An excerpt from Sugar Free.

“What do you want to do?” Ginny said.

“Chinese jump rope.”

“Tilly, you always want to play Chinese jump rope,” Renée said.

“So?” Tilly said.

Renée didn’t have an answer to that.

They let Tilly go first. Renée and Ginny faced each other, put the large elastic loop that was the jump rope around their ankles, and backed up until it was taut.

“What happened to you?” Tilly said to Ginny. “My mom says you’re really sick and that you could die.”

“Tilly, don’t say that!” Renée said.

“I’m OK. I take medicine.”

“My mom says you have to test your pee,” Renée said with a giggle.

“Oh, no, I don’t do that.”

“My mom says you can go blind and …”

“Tilly!”

“I just can’t have candy and stuff.”

Tilly stepped on the rope, so it was now Renée’s turn.

“No candy? Wow. I’d hate to be you,” Renée said.

“I’m OK.”

“And people lose their toes and feet and stuff.”

“Tilly!”

“Well, they do.”

“Just be quiet and play the game,” Renée said.

It was hard for Ginny to admit, but most of the time, she felt unwell. Sometimes, she felt irritable and sluggish. Other times, she felt lightheaded and confused. She just wanted to feel like herself again. She felt closest to normal when she was bouncing and running, but even that often ended with her getting weak and weepy. Maybe she was just thinking about it too much. Maybe she needed more distractions.

Her eighth birthday was coming up on May 20th, and because it was a Saturday, her mother planned a party. Besides Tilly and Renée, Ginny’s mother invited other kids from Ginny’s second-grade class. There were presents and games, and best of all, her mother guaranteed there would be a cake she could eat.

First, her mother brought out a traditional layer cake with thick chocolate butter-cream frosting and eight candles on it that read “Happy Birthday, Ginny!” That was for the guests. Then, she brought out a special cake for Ginny. It hadn’t risen very well; baking with artificial sweeteners was difficult. And there was no frosting. It looked a lot like something one might get from an Easy-Bake Oven, only bigger and not as symmetrical. It wasn’t fluffy. It wasn’t creamy. It was kind of dry. However, it tasted alright. Ginny could live with that.

The academic year ended with Ginny’s place near the top of the class secured, thanks to Tilly and especially Renée. In July, to regain a semblance of normalcy, Ginny’s parents planned a trip to Cape Cod. This would be the second family vacation without Asher. Last year, he said, now that he was almost 18, he was “too old” to go with them. Ginny didn’t speak to him for a week after that. Then, he was drafted.

Having breakfast out was an Eastman family favorite pastime, one of the many perks of being on vacation. Their first morning there, however, they couldn’t get in the door of the motel diner. After waiting, her father went to ask how much longer it would be.

“Another hour,” he reported. “Let’s find a different place.”

The next diner they drove to was also crowded. Ginny was starting to feel strange, like that sensation she’d have before her knees would bend by themselves.

“Let’s not wait,” her mother said.

They got a table at the next place. Ginny wasn’t feeling so great. She didn’t think she could speak anymore, and her eyes were starting to twitch. They were darting all over, making it hard to focus.

“Could you bring an English muffin right away? She’s a diabetic.”

Ginny didn’t mind her father mentioning her condition if it stopped what was happening. In a minute, there was an English muffin in front of her. Her mother sprinkled some sugar on it. Ginny tried to take a bite but found her throat was tightening. She put her head on the table. Someone brought a large orange juice, and her father helped her drink it down.

Ginny waited for that lovely sensation of renewed energy. Instead, she vomited all over the table, and her body went into spasms.

Her father grabbed her convulsing body and hurried toward the nearest exit. Ginny vomited again as they approached the car, this time over his shoulders and onto the pavement. Her mother got in the back seat with her so her father could drive.

Ginny’s survival instincts kicked in.

Whatever you do, stay awake.

A healthy amount of stubbornness was keeping her conscious. It was possible she was shaking more violently because she refused to succumb. The car stopped. They were at the hospital. Her father carried her in, and soon, she was lying on a table surrounded by people in white coats who were holding her down as she thrashed around. She felt a needle go in her arm, and she thought, OK. They got me, and she let everything go black.

She woke up in a quiet room. Her left hand was aching from a large needle stuck in the back of her hand that was attached to an IV. She wanted to get off her back, but when she tried to turn onto her side, the short IV line kept her where she was.

A nurse came into the room carrying a breakfast tray. She set it up in front of Ginny.

“Good morning,” she said.

Morning? What happened to yesterday?

“What time is it?”

“About seven.”

The nurse gave her a shot of insulin.

“If you need anything, there’s a button to your right.”

Scrambled eggs, buttered toast, and orange juice. They tasted great.

Ginny was thereafter sent to school with a roll of Lifesavers candy in her book bag. The intention was that if Ginny wasn’t feeling right, she could take one or two, and all would be right with the world. Sugar was poison unless it wasn’t.

Urine testing was the norm in the ’50s and ’60s and for the several years that followed, but it meant very little as far as actual blood sugar was concerned. These tests showed what was happening hours earlier, not at the time of the test. There was a general attitude in Ginny’s house that low meant she was behaving and high meant she wasn’t. If the test was positive in any way, trace (green), medium (yellow), or high (orange), her parents would lecture her about everything that was going to happen to her if she didn’t act right. Sometimes, they’d just tsk, which, in some ways, was worse. A negative result (blue) could mean normal blood sugar, around 80 to 110 mg/dL, or it could mean a dangerous low, like 40 or below. Nothing about this system was precise enough for someone to know when to have sugar or how much to have.

As a result of Ginny’s experience in Massachusetts, however, she could now sense a blood sugar drop about a half hour before any danger. And if that was happening, she knew it would take more than one or two Lifesavers to stop it.

Robin D’Amato is a writer and author of Sugar Free.