My father, in his early 70s, has had diabetes for over 45 years and had a slight stroke two years ago. He now seems to have more hypos than normal and doesn’t get the warnings he used to. Are there particular things he should be doing to avoid this?

Elderly people who have long-standing diabetes quite often lose their symptoms for hypoglycemia, a phenomenon called �hypoglycemia unawareness. This may be due to a general phenomenon of aging and the fact that dietary intake tends to lessen as people get older. Low blood sugar values are a risk factor for future strokes. So, it may be advisable to relax strict metabolic control a little bit, targeting for higher blood sugar values (not too high though). Using pre-meal lispro or Regular insulin with NPH or Lente at bedtime only is a safe approach. This advice should help decrease your father’s risk and number of hypoglycemic events.

MS

[Editor’s comment: It’s unclear if your father has �type�1 or �type�2&nbsp diabetes. It might be worth considering a decrease in his pills or insulin, depending on his current medication plan.

In any case, this is an issue that must be discussed with his physician. If he’s unwilling to bring it up himself, then you should take the initiative to do so.

WWQ]