[Treasured]

I have Type II diabetes and on oral meds which have brought my A1C down from about 18 to 9.7 as of this week at the doc's office. And I'm wondering if there is a level that the surgeons or even insurance companies don't want it to be above at the time of surgery? My diabetes is currently uncontrolled as it fluctuates a lot still but has obviously come down. I've been resisting going on insulin for quite some time because at least my A1C is coming down, but now I'm worried that I might be over the "safe" level for surgery.

Also, my dr & I discussed starting on Lantus but, because we thought my surgery might actually be in the very near future, we decided against it until finding the answer to this question. She didn't know. But she did say that starting insulin this close to surgery might actually slow down the healing process .. although we both realized that high blood sugars would do the same thing. I seem to be in a Catch-22 here.

Any thoughts and/or experiences with this would be appreciated.

[DocSanae]

You will have to check what your surgeon of choice actually requires.
However, here are the guidelines from the diabetologists' point of view.

I have just checked the most recent clinical practice recommendations (2006) for both ADA (American Diabetes Association) and JDS (Japan Diabetes Society).

With the ADA criteria, no metion of A1C is made, but, states that "better outcomes were related with fasting and admission blood glucose <126mg/dl (7 mmol/l) and all random glucose levels <200mg/dl (11.1 mmol/l). Also note that the correlation between A1C and mean plasma glucose level for the past 2-3 mo is,
A1C%, mg/dl, mmol/dl
6 ,135, 7.5
7, 170, 9.5
8, 205, 11.5

The JDS criteria states flat out that for elective surgery, A1C and related fasting/2hr post prandial glucose levels should be
A1C below 6.5%, fasting glucose below 130mg/dl, 2hour post prandial (meal) glucose below 180mg/dl.

In my own experience here, most surgeons have required A1C below 7.5% for elective surgeries.
So, you will probably have to aim for A1C below 8, with your fasting glucose level below 126--because your A1C level will take longer in coming down than your fasting glucose level. However, if you have diabetic retinopathy (vascular degeneration of your eye ground), rapid lowering of your blood glucose may induce bleeding, so, you will need to take it slowly there. If you are being seen by an endocrinologist, you should consult on how fast your glucose level can be brought down, and if you have not been checked by an opthalmologist within one year, preferably 6 mo since you are considering a major surgery, then you should get a consult there as well.

I hope this helps.

[spierce71k]

Hi Treasured,

I actually have reviewed for insurance coverage of MOS in the past. Most insurance companies do not review the A1C as a measure of whether you do or do not have coverage for the surgery, nor do they make the decision as to what it must be before you have surgery. That's up to the surgeon. BTW, congratulations on the drop for 18 to 9, that's fantastic and definitely will be a big help when you do have your surgery. You probably know what the recommended guideline is to show that glucose is controlled, so I won't bore you.
Shannon

[Treasured]

Thanks, both of you. There's just so many "rules" to all of this! There seems to be a fine line between being "sick enough" and "too sick" to qualify!

Shannon .. I just noticed ... you're in McKinney! I'm just past Farmersville on 380 ... we're practically neighbors! How cool is that??!!

[spierce71k]

I live just off of 380 in McKinney - we're practically neighbors. We'll have to get together some time. I just bought a new bike and a trailer for the baby so I'm going to take the kids out riding today.
Shannon

[Treasured]

Well have fun! I'd love to meet you .. and baby! I'm off for a day of hair, nails, and shopping! (One of the perks when the babies have all grown up! LOL!)

Deb

[spierce71k]

what do you mean when the kids grow up. I do that every once in a while just to get away from them. I leave them with dad for a few hours.

[Treasured]

We have EIGHT kids! There was never the time or money for anything like that at our house! LOL! I did my own hair and everyone else's, used sewing scissors to trim my nails, and shopping meant a trip to the grocery store with a couple of toddlers hanging onto my shirtail and a baby on my hip! (And I wouldn't trade a single one of them today for all the pampering & shopping in the world!)

[freebird]

that's too cool that you guys are neighbore. I met somebody online that live about a half hour away from me and we are planning on going to a support meeting in Ottawa together.
Sorry to go back here. I too have diabetes and have been wondering about my sugar levels. I know my surgeon requires controlled sugar levels but he never did explain exactly what that meant. Does anybody know how long you have to have controlled levels. I read what you wrote Doc and in simple words please repeat if possible? I know ask my surgeon but he lives 6 hours away and doesn't do phone consults.

[DocSanae]

Well, as far as I know, most surgeons will operate as soon as the data comes within the required level. There isn't a requirement for the data being within the acceptable limit for an extended period of time. At the university hospital where I trained and later was on staff, we would get refferal from the surgeons to bring the glucose levels down, then they would operate as soon as the level was within the safe range.
So, so long as your fasting glucose is below 126 at the time of your admission, it doesn't matter if it's been that level for a year, or for only a few days. Well, for your A1C to be below 7, you need to have had your fasting glucose level below 126 for a couple of months, but since ADA's criteria for surgery is only for glucose and doesn't mention A1C, most likely, US surgeons will go along with that.
Here, our surgeons prefer both glucose and A1C within the criteria, but for immediate reference, if the glucose level is OK, then they will go in.
There are several types of self monitoring glucose analyzers, so if you don't have one, you could consult your PCP about getting one so you can monitor your glucose every day, and take medication if you need to, to bring it down the the safe level.

The reason glucose control is required, is because the higher the glucose level is, the higher the incidence of complications and infections post op becomes, so, all surgeons are pretty serious about good blood sugar control. It's going to affect their efforts for the best results possible.

Does this help?