Use of Tirzepatide for Severe Reactive Hypoglycemia in a Patient with Obesity

Abstract Reactive (postprandial) hypoglycemia is an under-recognized condition that can significantly impair quality of life. Standard management relies on dietary strategies, but refractory cases may require pharmacologic intervention. We describe a 35-year-old woman with class II obesity and recurrent symptomatic postprandial hypoglycemia (confirmed by Whipple's triad) refractory to diet modification and acarbose. Endocrine evaluation excluded insulinoma and other secondary causes. Off-label low-dose Tirzepatide was initiated, and continuous glucose monitoring performed after treatment showed substantially more stable glucose profiles and very few hypoglycemic events. The patient reported meaningful symptomatic improvement over the long term.