Diabetes is a condition that tends to affect the daily life of individuals. However, it goes beyond that. Diabetes can alter surgical plans if HbA1c test levels are too high, which is why primary care doctors should be asking patients to take frequent tests before surgery.
Key Takeaways
- If the results of an HbA1c test are over 8%, surgeries will need to be canceled because of anesthetic complications and a higher risk of post-operative complication.
- If the Hemoglobin A1C is 7% or lower, surgeries will likely be green-lighted.
- HbA1c test levels can often be lowered by implementing lifestyle changes like consistent exercise, eating whole foods, and managing stress or by medication.
When is it Safe to Operate with Diabetes?
An A1c test shows your average level of blood glucose (blood sugar) over a time period of approximately 2-3 months. Before a surgery is scheduled and before it takes place, doctors should be either asking when a diabetic patient’s last HbA1c test was or asking the patient to take a test for accurate readings.
In general, surgeries will not be scheduled or completed if an A1c test result is over 8%. This puts diabetic patients at a higher risk of anesthetic or post-operative complications. A1c results of 7% or lower are ideal for a safe surgery.
What Are the Risks of Operating with a High A1c?
Diabetic patients with a blood glucose level of 8% or higher are more at risk of:
- Infection
- Poor wound healing
- Longer recovery periods
- Hospital readmission
- Hyperglycemia or hypoglycemia
- Electrolyte imbalance
- Diabetic ketoacidosis
It is very important not only to monitor your glucose levels before surgery, but afterwards as well.
How to Lower Your A1c
Sometimes, diabetic patients will receive medication to help lower blood glucose levels. However, lifestyle changes are more often the suggestion. Your doctor can help you prepare for surgery by monitoring lifestyle elements like:
- Diet. Committing to whole foods like vegetables, whole grains, legumes, nuts, lean protein, and fruit is one of the most common and successful ways to manage blood glucose. You may even be referred to a nutritionist to help you achieve a sustainable diet.
- Exercise. Another highly successful blood glucose management tool is movement. It doesn’t have to be high-intensity or long workouts, but consistency is key. Taking walks, joining a low-impact exercise class at a gym, or hiring a personal trainer to help meet your goals is one of the best ways to lower HbA1c levels.
- Stress Management. High levels of stress may contribute to high levels of blood glucose. Having stress management strategies like yoga, meditation, and other hobbies that you enjoy increase mental health, which in turn has an impact on physical health.
- Curbing Smoking Habits. Nicotine has proven to increase blood glucose levels, increase the risk of developing diabetes, interfere with the effectiveness of insulin, and makes it harder to manage diabetes.
Frequently Asked Questions about Diabetes and Surgery
1. Does diabetes increase my risk of complications from surgery?
Yes, diabetes can increase complications and risks of surgery. Elevated blood sugar before, during, and after surgery is linked to slower wound healing, a higher risk of infection, and longer hospital stays. Diabetes can also affect the heart, kidneys, and nerves, which matter for anesthesia and recovery.
2. What should I do with my diabetes medications and insulin before surgery?
This depends on the specific medication and the type of surgery, so you should follow the instructions from your surgeon, anesthesiologist, or diabetes provider rather than adjusting things on your own. For example, certain drugs (such as SGLT2 inhibitors) are commonly paused several days beforehand, while others may be continued or adjusted. Insulin doses are often reduced, particularly long-acting insulin the night before, because you’ll be fasting. Ask for written instructions in advance and bring a list of everything you take.
3. How will my blood sugar be managed during and after surgery?
Your blood sugar is typically checked frequently on the day of surgery, and the team may use insulin (sometimes through an IV) to keep it within a target range. Fasting, stress, and anesthesia can all push glucose up or down, so close monitoring is necessary. After surgery, you’ll usually continue to be monitored until you’re eating normally and can return to your regular routine.
If you or someone you love needs an orthopardic surgeon in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.
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