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A1c Too High For Surgery

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

Preoperative A1c And Clinical Outcomes In Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures

OBJECTIVE To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery. RESEARCH DESIGN AND METHODS Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women’s Hospital. Patients admitted to the hospital for ≥1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study. RESULTS Of 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C ≤6.5% [N = 109]; >6.5–8% [N = 202]; >8–10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values ≤6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comordity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate. CONCLUSIONS Our study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed. Diabetes mellitus i Continue reading >>

"a!c Level Before Surgery": Diabetes Community - Support Group

The risk of infection and poor healing is very high with your glucose levels out of control. I can understand why a surgeon would want your A1C to be in a safe range before performing surgery. Follow my journey at www.mch-breastcancer.blogspot.com I've had lots of surgeries and no one ever tested my A1C as part of my pre-op work-up I had back surgery when my blood glucose was way too high and it took forever to heal. I was in an emergency situation and it was determined that the risk was higher to not have the surgery than to have the surgery. Five months later I had another back surgery and my A1c had dropped from 11.9 to mid 7's, my healing time was much quicker. The bottom line is that the better your A1c is and the better your overall health is the lower the risk for complications is and the opportunity for better outcome is higher. I do not know what "requirements" each doc has for surgery but I would be looking for a good discussion with your doctor to understand specifically what he is looking for and why. It also may be time for another opinion. I am not a Dr or nurse but I can say I have T-2 (in remission) and have been through a partially torn rotator cuff surgery. I did not have an A1c done before surgery, I did have the normal blood tests which included the glucose readings. But then my A1c has never been over 6.2. Perhaps that is why they did not do the A1c. I can see the need for your A1c to be within the normal range prior to surgery because it is a healing aid. We as diabetics do not heal well to begin with and a high A1c will only prolong the healing process. Not only that if your A1c is not in the 5 to 7 range now it could get worse after the surgery due to stress, pain and medications. It is typical to have complete rotator cuff tears surgery repairs Continue reading >>

Diabetes And Joint Replacement Surgery 101

Diabetes And Joint Replacement Surgery 101

If you’re living with diabetes, you know better than anyone that your rulebook for general health is different than most. To add another layer to your health management puzzle, chances are you’ve found this post because you’re a diabetic preparing for a hip replacement or knee replacement or are trying to decide when the right time for a joint replacement is. With this, know that joint replacement surgery is one of the most successful procedures in all of modern medicine and that you have the power to further reduce your risk factors. What you do in the weeks leading up to your hip replacement or knee replacement will have a huge impact on your surgery results and recovery time. This is especially true for those with pre-existing conditions like diabetes. Taking action before surgery in a results-driven program is called “PreHab”. Read on as we talk about how diabetes can affect joint replacement surgery, examine surgical complications for those with diabetes, and offer some prehab diet suggestions to optimize your health before due day. How Can My Diabetes Affect Joint Replacement Surgery? Diabetes (especially when uncontrolled or paired with a related disease) greatly affects recovery time from joint replacement surgery. Those with diabetes are at a greater risk for infection, slower wound and incision repair, as well as a laundry list of secondary complications. Uncontrolled Diabetes: Blood sugar levels that are too high (240 and over or consistently outside of optimal zone) is often due to improper diet, lack of exercise, inconsistent medication use and other factors. The risks associated with uncontrolled diabetes include: heart disease, kidney disease, eye damage, neuropathy, amputations, dental issues and more. Controlled Diabetes: Blood sugar levels ma Continue reading >>

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric Bypass Surgery May Lower Diabetes Risks, But Also Carries Dangers

Gastric surgery may not only help people combat obesity: Evidence shows it can also help reduce diabetes risk factors. A new University of Minnesota study published in JAMA on June 5 reveals that mild to moderately obese patients with Type 2 diabetes had more improvements in their blood glucose, cholesterol and blood pressure after they underwent gastric bypass surgery, than patients who made lifestyle changes with medical counseling. About 35.7 percent of the U.S. adult population is obese, according to the Centers for Disease Control and Prevention. Obesity has been linked to heart disease, stroke, Type 2 diabetes, some cancers and some of the leading causes of preventable death. About 25.8 million people have diabetes in the U.S. as of 2010, the NIH reports. The vast majority of those people have Type 2 diabetes, which is when the body does not produce enough insulin or the cells do not use the insulin. Insulin is produced by the pancreas and is required for a process in which the body wants to use energy from glucose, or broken down sugars and starches obtained from food. The best treatment for Type 2 diabetes is weight loss, but controlling glucose levels, blood pressure and cholesterol are important as well, the study authors noted. However, the optimal way to manage all those factors remains unknown. Researchers looked at 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0 percent or higher, body mass index (BMI) between 30.0 and 39.9 signifying they were obese, a C peptide level of more than 1.0 ng/mL, and Type 2 diabetes for at least six months. The subjects were divided into two groups and followed for a year. The first group underwent Roux-en-Y gastric bypass. The second group was instructed to change their lifestyle and have intensive medical mana Continue reading >>

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Diabetes And Its Negative Impact On Outcomes In Orthopaedic Surgery

Go to: PATHOPHYSIOLOGY Diabetes mellitus can be broadly classified into three types, based on the onset of symptoms and the absolute need for insulin replacement. Patients who have an absolute requirement for insulin, secondary to autoimmune dysfunction of the pancreatic beta cells, have type 1 DM. The vast majority of patients have type 2 DM which is associated with older patients, elevated body mass index (BMI), genetic predisposition, history of DM during pregnancy, less active individuals, and certain ethnic groups. Four out five patients with type 2 DM have an elevated BMI. Children and adolescents, particularly from certain ethnic and racial groups (African - American, Mexican American, and Pacific Islander), are being diagnosed with type 2 DM at an increasing rate. During the early stages of type 2 DM the pancreas usually produces insulin, however insulin resistance is present and glucose metabolism is negatively impacted. A small percentage of pregnant women develop gestational DM and 40% to 60% of these patients will ultimately develop type 2 DM within 5 to 10 years. The end result of DM, regardless of the etiology, is hyperglycemia. The primary energy source for our body is glucose, and glucose is stored as glycogen in the liver and skeletal muscle. Insulin facilitates glucose uptake into the peripheral cells, assisting with the storage of glycogen. While patients with type 1 DM have an absolute need for insulin replacement, patients with type 2 DM initially produce insulin, sometimes in high amounts. The problem is so called “insulin resistance”, in which the cells become less sensitive to insulin and hyperglycemia results. Stress hyperglycemia can occur in hospitalized patients without a previous history of DM and is defined as any serum glucose > 140 mg Continue reading >>

Surgery Doesn’t Have To Be An Ordeal For People With Diabetes

Surgery Doesn’t Have To Be An Ordeal For People With Diabetes

North Carolina-based Marc S. Stevens, MD, FACS, is one of the top orthopedic surgeons in the country. Previously, while practicing in Little Rock, he was named Arkansas Physician of the Year. In addition to his orthopedic expertise, Dr. Stevens has developed a reputation as an expert in nutrition, especially as it relates to wound healing, bone and joint health, and healthy weight. To learn more about Dr. Marc S. Stevens go to www.DRSHealthInc.com When Dr. Stevens spoke recently with Diabetes Health Publisher and Editor-in-Chief Nadia Al-Samarrie, he provided a surgeon’s point of view about surgery for people with diabetes. Nadia: Your focus on nutrition is wonderful-and unusual. Why are you so interested in nutrition? Dr. Stevens: You have to go back to the 1980s, when proponents started to claim that good nutrition could do anything: “It will grow your hair back, it will make you taller, it will make you stronger, it will make you 18 again.” Instead of getting involved and trying to redirect those outlandish claims in a more scientific direction, medicine kind of stepped back and said, “Well, we’re not going to have anything to do with nutrition anymore. We’re just going to go what’s called the allopathic route and focus on what we do best.” As a result, we lost a chance to connect with an important aspect of health. Most doctors still grasp that nutrition is vital. The reason we call certain things “vitamins” is because they are vital minerals, essential to good health. We all check for them, and we treat deficiencies when we find them lacking. But when it comes to prevention and how nutrition can support wound recovery or preparation for surgery, we just don’t typically think that way. Because I have paid close attention to nutrition, I’ve be Continue reading >>

Diabetic With An 8.6 A1c And Surgery? Is It Safe?

Diabetic With An 8.6 A1c And Surgery? Is It Safe?

Diabetics under good control can be excellent candidates for liposuction. I don't see a problem going forward with liposuction but this is something you should discuss with your endocrinologist as well as your plastic surgeon. Diabetic with an 8.6 a1c and surgery? Is it safe? You may qualify for surgery, but you need to discuss with your surgeon as well as your primary physician. An in person consult with an an ASPS board certified surgeon is the only way to determine the best route for your body and your goals. It is all about designing the perfect plan for You. Good luck, please let us know how it goes. -Dr. Constantino Mendieta A1C of 8.6 before elective surgery Thank you for your question about your liposuction and breast augmentation. Your A1C is a little high - suggesting your diabetes may not be well controlled. You should be cleared for surgery by the doctor treating your diabetes. Always consult a Board Certified Plastic Surgeon. Hope you find this information helpful. Best wishes. View all Liposuction reviews These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. Continue reading >>

Precautions For Patients With Diabetes Undergoing Surgery

Precautions For Patients With Diabetes Undergoing Surgery

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. There is a rising incidence and prevalence of diabetes mellitus. About 50% of people with diabetes mellitus are unaware of their condition. Approximately 25% of all patients with diabetes undergoing surgery are undiagnosed on admission to hospital. Patients with diabetes have a higher risk of cardiovascular disease. Patients with diabetes have a higher perioperative risk. They are more likely because of their disease to require surgery and those undergoing surgery are likely to be less well controlled and to have complications from their diabetes. Surgeons and anaesthetists operating on patients with diabetes should be familiar with the risks attached to having diabetes, and to the particular risks of the particular surgery and of anaesthesia in patients with diabetes. Risks and complications of diabetes mellitus Patients with diabetes mellitus are at risk of the complications of the disease. It is worth considering these in outline when considering how best to care for patients with diabetes undergoing surgery. See also separate Diabetes Mellitus article. Perioperative risks and complications of diabetes mellitus It is important in assessing risk of complications in patients with diabetes undergoing surgery to consider the specific type of surgery and anaesthetic technique. There is evidence for higher risk in those with diabetes undergoing surgery and, when such evidence is lacking, it may in part be testament to the relative safety of modern surgery and anaesthesia. However, the following risks and observati Continue reading >>

Saying ‘no’ To Patients With Diabetes

Saying ‘no’ To Patients With Diabetes

Patients with diabetes are no strangers to dealing with the complications associated with their disease. As foot and ankle surgeons, we also often face the challenge of treating the complications and sequelae of this pathologic process including lower extremity deformity, non-healing wounds, Charcot neuroarthropathy and infection to name a few. However, what happens when we, as intervening medical professionals, are the cause of a relatively predictable complication? What about when a patient with diabetes at increased risk for complication requests elective surgery? Is it our obligation to treat these patients as we do those without diabetes or should we approach these patients with a more wary and conservative eye? In other words, when is it okay to say “no” to a patient with diabetes? Although these are certainly questions without definitive answers, a review of recent literature may help podiatric surgeons make relatively judicious decisions. There are times when the medical profession may be a little too eager to please and when it seems like patients can always find a surgeon who will say “yes.” In a similar way, it can sometimes be difficult to remember that it is not our primary job to please our patients but instead to diagnose, educate and recommend. Just because a patient is willing to entertain increased perioperative surgical risk does not mean that we have to as well. It is okay to say “no.” Saying ‘No’ Because Of Poor Glycemic Control There is an increasing body of evidence that one should reconsider elective surgical intervention in the setting of uncontrolled hyperglycemia, both in terms of short-term and long-term control. Perhaps one can most easily appreciate this with long-term control of the hemoglobin A1c value. It can sometimes be Continue reading >>

Ultimate Guide To The A1c Test: Everything You Need To Know

Ultimate Guide To The A1c Test: Everything You Need To Know

The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>

A1c Too High For Surgery?

A1c Too High For Surgery?

This is my first time posting. I am still working on the requirements that the insurance company requires and hope to submit for approval in June to have surgery (RNY) this summer. I'm diabetic and I went to a nutritionist this past week and she told me that no surgeon would operate on me with my A1C as high as it currently is (8.7). Has anyone had their surgery postponed or canceled due to their blood sugar being too high? I'm going to work hard on getting my A1C down before the summer but this has me concerned. None of my other doctors have said this could delay the process. I'm doing this surgery hopefully to reverse my diabetes or at least get me off some of my meds. What are you eating, start reducing your sugars and drabs remember everything you eat turns into sugar, replace at least 1 meal with a Protein Drink you will see a huge difference in a month. I agree cut down your carbs and sugar intake. Stay away from juices very high in natural sugars. If you eat yogurt get plain and add your own sweetener to it and a little fruit. Protein shakes are great but read the label for ingredients and make sure there is not sugar in it. If you are going to make your own shakes then I recommend Jay Robb whey Protein powder made with stevia. It comes in vanilla , strawberry and chocolate . You can find it at a Whole foods, Amazon , eBay or directly from the company. If you want some flavors added to it I recommend Toscani sugar free syrups made with Splenda. You can find them at World Market, Amazon, eBay or directly for Toscani. These are just a few suggestions of what I would do. I had diabetes and was on 2 types of diabetes medicine prior to surgery. During the 6 month medically monitored weight loss program mandated by my insurance company, I lost 20 pounds. As a result I Continue reading >>

Operation And High Sugar?

Operation And High Sugar?

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community can anyone tell me,,,, im due an operation on xmas eve if blood sugers are high during and after it will it affect either the actual operation or the recovery? A few years back I had to have an operation on my elbow. The operation was cancelled twice as my Hba1C was too high. The reason I was given was that it takes a diabetic longer to get over things/prone to infections and the time it takes to heal. This was just my experience, so hopefully others will be able to help also. I think this is a question best asked of your surgeon who will have all your medical details and will know the procedure you are about to have performed. I'm sure you will be in safe hands but for piece of mind ask your surgeon before the op :thumbup: Best wishes and I hope you are still able to enjoy xmas after your op :thumbup: hi thankyou both, reason i ask is am pre diabetic ( if thats the right term) my last hba1c was 45mmols in april,,, ive been having lots of symptoms latly and been doing tests again after not doing any since april when i did a couple fo spot checks and im regulay hitting 17 2 hours after food and my morning test is nearly always above 10,,,, i know that coupled with the symptoms means maybe now i am diabetic,,,, i am going fri to have bloods taken again for a hba1c after having seen an incredibly dismissive nurse last week and said i was concerned. the operation is to remove a cyst in my head im terrified enough i also have 5 children im worried this will affect things,, ,ive not got my pre op till the 11th dec, :-( i guess by then i should know the results of fridays bloods. Once you get your HbA1c result, I would make an appointment with your GP and di Continue reading >>

Preoperative Glycemic Control For Adult Patients With Diabetes Undergoing Elective Surgery

Preoperative Glycemic Control For Adult Patients With Diabetes Undergoing Elective Surgery

Tristan B. Weir, BS, Florida State University College of Medicine, Larry C. Deeb, MD, Florida State University College of Medicine As the prevalence of diabetes continues to increase in the United States, a higher proportion of elective surgical candidates will require specific preoperative education and guidelines to maximize patient outcomes and reduce the costs of care. The purpose of this article is to review the current literature to determine how preoperative glycemic control affects the lengths of hospital stays, postoperative complications, and mortality in people living with type 1 and 2 diabetes. Additional recommendations are provided for preoperative hypo- and hyperglycemia, the use of insulin pumps or continuous glucose monitors, and day-of-surgery management of insulin and oral hypoglycemic agents. Gaps in medical evidence are acknowledged and future directions in research are proposed to provide high-quality guidelines for the preoperative care of adult patients with diabetes. Introduction As the prevalence of diabetes increases in the United States, practicing physicians must be able to educate and manage these patients in the preoperative setting. With 29.1 million (9.3% of the U.S. population) Americans living with diabetes today, nearly 1 in 10 surgical candidates may have diabetes and require special recommendations before surgery [1]. While the 2011 Joint British Diabetes Societies Inpatient Care Group (JBDS) created guidelines for the preoperative management of patients with diabetes undergoing elective surgery, many physicians in the U.S. may not know these guidelines exist [2]. In a 2014 study on preoperative hemoglobin A1C (A1C) and its effect on clinical outcomes for patients undergoing surgery, the authors say “there are no standards of care Continue reading >>

Surgery Cancelled..again...a1c Levels Still Too High

Surgery Cancelled..again...a1c Levels Still Too High

Surgery cancelled..again...A1C levels still too high I am sorry that I do not know what A1C levels are:(I feel sorry for you but remember everything happens for a reason and you will have your surgery soon. Sending good thoughts and prayers to you. KEEP YOUR CHIN UP!I ALSO AM DIABETIC SO I KNOW THE STRUGGLESWITH A1C LEVELS. JUST DO EVERYTHING IN YOURPOWER, TAKE MEDS, STAY AWAY FROM SUGAR ANDTHE LEVELS SHOULD COME DOWN.JUST KEEP THINKING POSITIVE THOUGHTS, STAY DILIGENTAND SOON YOU WILL BE JOINING US ON THE LOSERSBENCH.KEEP SMILINGTHERESE Oh I'm so sorry your surgery was cancelled. Did the doctor tell you what your A1C levels should be? I was ( I guess I am still am but my A1c was 5.2 last checked) a type 2 diabetic and before surgery my A1C levels were 7.5. My WLS surgeon never told me to watch my numbers or surgery would be cancelled. Are you on insulin or something to bring your numbers down? When will they check you again and what numbers are they looking for?Don't give up!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Hang in there hon. highest 239/Day of surgery 225/Current 119 TT and Breast Lift 3/08 awwww hun I hate to hear that. Wish I could let u borrow my A1C level long enough to get u through. After it bein a bit higher my pcp added an extra med and I started wat*****arbs more close. I got it back down to 6.5 now.And YES being diabetic Justa lil note to warn all pre and post ops. GET YOUR PROTEIN IN EVERYDAY!!! I have done rather crappy with mine since day 1 and I am paying dearly with VERY slow weight loss, major hair loss, and all out feelin like shit! PLEASE!!!! Follow your program's rules!! Continue reading >>

A1c Is A Predictor Of Clinical Outcomes Following Noncardiac Surgery

A1c Is A Predictor Of Clinical Outcomes Following Noncardiac Surgery

Researchers discover that preoperative A1C is related to length of stay in the hospital following noncardiac surgeries…. Acute hyperglycemia at the time of surgery is associated with poor clinical outcomes in all patients. Furthermore, diagnosis of diabetes mellitus is known to be a risk factor for complications postoperatively. Some healthcare practitioners use insulin infusion protocols to provide better glycemic control and prevent hyperglycemia during and after surgery to help lower the risk of complications. Less is known about the effect of chronic hyperglycemia on surgical outcomes postoperatively, and whether addressing this issue prior to surgery would improve outcomes. A study was therefore designed to evaluate whether A1C impacts outcomes following surgery independent of any hyperglycemia that may occur perioperatively. Data for this study was obtained from the National Surgical Quality Improvement Program database and from the data registry of the Brigham and Women’s Hospital. Data for patients having noncardiac surgery from 2005-2010 and requiring admission to the hospital for ≥1 day following surgery were included in this study. The 622 patients were divided into four groups based on their A1C levels. The groups were as follows: A1C≤6.5%, A1C 6.5-8%, A1C.8-10%, and A1C >10%. Patients were compared to nondiabetic control subjects of the same age, sex, and BMI. The results of the data obtained showed patients with A1C 6.5-8% had a hospital LOS similar to the matched group of nondiabetic patients. Patients with an A1C≤6.5% or >8% had a hospital LOS that was significantly longer when compared to that of the matching nondiabetic patients. It may seem surprising that A1C≤6.5% was also associated with increased hospital LOS. It is thought that this co Continue reading >>

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