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My dad is a diabetic, and has had a foot wound for about 2

hello my dad is a...
hello my dad is a diabetic, and has had a foot wound for about 2 years. He is seeing a doctor for that and wants him to stay off his feet, which caused him to now weight about 367lbs. Another doctor of his deals with his lungs and heart. He had just told us his heart is at 27%. He is short of breathe all the time now his hands shake from time to time. What is the cause of that and do we need to stress over that.
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Answered in 8 minutes by:
9/13/2013
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,124
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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It will help if you could provide some further information:
How well controlled is his diabetes?
What does his blood sugar run in the morning before breakfast and during the day?
What was his last HgbA1c?
Have you checked his blood sugar during these spells during which his hands shake?
Does he also have chronic lung disease?
Or is his shortness of breath related to the heart dysfunction of 27%?
Where on the foot is the foot wound?
How long has he been off his feet?
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Customer reply replied 4 years ago
his diabetes is controlled i know the always is. He checks his blood sugar throughout the day it in the 60's and 80's. doesr check when the shaking starts and short of breathing is most likely caused by heart problem wound is on right bottom also had little and bone cut out
Thank you for the additional information.

I ask about the blood sugar during the episodes of shaking because this is one of the common symptoms that can occur when the blood sugar gets too low. One of the potential side effects of a medicine designed to lower an elevated blood sugar is that the sugar level may swing too low. It usually requires a blood sugar lower than the 60s to have symptoms, but the accuracy of the blood sugar monitor also needs to be considered. When the monitor result is in the 60s, it is possible that the blood sugar is really in the 50s. Therefore, if he checks his blood sugar during these episodes and they are consistently in the 60s, there should be concern about whether these are from low blood sugar.

If the blood sugar is normal during the episodes, then the shaking is likely due to the shortness of breath. Any cause of significant shortness of breath can have shaking associated with the symptom. This is a non-specific response to the stress of having shortness of breath, and also may be exacerbated by lowered levels of oxygen, even if not to the level that it requires oxygen supplementation.

Resolving the dilemma of the activity level is more complicated. I can see why it is important to avoid weight bearing given the location of the wound, but the heart/lung doctor is correct that activity is critical for management of all of his medical problems. In trying to balance these needs, I usually suggest a greater restriction in activity for a short period of time, such as for a couple weeks. However, when it becomes apparent that it will take a long time to heal a foot wound, it is appropriate to find some method of increasing activity without weight bearing. There are a couple of options, including getting into a pool (with appropriate bandaging and protection of the wound) or performing exercises that do not place pressure on the wound, either by involving the upper body alone or avoiding pressure on the wound. For example there are bicycles that are powered by the arms, or he may be able to use a stationary bicycle if the pedals can be used without placing pressure on the wound.

If you have any further questions, please let me know.
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,124
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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