instruction: hello doctor my father is a heart patient and also has a problem with high sugar but two weeks before his be level and sugar level dropped a lot and he started feeling very low with some kind of palpitation after some prescription his be level and sugar are normal but the problem of palpitation is still there to whom should I consult for him
output: hello sorry to hear about your father when you say heart patient I assume he has had a blockage to the artery supplying the heart coronary artery disease or has had a heart attack myocardial infarction in diabetes management the duration of diabetes and the level of control in the past is very important for present management as well heart patients will be generally prescribed be blood pressure reduction tablets amlodipine losartan telmisartan cholesterol lowering tablets simvastatin atorvastatin blood thinner tablet aspirin clopidogrel and heart rate reduction tablet beta blockers atenolol nebivolol bisoprolol the cause of your father symptoms has to be found out low be can be caused by high heart rates and palpitation arrhythmia in such a scenario your father has to be reviewed by his cardiologist to see if there is a trigger like decreased blood supply ischemia or salt imbalance electrolyte abnormality and adjust the medications both be and heart rate medication a low sugar will usually raise heart rate and be but here the be had fallen so low sugar hypoglycemia may not be the cause of these symptoms one thing you might like to keep in mind is that if someone is on blocker his heart rate will not go up during hypoglycemia so the cause of low sugar remains unexplained a review of his diabetic management viz timing of diet intake dosage of insulin medications timing of medicines type of insulin have to be reviewed to find the cause a simple and common reason would be that he could have reduced his food intake or avoided it altogether due to his heart symptoms on that day resulting in low blood sugar now coming to his present symptom of palpitation as his sugar level is normal range as per your information it seems unlikely that his diabetes could be the cause of his palpitations so my advice is to recheck his blood sugar both fasting and post food two to three times to confirm the absence of low sugar and to review the heart condition and medication with his cardiologist a point of note is that if your father is quite elderly has been a long term diabetic has other co existing medical conditions like kidney dysfunction mobility issues it is better to go for a medium control of diabetes rather than very tight control of blood sugar levels I hope this helps