A Veteran Presenting With Symptomatic Postprandial Episodes

Idiopathic postprandial syndrome (IPP) presents with hypoglycemic-like symptoms in the absence of biochemical hypoglycemia and remains a diagnosis of exclusion. Its pathophysiology is poorly understood. The diagnosis requires thorough evaluation and the Whipple triad criteria. Treatment typically involves dietary modifications, including reduced carbohydrate intake, increased protein and fiber, and frequent small meals. Continuous glucose monitoring (CGM) may be a useful adjunct in correlating symptoms with glucose trends, but its role is still evolving.

A 41-year-old male veteran presented with chronic postprandial episodes characterized by lightheadedness, nausea, tremulousness, anxiety, and other adrenergic symptoms occurring after carbohydrate-heavy meals. An extensive workup was unremarkable. CGM confirmed normoglycemia during episodes, ruling out true hypoglycemia and supporting a diagnosis of idiopathic postprandial syndrome. He was referred to a nutritionist for guidance on a high-protein, high-fiber, low-carbohydrate diet and subsequently reported symptomatic improvement.

This case highlights the importance of recognizing IPP as a distinct clinical entity, especially due to its nonspecific clinical presentation. Early identification allows for a more accurate diagnosis and targeted treatment through tailored dietary and behavioral strategies, helping to alleviate symptoms.