The Importance of Controlling Blood Sugar Levels Before Surgery
By: Brian Hoeflinger, MD
December 8, 2024 | #25
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
What is the term for the process by which the liver produces glucose from non-carbohydrate sources, such as amino acids, during fasting? (the correct answer is at the end of this email)
- A) Glycogenolysis
- B) Lipogenesis
- C) Glycolysis
- D) Gluconeogenesis
Why it is Important to Control Blood Sugar Levels Before Surgery
As a neurosurgeon, one of my primary concerns is ensuring that my patients are in the best possible health before undergoing any surgical procedure. A critical aspect of this is maintaining well-controlled blood sugar levels, especially for those with diabetes or pre-diabetes.
I like to stress the importance of the hemoglobin A1c (HbA1c) test, which measures the average blood glucose levels over the past 2-3 months. This test is crucial in diagnosing pre-diabetes or diabetes and monitoring how well an individual's diabetes is controlled.
For people without diabetes, a normal HbA1c level is 5.7% or less. However, those with diabetes typically have a level of 6.5% or greater. In my practice, I aim for an HbA1c level of 7% or less before proceeding with spine surgery. Achieving this target ensures that we minimize potential complications and optimize the patient’s recovery process.
Why is This So Important?
Controlling blood sugar levels before surgery is vital for several reasons:
- Reduced Risk of Infection: Elevated blood sugar levels impair the immune system, making it harder for the body to fight off infections. This is especially critical after surgery, where even minor infections can lead to severe complications.
- Improved Wound Healing: High glucose levels affect blood flow and oxygen delivery to tissues, which are essential for proper healing. Delayed wound healing can result in longer hospital stays, additional procedures, and a prolonged recovery.
- Lower Risk of Surgical Complications: Poorly controlled diabetes increases the risk of complications such as cardiovascular events, kidney issues, and nerve damage during or after surgery. By optimizing blood sugar levels, we can significantly lower these risks.
- Enhanced Outcomes: Patients with controlled blood sugar levels generally experience smoother recoveries, fewer post-operative complications, and better long-term outcomes. Achieving optimal glucose control sets the foundation for overall success.
- Prevention of Hyperglycemia and Hypoglycemia: During surgery, stress can cause fluctuations in blood sugar levels, which can be dangerous if not well-managed. A stable HbA1c level helps minimize these swings, ensuring safer anesthesia and surgical processes.
When a patient comes into my office with an HbA1c level of 10% or 11%, I will postpone the surgery and work with them to get their blood sugars under better control. While this may delay the procedure, it is a critical step to protect the patient’s health and ensure the best possible surgical outcome. Managing blood sugar levels requires a comprehensive approach, including lifestyle changes, medication adjustments, and regular monitoring. I often collaborate with primary care physicians, endocrinologists, and dietitians to create a tailored plan for each patient. It’s a team effort to ensure that every individual is set up for success.
If you have diabetes or pre-diabetes and are considering surgery, I urge you to work closely with your healthcare team to manage your blood sugar levels. By doing so, you can reduce your risk of complications, promote better healing, and ensure a smoother recovery process. It’s not just about the surgery itself; it’s about setting the foundation for a healthier future. Remember, knowledge is power when it comes to your health. Taking proactive steps to manage your health before surgery can make all the difference in your outcomes. If you have any questions about the HbA1c test or managing your blood sugar levels before surgery, please don’t hesitate to reach out to your healthcare provider. It’s never too late to take charge of your health.
Stay informed, stay healthy, and always prioritize your well-being.
Impactful Quote of the Week
"He who has health has hope; and he who has hope has everything.”
- Arabian Proverb
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).
My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
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Medical Trivia Answer:
The correct answer is D) Gluconeogenesis. Gluconeogenesis is the metabolic process by which the liver produces glucose from non-carbohydrate sources, such as amino acids, to maintain blood sugar levels during fasting or low-carbohydrate intake.
