Where does Insulin inbalance figure in post operative upper GI surgery?

[medway]

5 months after a Merendino interposition, 10cm of jejunum between my oesophagus and 2/3 stomach, I still get bad stomach ache or cramps after eating with lots of wind and have not identified the reason why as there seems to be no pattern. My local doctor who was a surgeon suggested I was suffering from sudden surges of insulin causing the pain/wind as it is sometimes followed by feeling weak and wobbly which he says is the effect of too much insulin and I then need to take a sugar cube. Comments?

Nowhere in any of the literature have I seen insulin mentioned. I am not a diabetic. Is there any corrolation between insulin and bile? Could it just be bile? I have no reflux.

[OPA_LarryR]

Hi - let me start by emphasising that we're not medical people here and every patient is different - both the diagnosis which led to surgery AND the extent/type of surgery undertaken.

Having stated that the symptoms you describe are closely associated with "dumping syndrome", which is a common side effect of oesophagogastric surgery.

Essentially it is caused by under digested food entering the gut too quickly. Something that is well controlled pre surgery.

This leads to cramping and wind as you describe.

It also can result in the over production of insulin which in turn can result in a low blood sugar condition called hypoglycemia. The low blood sugar outcome is due to the fact that insulin is very aggresive and doesn't stop removing sugar until it is exhausted. So if you over produce it hunts down the sugar reserves which are in the brain. Because of this low blood sugar often manifests as feeling weak/faint.

There are some things you can do to help if this is found to be the underlying reason for your symptoms.

Low Glycemic Index and Glycemic Load diets will help as they favour slow release foods that do not spike your system. After this type of surgery some patients do not do well on sugary diets. That includes carbs such as bread, cereals and potatoes.

If you do get the symptoms, take some sugar. Again I know that sounds conter intuative but once your levels are depleting a few sweets or glucose tablets can assist in stabalising the condition.

Also remember to eat little and often. Also in my own experiences, don't move around after eating and don't drink lots of liquid while eating.

Hope some of that helps. I'm sure that others will offer their advice also.

I wish you well.

Larry

[Hidden]

I am glad Larry replied to this - he understands it much better than I do!

I do think that many of us need to understand this more clearly. So much of the dietary and nutrition advice seems to need turning on its head from conventional situations! There is a brief bit about low glycemic food on the SOSG website sosg.info/diet.aspx

Alan

[medway in reply to Hidden]

Thank you both. The SOSG diet comments are very helpful. Over eating is probably one of my problems as i have 2/3 stomach and can eat a normal size meal but I must think smaller.

Interesting comment about insulin. I'm worried about taking a sugar lump too early. My doctor suggests only when i feel wobbly but dont always get this.

Also interesting that bread with grains is good. Came off this for stodgy wholemeal which is difficult to swallow. Back to grain bread.

I like the alcohol in moderation comment. I've been banned ! My surgeon says there is no evidence that alcohol causes cancer but if it does it took 66 years to do so, so i'm now clear for another 66 years....!

[Hidden in reply to medway]

With the late dumping, it is the process of the food rushing through the body at an abnormal speed (ie your digestive tract is so much shorter) that is tricking your system into releasing large doses of insulin, which in turn causes the dizziness / dumping syndrome. So taking something sweet early spreads the signals out to create less of a spike.

It is definitely a good idea to eat smaller / little and often. Don't give yourself further punishment by 'normal' sized meals!

[StephanieC]

I had never heard of a Merendino procedure previously, and your description is the first to pop up on Google when I tried to see what it was!

It does sound like a case of overeating/dumping given the symptoms you describe however given the surgery described this is a little surprising as it sounds to me that from the bottom 2/3rds of your stomach your gastrointestinal tract is intact?

I completely agree with the suggestions given above and hope these will help. It may be worth trialling a course of probiotics as well "Actimel" "Yakult" or a capsule form. If taking the drinks I would try 2 a day for 6 weeks. Also peppermint oil capsules may be helpful when you experience the symptoms, you can get these from chemists/large supermarkets - and if they work you can ask for them on prescription.

To my knowledge there is no relation between bile and insulin.

I hope your symptoms improve as time progresses, I am sure your new digestive tract is still finding its way. Make sure you chew your foods very well to make life easier on yourself and eat slowly.

[medway]

Thanks Stephanie for your comments. There are obviously differences with the Merendino op against the full pull up. its supposed to have less effect on your life and i'm informed the survival rate is excellent assuming the surgeon 'gets it all'. In my case I have been told so.

I did have a spell for 2 weeks with no problems and I was taking Lactulose to keep regular, Kalonticon gel similar to Gaviscon and Actimel. I returned to them 3 days ago and no bad belly aches at this time. It may be backing up in the digestive system that causes the belly aches. I occasionally get the sweats which I think is dumping. My surgeon thinks so.

I do find that sometimes it is difficult to swallow after a few mouthfuls due to wind that is already in the stomach and a kink, on purpose or not I dont know, in the jejunum makes it difficult to get rid of the wind when the food is piled up. A few minutes later after the food has gone down, I can continue eating ok. i was not informed of the kink until i got a copy of a letter to my doc. This must be why i get no reflux.

I hope these comments on the fairly rare Merendino op are helpful to people with just T1 who want to remain active. I now do everything including upside down!

[telo]

Hi Medway

Found this site as I was searching for a reason for my stomach cramps. Had an Ivor Lewis op in May 2011. Apart from a couple of real minor problems I am going really well. I suffer from the odd case of being sick in the middle of the night, the common denominator appears to be deep fried food, so I try to give that a miss now. The other problem is quite sever cramps after I eat, but only appears to happen in the mornings! Today I realised that I think they may be caused by eating cereals, and after reading a few things on here about GI food, I think I am right. Think it may be a combination of the sugar, fibre and eating/drinking at the same time. Going to stick to toast for breakfast for a few mornings and see how it goes.

Best wishes

Terry

[medway]

Hi Telo. I think everybody is different. My problems occur latter in the day. I'm ok in the morning. Overeating definitely makes it worse as does too quickly. Also if you have wind in the system before you eat. What I eat desn't seem to be a factor as I never know when I will feel ill. One day something may make me feel ill and the next time I'm fine.

Seems to be trial and error for each person.

[jay2908]

Yes, it is a bit random. To help prevent pain and bloating try taking some movicol, it's a gentle laxative. I tend to take it as soon as I start to suffer from bloating, but prior to my next meal. I guess the key is to keep the digestion moving.

[medway]

I'm now convinced that insulin imbalance can be a factor (although i have not had the pull up method). I've been doing really well and nearly back to normal but last week got over confident............

I was on a recovery holiday in Greece and overdid it food wise as i thought i was ok. Wrong. I had a larger than normal meal, starter and main meal and then felt very full and rough and laid down for an hour and fell asleep. Woke up fine, had 2 sips of pepermint tea, but 2 minutes later VERY hot and sweaty and then felt like I was going to die. felt really ill. We know a piece of sugar is the remedy for too much insulin, so my wife gave me a piece of sugar and 5 minutes later I was fine.

I think this is conclusive that insulin dumps can occur making you feel ill, so the question then is, is all dumping to do with excess insulin? The problem with the sugar lump test is that if you take a lump of sugar and its not excess insulin you are suffering from it may cause too much insulin and make you feel ill.

The answer in my opinion is that if you feel really ill, very hot and sweaty, try a lump of sugar but not if you have any other symptoms than these.