AskNadia: My Doctor Won’t Perform Surgery Because of My High A1C

Dear Nadia:
I have diabetes and am in desperate need of knee surgery. My doctor won’t perform the surgery because my A1c has been between 7.1% and 7.4% for the past year. My insulin doses have been adjusted but I can’t seem to get below 7%, which is where they want me. This has really affected my quality of life. Do you think I should get a second opinion?
Dear Kris:
I think you should get a second opinion.
But it’s not because I think you’ll find a doctor who is willing to accept a higher A1c. It’s because I think a second opinion will let you see for yourself how cautious doctors are when dealing with a person with diabetes who wants to undergo elective surgery.
The reasons why surgeons are reluctant to operate on patients with high A1c’s is that high blood sugars substantially increase the threat of post-operative infections and cardiovascular problems.
 The 7% goal your doctor wants you to meet is the generally accepted A1c percentage in the medical community. The ideal range for avoiding complications from surgery is from 80mg/dL to 150 mg/dL. That higher figure is already way above the 4.4% A1c (80 mg/dL) that is considered a normal blood glucose reading for people who do not have diabetes.
So, assuming that your second opinion confirms the first, how do you get yourself down to 7%? It depends on the effectiveness of your insulin(s) and your personal diet and exercise habits. (Obviously, your knee is preventing you from regular exercise, so you have to look at insulin and diet as your main means of control.)
First, you may want to look at how you are using your basal insulin. Can you track when it reaches its peak and how long that peak lasts? If you can answer this and share it with your physician, they may want you to try a different basal insulin that performs better than the one you are on now at establishing a longer baseline.
Do you also take a bolus insulin? If you do, your physician may want you to try a different bolus insulin,  quickly effective—and predictable: For maximum effectiveness you want to time your bolus injections with when you sit down to eat.
Your diet may be the last barrier between you and the 7% A1c you’re hoping to reach. How many carbohydrates—and what kind—do you consume? Are you closely tracking them? It may be that by shifting your emphasis from one food group to another, say, from fewer carbs to more protein, there will have a noticeable effect on your numbers. Your dietician can review your diet to help you reach your A1c goal.
In the meantime, you have a bum knee that needs attention. Ask your doctor if s/he can refer you to a joint specialist who has experience with diabetic clients. Even if for now the specialist can’t help you, ask if s/he has specific program intended to prepare a diabetic patient for surgery. That will tell you that there is a successful approach that you can try.

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Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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About Nadia:
Nadia is a diabetes advocate who was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview now Diabetes Health magazine.
Nadia has received 14 nominations for her work as a diabetes advocate. She has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized, and  published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News,, Brand Week, Drug Topics, and other media outlets.


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