MixedPaste MagazineAn unsettling thriller that won’t be for everyone. However, it’s likely to hook those looking for a departure from the typical approach to the genre, which so often pits an innocent protagonist against a killer ... Its devastating opening will serve as a litmus test for many, determining whether they put the book down or read all the way through. The novel kicks off with a bold choice and continues to unravel in surprising ways. And its premise is its strongest quality ... The author’s depiction of the main character is nuanced and balanced enough to leave readers feeling more than a little unnerved ... Rothchild flips many of the stereotypical serial killer qualities on their head ... Blood Sugar’s protagonist remains a remorseless killer. But it’s a testament to Rothchild’s writing that she can so frequently get readers to forget this fact ... Getting the audience to relate to and at times root for Ruby turns out to be both the book’s strength and its Achilles heel. As Blood Sugar pushes toward its ending, the novel trips over itself trying to find a satisfying conclusion. One has to wonder if it ties up its loose ends a little too neatly ... While the novel offers plenty to analyze on that front, its ending still leaves something to be desired. Once Ruby’s finished recounting her misdeeds to the audience, the pacing starts to slow. The twists and turns don’t feel nearly as shocking beyond the halfway point. At times, Blood Sugar’s later chapters teeter on the line between a thriller and a contemporary novel ... That shouldn’t deter readers from picking up Rothchild’s debut. There’s plenty to appreciate about this story, including how it upends expectations about what this genre is supposed to be and do. It’s an entertaining tale that grips you in the first half. By the time it slows to catch its breath, the audience will be invested enough that they’ll want to keep reading.