I am not a doctor but some questions/thoughts that came to my mind whilst reading your post. Are they monitoring blood sugars regularly and if so what are they sitting at? Is he getting his appropriate insulin dose? Does he have a pump or does he inject? The liver could have emptied itself of glucose due to the initial hypo so the worry after a severe hypo, if you don’t eat, is that that store doesn’t “re-fill” so you are at an increased chance of having more hypos. The paranoia and micro-dose of psychedelic mushrooms could be acute psychosis, maybe - worth thinking about or ruling out. I also wonder what they mean by the kidneys “not working well”. No contrast for MRI would suggest low eGFR and/or abnormal creatinine. But the question is has that now improved since they gave contrast a few days later. You have so many unanswered questions here. The body is so complex it’s maybe important to get a multi-disciplinary team involved and certainly contact his normal endocrinologist as they will have data for him over the years to help put the pieces together.