Oesophageal Patients Association

Insulin based dumping returns....whats going on?


I had an 'ectomy and stomach pull up 2 years ago due to Achalasia. All of my Oesophagus was removed. I made a good recovery apart from the usual stuff, and have been discharged from the support of my surgeons team.

However over the last month or so, I have noticed that after eating any meal, I feel faint and wobbly in my arms and legs, and the slightest exertion makes me litteraly pant for breath. I think that the cause is an Insulin spike, so I will take a Glucose tablet after eating to see if it helps.

Concomittant with this starting I find that my fat absorbtion is poor [my poo has started floating again]. I would like some opinions about wether there is a link between poor fat absorbtion and dumping or any thoughts on why early dumping should start happening again.

Also when should i take sugar after a meal please? Immediatley or only when i feel the symptons?

thanks for any feedback......


4 Replies

Having the oesophagectomy does mean that the vagus verve will have been cut, and you know only too well the effect that this has on your digestive system! It is suprising how well we get to know our own bodies after all this, isn't it!

If you feel instinctively that it is an insulin spike, then you will not be alone. Long term dumping syndrome can make some people diabetic, so you may want to pursue this aspect, especially in relation to testing / monitoring insulin levels.

The glucose tablet should have a dramatic effect in re-balancing things, and should indicate whether you are right or not.

I think that you may well have to think very carefully about adopting low Glycemic index food. This may start you thinking that you are invading the land of the dieters who need to lose weight, but most of the information about low GI foods is done for their needs, and it does not stop the info being useful for you too. the-gi-diet.org/lowgifoods/

Basically, the low glycemic index foods are processed more slowly by the body, especially re sugar absorption, so this helps even out the spikes.

Some people take something sweet before they eat to try and even things out, and sometimes afterwards. I have not suffered any of this personally, and I am only repeating what others have told me. It seems to me a little bit like trial and error, but if you are careful, you will find out what method suits you best, and for what foods.

There is a posh name - steattorhoea - for when stools are a pale colour. They may also be oily, may float and/or have a poor smell. Typically caused by poor mixing of food with pancreatic secretion, and having excess fat in the stools. This is usually treated with creon, which helps digestion of fats. Have you started eating differently lately?

All of which you probably knew anyway, and your real question was about a link between poor fat absorption and dumping starting again. I do not know the answer, but it sounds as if something has changed. I think I would start (again?) on a food diary to monitor what causes most trouble. I would try and see a specialist Upper GI dietician for advice, and I would also think about getting yourself tested for vitamins, minerals and other things that might be a bit out of balance.

Hope it improves soon




I'm going to add a little to what Alan has already outlined. Before I do, I would urge you to discuss your symptoms with your specialist nursing team and also your dieticiain. There are numerous possibilities and the only effective way to sort this out is to undergo some observations and tests.

Having said that I'll tell you what I've learnt over the last 6 years.

1. if dumping syndrome is going to solve itself as does happen for many who have this type of surgery it usually does so within 18 months of surgery. Thos who continue to experience dumping syndrome are probably stuck with it and will need to adapt to minimise its impact on daily life.

2. the transition o undigested food into the gut presents a challenge. In particular the pressence of what the gut believes is are extremely high levvels of glucose. This is what causees the insulin spike and subsequently leads to hypoglycemia when too much insulin has been produced and results in low blood sugar some 2 hours later. If you want to counteract this to some degree try taking something sweet an hour after you have eaten .this can help. If you do go hypo the 2-3 glucose tablets will usually rebablance you.

3. It is worth looking at glycemic load diets. Also try and avoid sugary foods on an empty stomach.

4. There is some evidence that long term dumping syndrome sufferers can become insulin resistant due to the magnitude of spikes incurred over several years. This has happened to me and that's why I'm much more vigalant than I used to be about my intake of sugary foods. That's basically caused by carbs and sodas. So it isn't too difficult to get them reduced in the diet.

5. Malabsorpition is a common problem with this surgery and can be assisted by supplements. Talk to your team and get your blood checked out so that they can see if this a contributory factor. Often a mix of diet and supplements can go a long way to resttoring the balancce.

I wish you well and do let us know if you need more input.



thanks both for taking the time to answer in such detail. taking a sugar cube after eating seems to have taken the edge off things, and I shall continue to experiment to see how this works best for me. i find i feel a bit hypo almost immediatly after eating.

I had taken Creon in the past but not now and stopped because it seemed to have little benefit. I originally thought that my symptoms were due to anemia, but my blood test showed that my haemoglobin was ok at 13.67 whilst my iron reserves were nearly zero, so i am taking iron tablets. The blood test showed no sign of B12 issues.

I think I shall ask my GP to refer me to a dietician at Oxford where I had my op as they have experience with post 'ectomy dumping and take it from there....




It is definitely worth asking for the specialist dietician who has experience of patients who have had this surgery.


You may also like...