Question from Houston, Texas, USA:

My fiance is 25 years old and has been living with type 1 diabetes for seven years. He is very careful about his control and does a wonderful job. His last A1c was 6.1. He takes Lantus in the morning and in the evening along with Humalog for meals. He tests his blood sugar four times a day, and sometimes more, if needed. He started on the Lantus in December 2004 because he was having to many lows using NPH. He had no trouble with lows during the winter months.

Now that it is the busy season (he’s a farmer), he has been working longer hours and much harder, so he has had problems with lows. It doesn’t happen the day that he works hard, but usually 24 to 36 hours later. He tries to remember and eat extra food, but sometimes that doesn’t happen. The last low he had was bad enough that his parents had to give him a glucagon injection. He was able to drink a whole can of Sprite and still didn’t come around enough so he had to be transported to the Emergency Room for I.V. fluids. What can he do to help prevent the lows? Are there any dietary changes he can make to help this? Should he be asking his practitioner for a new insulin regimen? We are both at a loss. Everything seemed to be working wonderfully until lately. If you have any information or suggestions, they would be much appreciated.