How to manage ankle fracture in uncontrolled diabetes?

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

This is a pattern I see very often: when walking stops abruptly, sugars shoot up even if the tablets were working well before. Right now, your readings (fasting sugar 230 mg/dL and after-meal 350 mg/dL) need an active step-up.

There are two sensible ways we treat this, and we can choose depending on your comfort and how quickly you need control. If we go with insulin, I would start with a simple nighttime basal insulin such as insulin glargine at a low dose and adjust based on fasting sugars.

This is the quickest and safest bridge during immobility when sugars are running this high, and it is usually temporary. As soon as you are back to walking, the requirement often drops, and we taper it off.

If we try without Insulin first, then, along with continuing Zavamet (Metformin and Vildagliptin), I would add an SGLT2 (sodium-glucose cotransporter 2) inhibitor such as Dapaglifozin with proven heart benefit, once your kidney function is confirmed to be adequate.

In someone post-CABG (coronary artery bypass grafting), this class is my first add-on choice because it helps sugars and gives extra cardiac protection.

We will decide the exact doses after reviewing your recent creatinine or eGFR (estimated glomerular filtration rate) and a few days of home sugar logs.

This looks like a reversible phase triggered by immobility, and with timely adjustment, your sugars should settle back toward your earlier range as your ankle heals and activity returns.

I hope this answers your questions.

Please follow up if you need anything else.

Thank you.