Fasting for GA but get shakes if I don't eat frequently - help?

[BirdyBedtime]

I am having a 2 hour op under GA in a few weeks. I have been sent pre-op instructions saying that I'm to arrive at 11am, my op will be in the afternoon, so I can have tea and toast for breakfast then only sip water after 8am.

I get the shakes, sweaty, dizzy on occasion when I haven't eaten for a few hours. Usually I eat a huge amount in the morning (breakfast around 7am of 2 slices of wholemeal toast with pate or peanut butter or cheese or egg), small portion of porridge or scone when I get to work (8.30am) then snack on rice cakes, fruit through the morning and lunch sharp at 12. (I am a healthy weight and am in remission from an overactive thyroid in case anyone asks!).

I just don't know how I'm going to cope until my op on only some toast before 8am. By 11am I'll be seriously shaking and I don't know what will happen if I don't eat, as usually when I get like that (eg from being in a meeting without food) I need to have a quick carb hit asap.

I was thinking about glucose tablets as these dissolve and are quickly absorbed so are not sitting in the stomach, but I can't find anything online about whether that would be ok. I've got a pre-op appt a week before and don't want to sound like a hypochondriac but it's a real issue. Anyone out there either a doc/nurse/anaesthetist or have experience of a similar situation?

If you are having a GA you should not be having ANY fluids after breakfast!!! Recheck your instructions!!

Your shaking symptoms sound very, very odd and you should have mentioned this to your surgeon before now.

Even diabetics don't shake like that when their blood sugars drop - if only they did, so many crises could be averted!

Btw what do you mean you are in remission from an over active thyroid? That sounds odd too? Is your thyroid over active, or not?

Shaking, sweating and dizziness are all symptoms of hyperthyroidism but, crucially, they would not be "settled" by eating food so I don't think that is the cause of your shakes either.

Is it possible do you think that your shaking symptoms are a psychological response to a perceived need to eat food? Have you had eating issues in the past?

Zavi, but my instructions clearly say no food after 8am and only water (2 glasses, not fizzy) between 8am and 11am. The GA fasting guidelines were changed from Nil by mouth a few years back.

It's not at all odd to say I'm in remisison as that is the medical term used in my referral letter. I have suffered for many years from an overactive thyroid but am now off medication, but you are never cured from Graves Disease, just in remisison as it could come back. I only put that in because I thought someone might suggest an overactive thyroid as the reason for the shakes.

And, thanks, but I have no eating issues and I can assure you the symptoms are very much physical and not psychological!

Just because you have physical symptoms does not mean that their origin isn't psychological...

The symptoms you describe are just a very, very odd response to have to a short period of fasting. You also sound quite panicky at the thought of the short period of fasting thats on the horizon. That was what made me think your symptoms were possibly psychological in origin.

What do you think will happen if you fast for a short period? I suspect your symptoms would be discomforting but would also be self-limiting. I.e. would not require any treatment.

I think you've probably just fallen into an unhealthy eating pattern whereby you think you need to eat regularly in order to avoid those symptoms, you then start to get panicky if you don't eat, and feel better when you do. A bit of a vicious circle really.

By your own account you eat far more regularly than most people.

No doubt you will say thats because you need to...

This is nothing really more than a bad habit that youve created for yourself and I thefore suspect there is no real medical origin for it. Or cure.

Why don't you start practicing "fasting" for longer periods between now and the date of your op. just to get into the swing of things.

This will help you to feel more empowered and less panicky.

No water after 11am makes sense but that was not clear from your OP.

OP, you really need to contact your consultant and talk about your symptoms. How long have you been reacting like this? Was there any particular trigger for it? Some people just react differently to different things (and although unusual, it could just be your body's way of warning you), but if there was a sudden start then Zavi may have a point about the psychological reaction (e.g. if it started when you came off your medication you might have had some withdrawal symptoms that haven't been managed and are now psychosomatic).

I do know some people who just need a lot higher calorie intake than most people though.

Birdybedtime, mention this to the preop nurse.

Under no circumstances think that a bit of glucose/ water etc won't do any harm, if the stomach content gets into the lungs, the acidity will burn them and that is seriously not good. There are alternatives, when the anaesthetist clarks you, mention the shakes.

Good luck with your op :).

You will be fine. When I was in hospital there was a diabetic lady fasting before her op, and they had some kind of drip to keep her sugars in order, I'm sure a doctor or nurse could explain it. So nothing bad will happen to you if you feel unwell, just let your nurse know.

Assuming that there is no physical reason for needing regular food, remember that when you are fasting, you will not have to do anything. Just sit about getting bored, reading a magazine, etc. The pre-op appointment is the right place to discuss these concerns. I'm rubbish without food, but have fasted before surgery quite easily. In fact, most times I have been starved I was last on the list. Hospital food even tasted good after the procedures because I was so hungry .

I understand where OP is coming from. I can't do the 5:2 diet for exactly the same reasons and it's extremely unpleasant.

This is entirely normal for me and is connected to thyroid issues, underactive in my case. It is not psychosomatic, but is related to the complex relationships between thyroid and adrenal functions, and blood sugar levels.

Best mention that you have a tendency to hypoglycaemic symptoms when you go in - I am sure they will have a way of dealing with it OP - it can't be just us.

I get the same symptoms if I don't eat for a while. I assume it's low blood sugar as I'm pretty fit and underweight.

I don't think your symptoms are that unusual. I used to feel very shaky, sweaty and irritable if I missed a meal while I was premenstrual. Low carbing helped me, as did the menopause.

Um, no. It isn't psychological. I've been the same way for as long as I can remember. In my case it's triggered by a combination of being hungry and exercise/heat (e.g. Christmas shopping). I'm otherwise healthy (no diabetes, weight problem or known thyroid issues). I mentioned it once at a checkup and the GP said it was likely to be hypoglycaemic attacks. It was once bad enough, back in the days of signing when paying with a debit card, that I was suspected of stealing the card I was trying to pay with as my signature was so shaky.

As it's a hunger/heat thing with me, I wouldn't have the same problem that the OP is facing, but I'd agree that you should mention it when you go in. Tell them you get attacks of low blood sugar.

(just to clarify, I had this long before I could have got myself into a panicky unhealthy eating pattern, as the earliest attack I remember was when I was 4.)

Thanks for the last few replies which are much more helpful than the amateur psychoanalysis that came earlier.

I love the way that someone can put a psychological slant on something totally physical. FWIW I obviously DO need to eat more regularly than most as I maintain my weight with the amount i eat and lose weight /get the shakes if i eat less. I've eaten this way for as long as i can remember, long before my thyroid probs.

I will bring it up at my preop appt and see what they suggest as I certainly don't want to risk burnt lungs! I did mention it when i saw the consultant but she said as long as it's clear i could have eg squash up to 11am.

I'd say, try not to worry about it. It's only 3 hours from 8-11 am and you have to get to the hospital in that time. You'll need to pack your things and potter around your house a bit, so the time will pass quickly enough. When you get to hospital, things will happen fast (or they will seem to), you'll be checked in, fill out forms, change out of your clothes, use the toilet several times and be lying down before you know it. Then they'll take your glasses away and wheel you down the hall and the anesthaetist will give you something lovely and the next thing you know someone will be calling your name and telling you to wake up.

Definitely mention that you get shaky--maybe pack some snacks to take with you. I have always woken up starving from GA (once you're properly awake) and IME on the NHS food doesn't tend to arrive quickly!

Good luck! It's never as bad as you think it might be, try not to stress.

Fig - that sounds very similar to me. Thanks.

Good call on snacks for after as if I'm late on the list it'll be a crap nhs cheese sarni by the time i'm awake enough to eat. Or i could ask DH to bring me in some chips (unless that indicates issues with food )

Bear in mind your mouth and throat are likely to be very dry when you come round. I'd order a fruit juice ice lolly if your DH is fetching ... then the chips

I don't think it that unusual to get shakes when you are hungry. I get this sometimes as do other members of my family. None of us are diabetic. As soon as I eat or have a glass of orange juice I am fine again.

Maybe if you are lying in hospital bed you will not be using too much energy so may not be too bad?

I have the same problem, discussed it at my pre op. I was advised to eat porridge the night before. I had a glucose drip when I woke. I get migraines if I don't get my blood sugar up.

I get the shakes if I don't eat regularly. Interestingly, it is much worse if I eat breakfast than if I don't. If I eat breakfast, then within an hour/hour and a half, I get the shakes. If I don't eat breakfast, I can go most of the morning without food and be fine, but then as soon as I have lunch, It's the same.

It's called Ideopathic Postprandial Syndrome.

If you have demonstrably low blood sugars during the shakes, then it is a different condition called Reactive Hypoglycaemia

If it is either of those, you should find that by skipping breakfast, you won't trigger the shakes because you haven't had the carbohydrate load that your body reacts to.

Is there any possibility of going on a morning list?
Then you miss breakfast but shouldn't be hanging around all day if when things are delayed.

I agree with Footle. My brother and I are in our 60s and have these symptoms if we don't eat regularly and sensibly - carbs are your enemy, which is why people who eat cereal-based breakfasts may find it a problem.

It's not at all unusual, apparently - I haven't had an attack for years now, since I learned what to avoid.

Brother and I are both fit, active and within normal weight range - no eating issues!

Yes - agree that, over time, I've learned that carb-based breakfasts like cereal and toast are the absolute worst for bringing on an attack later in the day. Much worse than no breakfast at all. I've got the one where blood sugar measures low during an attack.

Wow lougle those links are really interesting. I have actually noticed that on the (rare) occasions when I miss breakfast my body does react differently in that I just get really hungry rather than the shakes. And, at the weekends when I tend to have a more protein based breakfast I can go a lot longer before needing to eat again. I will have to look into those more.

Unfortunately the way the surgeon does her list is that she always does this op in the afternoon so no chance of the morning list.

I do wonder whether it might be better to avoid brekkie altogether or have an egg and beans rather than the recommended toast. I might try these this week and see how long I last, and will dfinitely discuss it at my pre-op next week.