Reactive Hypoglycemia: This condition is characterized by a rapid drop in blood glucose levels after consuming a high-sugar meal, which matches the patient's symptoms. The body overproduces insulin in response to the high sugar intake, leading to hypoglycemia.

Insulin Resistance: Often associated with obesity, insulin resistance can lead to fluctuating blood glucose levels. The body's cells become less responsive to insulin, causing blood glucose levels to rise, but the pancreas may overcompensate, leading to hypoglycemia after meals.
Type 2 Diabetes: Although the patient's glucose levels are fluctuating, the high reading of 14.1 when fasted suggests impaired glucose regulation, which is a hallmark of type 2 diabetes. The obesity and rapid glucose fluctuations support this diagnosis.

Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to hypoglycemia. Although unlikely, missing this diagnosis could be life-threatening, and the patient's symptoms of hypoglycemia after meals could be indicative of an insulinoma.
Adrenal Insufficiency: This condition, where the adrenal glands do not produce enough cortisol, can cause hypoglycemia, especially when fasting. It is crucial not to miss this diagnosis, as adrenal insufficiency can be life-threatening if left untreated.

Gastric Dumping Syndrome: This condition occurs after gastric surgery and can cause rapid gastric emptying, leading to hypoglycemia after meals. Although rare, it could be considered if the patient has a history of gastric surgery.
Factitious Hypoglycemia: This condition involves the intentional ingestion of insulin or other hypoglycemic agents, leading to hypoglycemia. It is essential to consider this diagnosis, especially if the patient has access to these medications or has a history of factitious disorders.