My 20 year old son, who has had diabetes since age eight, has had a couple of times when he has gotten very low in his sleep. Luckily, we have checked on him and had to call 911. It worries me as he may move out after finishing college, and I fear for him living alone, because he will not carry diabetes identification or say that he has diabetes. What is the best thing to do? When you find someone in this state, can you tell how long they have been that way?

The best approach would be a proactive one. I would recommend monitoring in the middle of the night. Low sugars should be reviewed with his diabetes care team so that modifications can be made and geared at preventing low sugars. This requires coordination with care givers. The long-term risks are substantial, especially if not treated. The more low sugars you get, the more you lose your early warning symptoms of hypoglycemia. This means that there comes a time when individuals with frequent low sugars have no warning of a serious low blood sugar reaction. The time to act is now.

JTL

[Editor’s comment: Your son’s situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail so that an appropriate insulin regimen can be designed. See The Continuous Glucose Monitoring System, and ask your son’s diabetes team about using it.

SS]