How to manage my father’s high blood sugar and fever?

Question

Hello doctor,

I am a medical student. My father has been suffering from fever for seven days, up to 101 F. I have given him Ofloxacin 200 mg two times a day.

But the cause of the fever is unknown. All the blood reports are negative. He has been a known diabetic for 20 years, and his blood sugar is not under control. His fasting sugar level is 200 mg/dL, and after meals, 400 mg/dL.

He was taking Insulin two times a day, in the morning and at night. Since his sugar is not under control, he is taking it three times a day now. I have decided to give Metformin 500 mg with insulin in the morning, and Glycomet-GP twice during lunch, and Insulin as well as Metformin 500 mg at night.

My sugar level is getting controlled to 108 mg/dL fasting and 256 mg/dL after food in the morning, but at dinner, before food, it comes to 333 mg/dL. I have decided to change to Glycomet-GP 3. I need your opinion.

Please tell me which antibiotic to give for fever and which anti-diabetic to give to control blood sugar.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

If your father is having continuous fever for seven days with negative blood reports then probably a detailed evaluation is required. Tablet Ofloxacin is a broad-spectrum antibiotic against most bacterial infections. If his fever is not improving and the blood culture and sensitivity are not showing any organism, then he is probably having a parasitic infection or a viral infection. Antibiotics should be changed only after repeating the blood culture and sensitivity, and if there are organisms growing.

This is to be discussed with a complete clinical examination. Certain tests for infections like malaria and dengue might not show up in initial reports, and detailed repeat testing is necessary. Typhoid, a bacterial infection, is also elusive in early stages, and antibody testing might help.

Tablet Ofloxacin is a recommended medicine for typhoid, and if tests confirm it, then he might require a longer course. To control his blood sugar, he should get an HbA1C (glycated hemoglobin test) test done once every three months to know the average blood glucose level he has. During illness, he might be switched to Insulin on a sliding scale.

This must be done carefully. Infections usually cause high levels of blood glucose in patients. His meal timings must also be maintained, and a sample diet like the one given below might help.

Early morning: A cup of tea or milk with two biscuits of his choice (no sugar).
Breakfast: Two parathas with curd or two plain rotis with paneer or two idlis with chutney or sambhar or one bowl of upma or oats.
Mid-morning: Give him soup or a whole fruit, either an apple or a guava.
Lunch: Salad with rotis (two to three) or rice (one bowl) with dal or sambhar and a cup of vegetable. Occasionally, you can add some light fries to lunch. You can add two vegetables every day.
Evening: Tea or juice with two biscuits without sugar, and dinner should be the same as lunch with a slight variation.
Dinner should be lighter than lunch. Just before going to bed, you can give one glass of milk without sugar.

You might hold the decision to give tablet Glycomet-GP 3 (combination of Glimepiride and Metformin) after observing his blood sugar for two to three days at night before dinner. Anyway, he is on Insulin and tablet Metformin 500 mg at night, and this should be able to control the blood glucose to a certain extent. Stress him on having a regular diet plan. You have not mentioned anything about his diet, and it is suggested that he follow a strict diabetic diet given above, and his blood sugar is monitored at the same time every day.

In conclusion, please discuss this with his treating doctor and get any specific tests done to confirm a suspected clinical diagnosis. Any change in antibiotics can be done only after close clinical evaluation. I hope you have done a complete blood count and peripheral blood smear. Other basic investigations, like a chest X-ray and an ultrasound scan of the abdomen, might also help.

I hope this helps.

Thank you, and take care.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

It is good to know that your father follows a strict diabetic diet and does not consume much fat, oil, or masala. Please continue with this diet and make additions as mentioned earlier. Your father's blood sugar is usually elevated higher than normal during periods of illness.

Regarding his diabetes medicine, you might try giving him the tablet Glycomet-GP 3 at lunch and observing his sugar levels. Tablet Glycomet-GP 3 contains Glimepiride 3 mg and Metformin hydrochloride 850 mg, and might be able to control blood sugar better than tablet Glycomet-GP 2. There is another higher medicine tablet, Glycomet-GP 2 forte.

However, that is not required if his sugar is under control with the Glycomet-GP 3 tablet. Tablet Temazepam, a benzodiazepine, can be given in place of Lorazepam. This is to be strictly taken under the direct recommendation of a psychiatrist. It might require dose calculation depending on kidney function.

I hope this helps.

Thank you, and take care.

Regards.