22nd May 2024

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He had felt lethargic for 3-4 days and complained

A 74-year-old male is referred to the acute medical unit by his GP with lethargy and fever. He had felt lethargic for 3-4 days and complained of some left shoulder pain and back pain. He had rigors, but nil else in terms of positive symptomatology. He weighs 83 kg, has a history of Type 2 diabetes and benign prostatic hypertrophy. He is normally on Aspirin 75mg OD, Metformin 1g BD and Gliclazide 80mg BD. He has been moved to a level 2 unit as he requires vasopressors to support his blood pressure. A CT demonstrates fluid around his left shoulder joint, suspicious of a collection. The clinical team feel that his shoulder collection is the most likely source of his ongoing sepsis. The nurses have asked you to review his blood sugar control as he is not able to swallow his oral medications and his blood sugar has been 8-11 mmol/L over the last 2 days. His current blood sugar is 11 mmol/L.

What is the most appropriate action to control his blood sugar?

Select the SINGLE most appropriate option from the list below. Select ONE option only.