Hypoglycemia occurs when your blood sugar gets dangerously low, resulting in sweating, the feeling of weakness and dysphoria (the “don’t touch me” feeling you have when you’re sick and nauseous, possibly unconscious, as with the flu), and a variety of other symptoms. You basically go into a state similar to shock. The principal problem, however, arises from low blood sugar supply to the brain, resulting in impairment of function.

It’s a common problem in diabetic non-compliance (not eating low-carbohydrate foods while diabetic), which is especially prevalent in the poor. SABRINA TAVERNISE, of The New York Times reported on a new study in the journal Health Affairs, by Seligman and colleagues of the University of California, San Francisco, in which they analyzed the prevalence of hypoglycemia in low income populations at risk for hypoglycemia, as a function of time since the patients’ households’ last pay day. They found that hypoglycemia increases at the end of a pay cycle in low-income diabetics. They thus concluded that low-income diabetic patients have low access to food at the end of the month, resulting in frank starvation and thus low blood sugar.

I find this to be an unlikely scenario. It’s not that I don’t believe that low-income is tied to diabetes and hypoglycemia at the end of the pay cycle. I do believe it, and the Centers for Disease Control have determined that 8% of the population has diabetes, and that the burden is carried by low-income families. So I think the main effect, increased hypoglycemia in the poor at the end of their pay cycle, is correct (and Ms. Tavernise reports that experts in the field are happy with the methods, so I’m happy with them too as a non-expert in this field).

So what’s my problem with the conclusion? My problem is that it doesn’t necessarily follow that this effect is due to frank starvation. On the contrary, I suspect it’s just the opposite: I suspect that these diabetics are eating too much inexpensive high-carbohydrate junk foods at the end of their pay cycle, rather than starving. That leads to hyperglycemia, followed by hypoglycemia. Hyperglycemia is bad for you, but doesn’t feel as bad as hypoglycemia, and this pattern of diabetic non-compliance leads to the reported effect.

I believe this for two reasons. First, I’m diabetic (though I’m in remission as a result of my bariatric surgery last February), and though I used to experience hypoglycemia occasionally, it was never due to starvation, and it was always due to eating sugar out high-glycemic foods that led to hyperglycemia followed by hypoglycemia. True, I was never low-income, so my personal experience does not match the patients in the study exactly, but my experience does provide a possible alternative that does not rely on decreased access to food (though it follows there may be low access to high-quality, expensive, low-carbohydrate non-junk foods).

The second reason that I don’t agree with Seligman, et al.’s conclusion is that low access to food—starvation—doesn’t lead to low-blood sugar until its advanced stages (as in Sally Struthers’s starving African refugee children with distended bellies. Instead, temporary starvation results in ketosis (essentially, eating your fat supply). But if that was what was happening on a regular basis as reported by the study, obesity would be less correlated with low-income diabetics… but that’s untrue.


No, it follows better that low-income diabetics are visiting the dollar-menu at the end of the month and scarfing down cheap carbs rather than starving (which, in fact, would not lead to hypoglycemia in the vast majority of cases and, quite possibly, would instead be beneficial to the diabetic outcomes on the scale of a day or two each month).

That being said, this doesn’t change the fact that low-income diabetics are having hypoglycemic episodes at the end of their pay cycle as a function of poor diet. But the problem will not be fixed if you provide them with greater access to carbs… you must provide them with greater access to high-quality nutritious low-carbohydrate food.