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Suggest Treatment For Very High Blood Sugar Levels After Undergoing Bilateral Knee Replacement

Posted on Fri, 15 Nov 2019

Question: Dear Sir,
My Mother Has undergone Bilateral Knee replacement on 30th March 2018 its 19 days over now.From past 7-8 days My mother is not able to Sleep due to Anxiety and stress and also her Sugar level has been raised significantly after Food it was 320 and before food 220-224.

During Hospital stay Sugar Level was in the range of 13o-180 before food in Hospital after surgery
She is currently taking following sugar Tablets

Gemer P2 1-0-1 Before food
GLYCOMET GP 1MG For Sugar 0-1-1

My mother is diabetic from 10 years .She is taking Gemer P2 morning and night before food Does not have hypertension its under boarder range. No thyroid . Vegetarian diet .

Could you please let us know whether spike in Sugar level is Common during srgery ue to Inflammation and medication what can be done to bring Sugar under control.
Should we start insulin?

Answered by Dr. Minal Mohit (22 minutes later)

Brief Answer:
Ideally insulin is the answer for 6 weeks post surgery.

Detailed Answer:

Hi,

Post B/l TKR, we need very tight sugar control as knee replacement needs to be successful. so for this reason and many more insulin is the choice post surgery, 6 weeks.

I am suggesting you a plan, please stick to it for 3 to 5 days and let me know the sugar values.
1. tab amaryl M2 twice a day before breakfast and before dinner
2. tab istamet 50 /500 mg twice a day before breakfast and before dinner
3. insulin tresiba 10 units at bed time.
The rest you may continue as per your surgeon.
Recheck fasting and post meal sugars and let me know after 3 days.

Regards!

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Minal Mohit (25 minutes later)

Thanks for your Quick Reply.

Should we give Gemeor P2 1-1-1 along with the medicine s which you prescribed as mentioned below

1. tab amaryl M2 twice a day before breakfast and before dinner
2. tab istamet 50 /500 mg twice a day before breakfast and before dinner
3. insulin tresiba 10 units at bed time.

Also wanted to Confirm if Insulin can be given by us ot requires Qualified Nurse to provide Insulin Injection.Insulin which you prescribed is Injection or can be taken in tablets as well?

Answered by Dr. Minal Mohit (4 hours later)

Brief Answer:
Only the prescribed medicines to be followed.

Detailed Answer:

Hi,

Please do not give gemer P2, only follow today's plan.
insulin comes only as injection, no tablet insulin available
it can be given by you or patient herself can take, but you need to be trained. you can ask either the pharmacist, or the doctor, or any nurse, or ask for local NOVO NORDISK person to help.

Regards!

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Minal Mohit (14 hours later)

Thanks for the information. Today we have done test before fastening result morning resultwas 168 is this ok. we have not yet started giving medications suggested by you.Wanted to confirm if sugar level will not come down then the normal level if we start giving those medication do we need to monitor sugar level today and start or reduce the medication which you suggested if sugar levels are not at peak level

Answered by Dr. Minal Mohit (3 days later)

Brief Answer:
Please start the treatment as suggested.

Detailed Answer:

Hi,

Now , fasting 168 is still high. I would suggest please start the plan and then let me know.

Regards!

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Minal Mohit (1 hour later)

Fine thanks for your information.Today Morning when we checked it was 155 before fastening and yesterday after food it was 230 after food.

Wanted to confirm if we suddenly stop the existing sugar medication and start with new medication will they have any side effects or can be taken without any issues

Forgot to ask question Mam. My mother is not bale to sleep more than 2 hours due to stress,anxiety and mild pain. wanted to confirm if Sleep disturbance would cause blood sugar to get increased

Answered by Dr. Minal Mohit (3 hours later)

Brief Answer:
You can change the plan with no concerns.

Detailed Answer:

Hi,

We are changing few combinations and redesigning the plan. you can safely switch from existing plan to a new plan.

Disturbed sleep definitely will have an effect on sugars. you may add cap pregabaline sr 75 mg at night for all problems pertaining to sleep.

Regards!

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Minal Mohit (14 hours later)

Thanks.Im not able to get the below medicines due to non availability of prescription also not able to visit doctor to get that prescription since my mother is not able to walk post surgery.

1. tab amaryl M2 twice a day before breakfast and before dinner
2. tab istamet 50 /500 mg twice a day before breakfast and before dinner

Can we just give Insulin tresiba 10 units at bed time at night along with existing medicines ?
Gemer P2 1 -0-1 before food
glycomet sr 500mg 0-1-0 after food

Answered by Dr. Minal Mohit (10 hours later)

Brief Answer:
Sorry sir. If partial advise is followed, results will be partially good

Detailed Answer:

Hi,

Half-hearted things are never good. You need to follow the advise totally for expected results.

Regards!

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar