Question: I have sucrase-isomaltase deficiency. This is an intestinal enzyme deficiency that means I have extreme difficulty breaking down sucrose and starch. My problem is part genetic and part acquired. My father has a moderate to mild version of the condition. I had a bowel resection 3 years ago. I had 20cm of gut removed. Specifically the end of my ileum, my ileo-cecal valve and the beginning of my colon. This was emergency surgery. I had bowel ulcers and limited necrosis of the bowel. The ulcers and necrosis seem to have been the result of NSAID damage. There was no underlying pathology found (beyond the sucrase-isomaltase deficiency) despite extensive investigation. This operation has made my previously undiagnosed sucrase-isomaltase much more severe. I have been on a starch free and sucrose free diet for 8 months. This has really helped me. However ever since my operation I have had very bad blood sugar swing symptoms. After eating I often pass out and wake up completely starving. I eat and eat but the extreme hunger last for hours. This has improved somewhat with the new diet. It was much worse when I was eating a normal diet. But it is still causing me problems. I have to eat little and very often otherwise I pass out or get very weak. I cannot have any sugary food (like fruit or soup) in the mornings or early afternoon. I also experience this problem with exercise and even moderate exertion. I know intestinal enzyme deficiencies are associated with reactive hypoglycaemia. I believe this could be what I am experiencing. However, the advice given for reactive hypoglycaemia is to eat more complex carbs and I can’t do that. Is there anythingelse I could do? I have been looking for information on how to treat reactive hypoglycaemia associated with an intestinal enzyme deficiency. I bought a blood sugar monitor. I have tested my BSL at the times I feel ill and it has always been very normal. Does this sound like reactive hypoglycemia? What tests should I request? I used to also have irritability and feelings of shakiness and warmth. However thoes have resolved since I have been on the new diet. I am female 24 and 58kg.

Thank you that is very helpful. Would a glucose tolerance test (the kind given for type 2 diebetese) be at all useful? I experience problems following physical exertion and if I don't eat for too long as well as after a carbohydrate XXXXXXX meal. So I am not entirely sure if it is truely reactive hypoglycemia or another type of hypoglycemia. With this in mind are there any other tests you would recommend?