If a patient is symptomatic and blood glucose is normal, diagnosis of postprandial syndrome can be made.
Caveats:
An oral glucose tolerance test should never be used for the evaluation of suspected postprandial hypoglycemia [2] because the nadir for blood glucose concentration after the ingestion of 100 g of glucose may fall into the hypoglycemia range in normal, asymptomatic individuals [3].
Postprandial (reactive) hypoglycemia is a descriptor of the timing of hypoglycemia and is not a diagnosis. When biochemical evidence of postprandial hypoglycemia is confirmed, the cause must be determined. Samples should be analyzed only in those time points in which the plasma glucose concentration is less than 45 mg/dl (2.5 m mol/l).
Procedure:
1.
Perform the test after an overnight fast.
2.
Hold all nonessential medications.
3.
Have the patient drink ensure plus high protein drink (6 ml/kg with max dose of 360 ml).
4.
Draw blood for plasma glucose, insulin, C-peptide, and proinsulin at 15, 30, 60, 90, and 120th minute and at 3rd, 4th, and finally at 5th hour (see number 7). Observe the patient for symptoms and/or signs of hypoglycemia, and ask the patient to keep a written log of all symptoms, timed from the start of meal ingestion. If possible, avoid providing carbohydrate or food until the test is completed [4].
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