, validating the formal relationship in a clinical setting may be difficult for several reasons. First, seizures are not always witnessed and are often reported after the fact. In children, 75% of hypoglycemic seizures are reported as occurring
at night.5 Second, recording of blood glucose levels before, during, or after seizures rarely occurs. Without this information, it is difficult to determine whether a low blood glucose level was the cause of the seizure. Third, a long duration of diabetes is often accompanied by comorbid conditions associated with microvasular and macrovascular injuries. These injuries could be detrimental to nerve conduction and further confound the relationship between hypoglycemia, diabetes, and seizure. Finally, because of compensatory mechanisms in the body, particularly in type 2 diabetes, euglycemia or even hyperglycemia may occur during and after a seizure. These compensatory mechanisms make correlating the inciting hypoglycemic event difficult, even in a hospital setting.