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A!c Level Before Surgery
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optic1 posted:
I have been type 2 diabetic since 1998. In July of 2011 I had and accident where I injured my shoulder and back. This health organization I'm with finally allowed an X-ray in 09/11 which was negative and they put me on some pain pills since my arm was still in a sling and it was basically useless. The terrible pain continued and in 11/11 they authorized a MRI finally. On 12/20/11 I was able to meet with a doctor to go over the MRI. He said I had a complete rotator cuff tear and needed surgery. The request was put in for surgery and they finally responded in 02/2012 7 months later that my A1C was too high for surgery. I was told to have surgery that it needed to be between 5.0and 7.0 for a successful surgery. It was bad at 9.4. In March 2012 my blood test showed a A1c level of 8.2. Sometime this month I will have another test. My sugar control has been excellent since then so far.
My question is, I can fully understand good control for your blood sugar after the surgery for a successful outcome, but it has been 9 months so far and nothing has been done. I am worried about such things as Fatty Atrophy and not being able to do surgery at all. Is this type of A1C requirement BEFORE doing surgery because of your A1C level normal practices? Or is my provided just stalling and making an excuse just to hold off on doing surgery because I am diabetic or just finding a way out of it? I have lost use of my arm for 9 months now. They didn't even check out my back for 7 months but that damage is another story.

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I just want to know if surgery should have been done by now or is pre-A!C control the norm.
  • Yes surgery should have been performed with post op A1C Control
  • No surgery should not have been performed due to A1C level
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mhall6252 responded:
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.
Michelle
Diabetic since 5/2001
Follow my journey at www.mch-breastcancer.blogspot.com
Smile and the world smiles with you.
 
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Anon123567 responded:
I've had lots of surgeries and no one ever tested my A1C as part of my pre-op work-up
 
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dianer01 responded:
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.
accelerate out of the corners
 
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Debsbears responded:
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 done within a 3 month window, however high sugar levels will complicate the situation that is why I believe you are still waiting.

If I can make a suggestion talk to your managing Dr of your diabetes and find out about a dietitian who can work with you to bring your numbers down so you can have the surgery. I know my shoulder was in a sling for the 2 months I waited for surgery and it was quite painful.

7 months is a long time but until your numbers are in the "normal range" I doubt they will do the surgery sorry. That is my opinion. Best of luck to you please keep us posted. Deb
I shall wait upon the Lord and renew my strength.
Come follow my life's journey at:
www.mybearyspecial.blogspot.com


 
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Phototaker123 responded:
Check out Flutetooter's new posting about surgery with a high b.s. numbers.
 
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DavidHueben replied to Phototaker123's response:
I would not put a lot of stock in Dr. Bernstein's experience. In my opinion, it is atypical.

I have had eight eye surgeries in the last 15 months and they have always done a CBC, CMP, and blood glucose check during the pre-op workup.

While in the operating suite, I have been hooked up to a heart monitor, pulse onximeter, and BP cuff. When taken to recovery, the first thing they checked was my glucose level. A couple of times, I had to eat a couple of cookies and drink a real 7-Up to get it over 90 so that I could be released.
We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm.

- Winston S. Churchill




 
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flutetooter replied to DavidHueben's response:
David, The thing I am concerned with in case of any future sugeries for me is the glucose drip, not the presurgery tests you mentioned In the case of the woman who died, the drip added to her already high glucose level.
If at first you don't succeed, try, try again!
 
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cookiedog replied to flutetooter's response:
Flutetooter - I had major surgery last spring. I had to have the surgery as a way to stay alive until I get my liver transplant.

I had an a1c as part of my pre-op testing. I had a blood sugar check about 1/2 hour before surgery started. Based on my number the anesthesiologist gave me a small amount of insulin.

When I regained consciousness after the surgery, the doctors were reviewing the surgery with me. They told me they checked my BS during the surgery and gave me a bit more insulin when my BS started increasing.

I have been in the hospital 9 times in the past two years. I have never been given glucose. I am given saline in my IV to keep my hydrated.

I think I have been given adequate assistance with controlling my diabetes during my many hospitalizations.
 
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flutetooter replied to cookiedog's response:
It sound like you have been getting excellent care, cookiedog. Around here, I think they routinely start a glucose drip without checking as to diabetes. Scarey!
If at first you don't succeed, try, try again!
 
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optic1 responded:
Well thank you everyone for some good info.

I figured the VA was just taking their sweet time. It has been 10 months now, I wish they would have said this last July and not wait 8 months to tell me there A1C requirement. I am getting my sugar tested this week, and it should look good. I do not feel they will do the shoulder now at all since when I ran to the ER with chest pains last week and the doctor now has told me when they put a stent in that all my native arteries were blocked and I only had 30% flow thru one graft from a previous triple bypass and the stent would only open that graft to about 50%. They said I need a heart transplant and sent me home so I guess I am toast. Now I am stuck in the Social Security Disability waiting period and cannot get on Medicare till 07/2013. The VA won't touch the transplant so at this point there is no help. All my life I had blue cross/blue shield with my job but now it is all about tjis SSA waiting period. That sucks lol.

Just want to say thanks for your help though everyone.
Scott
 
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suzanneinWA responded:
Hi there,

I know you posted a long time ago, but I thought I'd throw my $0.02 in anyhow. I have been working with an insulin start nurse and my A1C has come down over a full point since my last check, but is still higher than what they want in order to do a hand surgery that I need. My nurse recommended asking my surgeon about doing a fructosamine test. Fructosamine testing allows the effectiveness of diet or medication adjustments to be evaluated after a few weeks rather than months. While it isn't a good test for finding out IF someone is diabetic, it may be a viable opportunity to determine if a person's glucose is under control enough for surgery and proper post surgical healing.
 
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brunosbud responded:
Some patients require insulin treatment, post major surgery, for high levels of blood glucose with no prior history of diabetes.

Going into surgery with an 8.2, or thereabouts, and you think the surgical team is "stalling"? Do you know what prolonged uncontrolled blood sugar does for wound healing and infection spread?

It aint good...


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