Diabetic with chills, fever, elevated blood sugar, low blood pressure

Patient : Infrequent sudden onset of chills with fever spiking to 103 and highter, low blood pressure and blood sugar level elevated. Chills subside and fever begins to decrease. Next day fever normal but left feeling lethargic. 78 yr old male diabetic who had bladder cancer 20 years ago and has bladder made from intestine with no problems since. Is this an emergency situation or matter to discuss with physician at next appointment?
Doctor :   The causes of fever in a diabetic could be multiple, but urinary infections and respiratory infections form the bulk. With urinary diversion into the gut, you would probably not manifest the classic symptoms of urinary tract infection. If you have loin pain, vomiting or high grade fever, particularly with low blood pressures, I would be worried and suggest you to visit the ER, to make sure the infection has not spread. If the fluctuations of blood pressure and sugars are low, you are otherwise comfortable and your general health/ appetite is good, you could wait for the next appointment (could be a viral prodrome). Take care.

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