Brief Answer:
Needs early medical intervention to prevent further spread.

Detailed Answer:
Hi XXXXXX! Good evening. I am Dr Shareef, a general surgeon answering your query.

The blood sugar level of your father is more than what is expected to be with anti diabetic treatment programme. Usually at this age the immunity of an individual is less than that in young individual, and this drawback when compounded by the presence of increased level of sugar in the blood could invite unsuspected infection in any part of the body. Even though it requires a clinical examination to be certain, from your history, the present swelling along with pain appears to be inflammatory which could be due an infection, or could be due to a vascular problem.

If I were your doctor, I would carefully look for an infective focus in the affected limb both in the front and back of the involved limb. Even a small unnoticed scratch could be the culprit in spreading infection specially when blood sugar is not properly controlled. The infection itself would also cause the blood sugar to rise more, and thus it would become a vicious cycle of raised blood sugar and infection compounding each other in making the condition worse. Once the source of infection is found, this has to be dealt with accordingly ,and possibly under the cover of Insulin and a good broad spectrum antibiotic along with a probiotic, as oral hypo glycaemic agenst might not be able to control his diabetic status in presence of infection/inflammation. After dealing with the cause (any wound, scratch however small it might be), I would advise him to keep his affected limb elevated and not to hang it down. This would help to reduce the swelling in the limb. An anti inflammatory along with a proton pump inhibitor would be helpful in relieving him symptomatically.

In addition to the routine investigations like a CBC and serial blood sugar estimations for regulating the dosage of Insulin, I would go for a Doppler Ultrasound of both the lower limb vessels to rule out a DVT (Deep vein thrombosis) of the right leg veins. Also an X ray of the knee might be helpful to rule out any bony lesion in this age group specially with the history of loss of weight (which could also be the result of improperly controlled blood sugar level).

I would involve the services of a general surgeon to have a clinical assessment of the affected limb to rule out an abscess formation in the deeper tissues which would not be uncommon in Diabetic persons.

As the condition in these individuals could worsen fast, I would advise you to either get him assessed by your family physician or in the ER of the nearest hospital at the earliest possible to avoid any preventable complications.

I hope this information would help you in discussing with your family physician/treating doctor in further management of your father's problem. Please do not hesitate to ask in case of any further doubts.

Thanks for choosing health care magic to clear doubts on health problems. I wish your father an early recovery. Dr Shareef.

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