A1cComplications & CareSurgery

AskNadia: Why Will My Doctor Not Operate on Me Unless My A1c is 7?

Dear Nadia,

I have diabetes and am in desperate need of knee surgery. My doctor will not perform my surgery unless my A1c is lower than it has been. In the last year, my range has been between 7.1 and 7.4. My insulin doses have been adjusted, but I can’t seem to get below 7, which is where they want me to be. My quality of life is pretty much nonexistent at this point. Do you think I should get a second opinion?


Dear Kris:

When it comes to surgical procedures for people with diabetes, ensuring optimal health and minimizing potential risks is of utmost importance. Your doctor’s request for your A1C level to be 7 or lower before an operation may seem like an additional hurdle. Still, it is rooted in the commitment to your overall well-being. 

A1C is a crucial measurement to assess long-term blood sugar control in individuals with diabetes. It reflects the average blood glucose level over the past two to three months by measuring the percentage of glycated hemoglobin in the blood. The American Diabetes Association (ADA) recommends an A1C target of 7% or lower for most adults with diabetes to reduce the risk of complications and maintain good health.

Importance of A1C Control

Minimizing Surgical Complications

Elevated blood sugar levels can significantly increase the risk of complications during and after surgery. High A1C levels are associated with delayed wound healing, increased risk of infection, and impaired immune function. By ensuring your A1C is well-controlled before surgery, your doctor aims to mitigate these risks and enhance your overall safety.

Promoting Wound Healing

Surgery involves incisions and tissue trauma, which require proper healing for successful recovery. Elevated blood sugar levels can impair the healing process, leading to delayed wound closure and increased susceptibility to infection. Lowering your A1C level helps optimize blood flow, oxygenation, and nutrient supply to the surgical site, facilitating timely and efficient healing.

Enhancing Anesthesia Safety

Anesthesia plays a vital role in surgeries but can pose additional risks for individuals with poorly controlled blood sugar. High blood glucose levels can interfere with the effectiveness of anesthesia, leading to complications such as prolonged sedation and difficulty in awakening. Maintaining a lower A1C reduces the likelihood of such issues, ensuring a smoother and safer administration of anesthesia.

Reducing the risk of cardiovascular events: Uncontrolled diabetes, reflected in your a1c, increases the risk of cardiovascular complications such as heart attacks, strokes, and blood clots. Elevated A1C levels contribute to the development and progression of these conditions.

By focusing on A1C control, your doctor aims to minimize the risk of cardiac events during and after surgery, safeguarding your heart health.

How to Lower Your A1C?

Medication Adjustment

Your healthcare team may review your diabetes medications and potentially make adjustments to help you achieve your target A1C level. This may involve changes in dosages, additional medications, or exploring new treatment options. Following your doctor’s recommendations and maintaining open communication about your progress is essential.

Dietary modifications

 Adopting a well-balanced diet that meets your diabetic needs is crucial for A1C control. Incorporating nutrient-rich foods, controlling portion sizes, and monitoring carbohydrate intake can help regulate blood sugar levels effectively. Collaborate with a registered dietitian to create a personalized meal plan that suits your requirements and supports your surgical preparation.

Regular physical activity

As approved by your healthcare team, regular exercise can contribute to better blood sugar management. Physical activity helps improve insulin sensitivity, promotes weight management, and enhances cardiovascular health. Please discuss suitable practices and their timing to your surgical procedure with your doctor.

While meeting a specific A1C target before surgery may seem frustrating, it is essential to recognize the underlying reasons for this requirement. Achieving a controlled A1C level plays a vital role in mitigating surgical complications. For the best possible outcome post-surgery, I recommend lowering your A1c to prevent potential diabetes complications.


You may also be interested in reading this refresher article about what level your blood sugar should be before and after eating and  How to Bring Down a Blood Sugar Over 200 mg.d/L.


If you need to know what your A1c is based on your regular blood sugar levels, This chart will help you know where you are rather than waiting three months before you tae a test.

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