Blood sugar dysregulation (dysglycemia) refers to an abnormality in blood sugar stability and can include high blood glucose levels (hyperglycemia) and low blood glucose levels (hypoglycemia). Although most people may be familiar with blood sugar dysregulation associated with certain medical conditions such as diabetes, the reasons for blood sugar dysregulation are many and likely influenced by several biological, psychological, emotional, environmental, physical, and genetic factors. Regardless of its cause, blood sugar dysregulation has been implicated in a host of problematic outcomes. Blood sugar dysregulation not only has been shown to negatively impact one’s mood, behavior, and energy levels but also to negatively impact memory, concentration, and focus. The response to highs and lows in blood sugar levels by suspects, witnesses, and victims likely has significant implications for criminal justice interviews of suspects, witnesses, and victims. Unfortunately, little research has been conducted on this topic. As such, this article serves as a call to action to promote increased awareness, training, education, and research pertaining to the implications of blood sugar dysregulation for interviewing in criminal justice settings.

Factors That Can Adversely Impact Blood Sugar Levels

Several factors can adversely impact the ability to manage one’s blood sugar levels effectively. The following are some of these factors:

• • Alcohol consumption
  • Artificial sweeteners
  • Chronic and toxic stress
  • Dehydration
  • Disruptions in routines
  • Drug use
  • Certain prescription medications (e.g., diabetes medications when not used appropriately)
  • Certain medical conditions and illnesses (e.g., diabetes, eating disorders, malnutrition)
  • Endocrine disruptors
  • Excessive caffeine intake
  • Excessive screen time exposure
  • Extreme conflict
  • Extreme weather conditions
  • Obesity
  • Overeating or undereating (e.g., binge eating and meal skipping)
  • Physical activity level (overactivity or underactivity)
  • Prenatal and postnatal trauma
  • Sedentary behaviors (e.g., prolonged sitting)
  • Sleep deprivation
  • Western diet consumption (e.g., highly processed and sugary and high fat foods)

Considering the factors mentioned above, it is likely that criminal justice interviewers will encounter, on a semi-regular basis, suspects, witnesses, or victims impacted by blood sugar dysregulation issues. Therefore, it is important for criminal justice interviewers to become familiar with the possible signs and symptoms of hyperglycemia or hypoglycemia.

Criminal Justice Interviewing Considerations

Although little empirically based literature has examined the impact of blood sugar dysregulation within the context of suspect, witness, and victim interviews, imbalances in blood sugar levels can likely contribute to issues during the interviewing process.

Criminal justice interviewers should consider that interviewees may be impacted by blood sugar dysregulation issues, which can lead to a range of physical and psychological symptoms, particularly if they have a history of diabetes or related conditions or are exposed to various environmental, socioeconomic, and lifestyle factors that can exacerbate blood sugar dysregulation issues. For example, poverty, homelessness, and food insecurity can all contribute to inadequate nutrition and inconsistent access to medication, leading to difficulties in managing blood sugar levels. Moreover, individuals living in stressful or traumatic environments, such as those experiencing domestic violence or other forms of abuse, may experience increased stress levels that can impact blood sugar dysregulation.

During a criminal justice interview, imbalances in blood sugar levels can significantly impact the interviewee’s ability to provide accurate and reliable information.

During a criminal justice interview, imbalances in blood sugar levels can significantly impact the interviewee’s ability to provide accurate and reliable information. If an interviewee has high blood sugar levels or hyperglycemia, they may experience cognitive impairment (e.g., decision-making, information processing), have difficulty concentrating, and struggle with memory recall. Moreover, they may become increasingly anxious or agitated, hindering their ability to provide accurate information.

Conversely, if the interviewee is experiencing hypoglycemia or low blood sugar levels, they may feel fatigued, confused, or irritable—or they may even lose consciousness. Such symptoms can hinder their ability to concentrate, focus, or recall specific details, leading to difficulty answering questions coherently. Additionally, they may become agitated or less cooperative, making communication during the interview more challenging. This behavioral reaction may also mislead interviewers into concluding that the person has different challenges (e.g., personality dysfunction) rather than understanding the medical cause of their interactions.

In addition to physical symptoms, blood sugar dysregulation can also impact mood and behavior. For example, low blood sugar levels can cause feelings of anxiety, depression, or irritability, which can affect the interviewee’s demeanor and response to questioning. On the other hand, high blood sugar levels can cause feelings of euphoria or agitation, impacting the interviewee’s behavior and ability to provide accurate information.

When encountering an individual with hyperglycemia or hypoglycemia symptoms, criminal justice interviewers should ensure they have water access, as they may become dehydrated, which can exacerbate their condition and lead to further complications. Dehydration can cause blood sugar levels to become even more imbalanced, leading to further cognitive impairment, confusion, and potential loss of consciousness.

Additionally, criminal justice interviewers should consider offering a break to the individual to rest and stabilize their blood sugar levels. For individuals experiencing hypoglycemia, interviewers should refer to their first responder or emergency medical training and provide a source for quick-acting carbohydrates, such as juice or a glucose gel. Also, interviewers should be mindful that stress can cause blood sugar levels to rise, leading to hyperglycemia, which can cause cognitive impairment, contributing to memory recall difficulty and confusion during the interviewing process. These reactions can be mitigated through the interventions suggested above (e.g., providing water, rest, and quick-acting carbohydrates if appropriate).

Throughout the interview, criminal justice interviewers should remain attentive to the interviewee’s altered blood sugar levels, which may contribute to several adverse behaviors and outcomes, and continuously monitor the individual’s symptoms of blood sugar levels imbalances. Interviewees with blood sugar dysregulation issues may present with any or a combination of the following signs, symptoms, and behavioral traits:

In some instances, the interviewee’s credibility may be questioned when the interviewer is unaware of the possible signs, symptoms, and behavioral presentations of blood sugar dysregulation. In the authors’ experience, blood sugar dysregulation may contribute to some or all the following outcomes:

• • Interviewee behavioral presentations may be misinterpreted by the interviewer
  • Interviewee uncertainty
  • Reduced coping abilities among the interviewee
  • Interviewee confusion
  • Interviewee carelessness
  • Interviewee irritability and agitation
  • Interviewee impatience
  • Interviewee hyperactivity
  • Interviewee self-control issues
  • Interviewee mood lability

Understanding the signs and symptoms of hyperglycemia and hypoglycemia is crucial to ensure that interviewees are in a stable condition and able to provide reliable information during the interviewing process. Criminal justice interviewers should be prepared to offer assistance, observe for blood sugar level imbalances, and provide necessary resources to ensure the safety and well-being of interviewees impacted by blood sugar dysregulation issues. By doing so, criminal justice interviewers can ensure that the information gathered during interviews is accurate and reliable.

Suggestions for Further Study

Future studies are needed to examine the impact of blood sugar dysregulation on a range of criminal justice and law enforcement situations, as such dysregulation can potentially contribute to serious miscarriages of justice. Researchers should investigate the role and impact of blood sugar dysregulation on suspect, witness, and victim interviews and consider modifications to existing interviewing approaches and protocols.

In addition, the literature pertaining to the forensic mental health and criminal justice aspects of blood sugar dysregulation is an underdeveloped area of study, and further research is needed to explore how such dysregulation may impact a variety of important topics, including

• • Confabulation
  • Court-ordered treatment completion problems
  • False confessions
  • Forensic evaluation interviews
  • Forensic interviewing of children
  • Investigative interviewing
  • Pre-sentence investigation interviews
  • Probation and parole compliance
  • Suggestibility
  • Waiver of Miranda rights
  • Witness reliability and testimony

Conclusion

Blood sugar dysregulation is a threat to emotional, behavioral, cognitive, and physical health. Interviewees with blood sugar dysregulation issues may be at an increased risk of experiencing difficulties during the interviewing process. However, empirically based research is needed to substantiate this statement. As highlighted in this article, blood sugar dysregulation within the context of the criminal justice system is an under-researched area of study. High-quality research is desperately needed on this topic and its implications for criminal justice interviewing.

Further research is also necessary to establish empirically based guidelines that consider best practices in interviewing suspects, witnesses, and victims who may experience blood sugar dysregulation and the associated problems. It is hoped that the information presented in this article will enhance awareness and understanding of blood sugar dysregulation and its potential impact on interviewee behaviors and outcomes. Until further studies have been conducted and education and training programs have been developed, the following recommendations are offered to professionals interested in furthering their knowledge and awareness of this topic:

• • Review key journals regularly to stay abreast of the latest peer-reviewed research on blood sugar dysregulation within the context of other fields of study.
  • Consult with blood sugar dysregulation experts and develop customized training for the organization or agency.

Please cite as

Jerrod Brown et al., “Interview Considerations—Blood Sugar Dysregulation: A Beginner’s Guide for Criminal Justice System Professionals,” Police Chief Online, August 30, 2023.