me the difference in layman's terms between what happens to me when I get dumping and someone having a diabetic hypo. I am almost 8 years post op and when I used to get dumping in the early days, it started with me being totally covered in sweat, feeling dizzy and shaky and felt completely wiped out. Now its not quite as strong, I don't get the sweat's as much but still feel dizzy and shaky and as a warning sign I often get what appears to be light's at the outside edge of both eyes. This seems to be happening to me more frequently than before so I am getting a little concerned about it. I know if I have a drink of coke and a Mars Bar I will be fine in half an hour so this is obviously a sugar based problem so any advice that I could present to my GP would be welcome as I want to discuss this with him and not intending any detriment to my GP, I'm don't believe that he has much experience on the subject of dumping.

Thanks

Steve

20 Replies

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  • Hi Steve

    Hi Steve,

    I had hypoglycaemia when I was 18 which was explained to me as my body allowing sugar to build up in my blood and then reacting with too much insulin and taking it all out which made me feel sweaty, faint, dizzy etc and to balance it I took decreasing amounts of sugar over a few hours to balance it back to a level line. Dumping it seems is similar as the gut absorbs water to deal with the food (sometimes causing the cramps etc) which transports sugar back to the bloodstream and triggers insulin production, since the sugar levels are suddenly raised the body efficiently works to remove it (a tad too efficiently as we only produce a one off hit of sugar) therfore we add sugar I use dextrose tabs and then something a bit more slow release to balance. Friends use boiled sweets, orange juice, dolly mixtures, lucozade etc As you say you learn how much is right for you and which foods or actions are guaranteed to cause dumping although there are often times I get it and have no real idea why. Your comment on light at the outside edges of your eyes is interesting as I have just started getting a strobe like flash on the outside edge of my vision too. I thought it might be a light migraine but would be interested to know what your GP says.

    Cheers Lizzy

  • Thank you for your comments Lizzy. Your dumping issues sound similar to mine and as you say apart from the lights. I will post on this when I have seen my GP.

    Kind Regards

    Steve

  • Hi Steve

    That is very interesting. I am coming up to three years post op and my symptoms have followed yours exactly, including the 'lights' which is a good way of describing it. We have a meeting of our local support group to discuss after effects later this week so I will bring this up.

    On another topic, I offered myself to help with the awareness campaign which I heard was launched today on the radio. I was interviewed over the phone and provided a detailed account of my 'story' but then heard nothing at all. I wonder if others on the site had a similar experience?

    Best wishes

    Martin

  • The Awareness campaign has started today. There is a piece in The Mirror and also the BBC website, and no doubt others to follow. bbc.in/15yeSfx

    mirror.co.uk/news/uk-news/t...

    Regarding the dumping v hypo issue, they are both created by too much insulin, so I am not sure that there is a difference as such. Have a look at the material on Food Workshop 2013 on the OPA website, which you may find helpful:

    opa.org.uk/pages/factsheets...

    Having the coke or other sugar-rich drink makes a rapid change to the balance and makes you feel better short term, but the real problem is trying to reduce the sudden insulin spikes in the first place. You may have done this already, but cutting out food with a lot of sugar / processed sweeteners (which includes stuff like white bread - see the low GI information as well), or carbohydrates that generate a lot of glucose suddenly in your system, will tend to smooth out the rapid rise in insulin. Adopting a diet as if you were a diabetic may also help.

    Protein tends not to cause a problem, but you might get problems with the texture of some meat. But eight years after surgery you are entitled to think that your system has settled down!

    Asking for a meter to measure your insulin:glucose level would be a good start.

    And do not forget that some people do become diabetic anyway, and having the surgery is not a guarantee against developing other kinds of conditions in due course.

  • Thank you Alan, lots of interesting reading there and it has certainly given me food for thought.

    Kind Regards

    Steve

  • Sorry Alan, your link does not work:

    404 Error - Sorry, the requested page /resources.html does not exist on this server.

  • Try this one instead? opa.org.uk/pages/factsheets...

    Some of the material has been taken down from the OPA website though, but the Dumping Syndrome ones can still be downloaded.

  • Hi Martin.

    Thank's for your comments, I'm glad to hear that I'm not the only one who has had "the lights".

    Thought I might be getting abducted by aliens -lol.

    Kind Regards

    Steve

  • To address the headline question: There is no real difference between hypoglycemia in dumping and diabetic hypoglycemia. Both are due to low blood sugar as a result of a spike in insulin. Late dumping is usually considered to be an insulin spike after quickly absorbing sugars dumped into the small bowel.

    The only clinical difference is that someone with dumping can adapt more readily to these changes, whereas diabetics either don't produce insulin or are less sensitive to its effects. Diabetic hypo is usually after a diabetic injects an insulin dose that is too large for the meal they eat or either don't eat after an injection.

    A diabetic cannot regulate their blood sugar normally without outside help (medicine, insulin, etc), whereas someone with dumping can. The dumping victim sometimes needs a little help (sugar) to raise the blood sugar up, but then their body should regulate the sugar normally after that.

  • Thank you Chris, that has explained thing's very well, all these comments are giving some great info to discuss with my GP.

    Kind Regards

    Steve

  • REPEATED FROM :- healthunlocked.com/oesophag... - with some edits

    It is difficult to explain this syndrome without diagrams ..but here goes :

    Dumping is a mechanical problem which then can lead to a bio-chemical problem called hypoglycemia.

    Thus there are two distinct stages.

    The normal gullet/stomach arrangement is similar to an hockey stick [ resembling the letter 'J' ]. Food descends [not by gravity but by waves of peristalsis or rhythmic squeezing ] the long thin pipe (the Oesophagus) and lands at the bottom of an expandable elastic bag (the Stomach).

    As the bag fills up and expands the level of chyme [liquid food combined with digestive juices] remains below the level of the outlet [the pyloric sphincter] The muscular walls of the bag churn away until sensors detect that the meal has reached a suitable state of digestion (mechanical breakdown and chemical breakdown by saliva,acid and protein enzymes) whereupon the pyloric sphincter relaxes momentarily and a small dollop of chyme (only about 3 ml) is extruded through the opening and on down around the bend into the Duodenum.

    The size of each dollop is about one percent of the meal and the frequency of passing is about once a minute so it takes approximately one hour and forty minutes for the entire meal to be passed. All this is variable depending upon how much of which foods were consumed.

    It is easy to see that when the stomach has been cut down from a normal capacity of 45-75 ml (empty,resting) & 1000 ml (average meal) & 4000 ml (gorged) to only about 300ml (a mug-full,when fully distended , post op) and also pulled up high into the chest then the foregoing original elegant arrangement has been completely destroyed.

    So if you overload the new relatively tiny stomach tube it's retention abilities are over-stretched and the entire contents can suddenly avalanche down.The pyloric sphincter valve cannot be relied upon to act as as a stopper since it is under tension;having been pulled up with the new stomach tube and it's regulating nerve supply (the Vagus) has been cut wholly or partially.

    This tendency to avalanche is exacerbated by (1) eating too much (2) eating too fast (3) having too much lubrication, that is liquids and (4) imposing strain by moving about.

    Now for stage two.

    Waiting downstream in the duodenum is a sophisticated set of taste sensors connected to the brain.

    Crudely put when a larger than expected 'dollop' arrives these sensors send 'panic' signals calling for for instance extra detergents to deal with detected fats which results in the gall bladder contracting and supplying a shot of bile.

    Via a separate pathway and in anticipation of the breakdown of that extra food and its absorption into the blood stream Insulin is secreted by the Pancreas.This secretory response is stronger if the 'avalanche' has an high carbohydrate content- the GI rating.

    Although osmosis is beginning to play a role at the beginning of the Duodenum the water balance is a very minor factor in the context of blood sugar. Indeed some authorities postulate that it may be helpful given that by drawing water into the intestines so reducing blood volume then blood sugar concentration per vol is increased.

    The action of insulin in the blood is to cause cells throughout the body to extract sugar from the blood and store it, ultimately as fat.

    If at the onset of dumping blood sugar levels were already low [ say you had had a walk and it was several hours since the last meal ] then the prematurely high levels of Insulin can deplete blood sugar to a point where coma,convulsions and even death can ensue.

    The liver's normal,natural Glucagon response will kick in eventually but not in time to avoid the hazards of a seizure or indeed brain damage from prolonged low blood sugar with unconsciousness.

    A characteristic of an "hypo " is that we become highly irrational and aggressive.Thus by the time that advanced stage is reached it is very difficult for a third party to intervene to rescue you. You will be unable to swallow sugar in solid or liquid form and the paramedics will struggle to find a vein that isn't collapsed in order to administer injectable Glucagon.

    The restorative antidote is sugar,immediately and in any form. Sugar lumps ,Lucozade (caffeine is contra-indicated), whatever ...personally I rely on Werther's Original taken the moment that the presentiment of being light headed and ill-at-ease,are recognized.Hopefully early enough to head off the ensuing symptoms of cold,sweatyness,trembling,disturbed vision. My standard 'dose' is invariably 7 sweets chewed quickly.

    Thus the trigger factors are :- Volume/Speed/Content/Liquidity/Movement.

    You can permutate these in any combination to suite your personal circumstances.

    I find that I can eat and drink any reasonable volume of anything provided I remain seated for at least 100 minutes after the last mouthful.For me this time interval is critical since it allows for the stomach tube to empty fully at it's normal slow pace. Conversely if I bolt down half a sandwich [carbohydrates] and then get in the car (walking and sitting with compression) to drive somewhere then I will be Hypo within the next two hours.

    I have the record of ambulance admissions to A&E and the broken bones from falling and convulsing to evidence the penalties for getting that balance wrong !

    PS:

    Clearly suggestions from some quarters that we should live our lives as if we are diabetics is, in my opinion an overreaction, particularly since Glaecemic Index is only one actor in the interplay of several factors.

    You might want to ponder if there is a lesson to be learned from the fact that during 6 weeks observation in hospital and out of boredom, stuffing myself with relatively high GI ward food, I never once went Hypo - why ?

    Because I was completely immobilized with a fractured spine ! (Due to a Hypo seizure)

    So for me at least movement is the key factor in controlling this horrible condition and that has protected me well for the ensuing 16 years. Of course the enforced hanging around is very tedious but my reading is up-to-date.

  • great article and answers a lot of my questions - just what happened to my husband recently, not much food all day then on coming home had quick snack, then off on farm machine to lift four heavy tyres on to back of machine, ate large amount of blackberries from hedgerow on way round, began to feel odd and almost fainted.

  • Hi Gutlesswonder.

    Thank you for going to the trouble of providing a very thorough and comprehensive answer to my question. It makes very interesting reading and is easily understandable.

    Kind Regards

    Steve

  • Very interesting gutless . Now I understand why I frequently have a hypo when/just after driving down to care for my mother mid morning .

    Relatively empty stomach ( because minimal breakfast hours previously ) grab something to eat which I munch while rushing round house getting ready to leave ,sit in car .

    And the visual disturbance ! Strobe describes it well ,it's like having a thousand watt light flashed in alternate eyes .

  • Hi Steve

    did you get an answer re the flashing lights at the edge of your eyes?

    Cheers Lizzy

  • Hi Lizzy

    I did mention it to my GP and he didn't really have to much to say about it, to be quite honest I don't think he is very well up on dumping. It makes me wonder how often a GP in a small village would come across this problem. I am still looking into it so if I come up with anything new I will let you know. It is strange but I don't get the flashing light's every time and different things can bring it on sometimes it's what I have eaten, sometimes overexertion, sometimes it's when i am mentally tired so it is hard to put it down to any one thing.

    Kind Regards

    Steve

  • An optician will tell you about 'flashers and floaters' that appear in your eyes. At the worst, flashing can mean a deteriorating / detaching retina so it is always worth getting this checked out properly. Which is not to say that disturbance to vision cannot also be caused by other things as well of course.

  • Hi Alan.

    Thank you for that, it's always good to know these things. Luckily I had my eyes tested last month so hopefully they are ok.

    Kind Regards

    Steve

  • Followed this with interest. I have similar experiences to Steve with dumping and hypo episodes with the added complication of a liver disease. I monitor my blood and they have been known to go as low as 1.4. My doctor has advised I call an ambulance should they go below 2.5.

    I hope you get the information and support you need Steve.

  • Thank's very much for that Itchy. I am considering monitoring my blood levels to see if i can get a handle on what's going on. Long live the Simpson's.

    Kind Regards.

    Steve

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