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How long is a piece of string? HbA1c query

I

IBEX82

Well-Known Member
Messages
274
Type of diabetes
Type 2
Treatment type
Insulin
So.. around 7 weeks ago I had my HbA1c done and it was 82.

I am scheduled for surgery and for that my HbA1c needs to be below 68-69. Due to taking steroids, I’ve now been placed on a combination of glic and insulin - I also low carb.

My query is… I’ve been monitoring my BG with finger pricks religiously and for the past 4 weeks or so the freestyle libre.

Between the finger pricks and libre, the two apps I use to monitor my BG are predicting a HbA1c of 42-46.

I’m due a blood test next week, and that will be 8 weeks since changes were made (diet for the first 3-4, medication for the last 4).

What are the chance of a hba1c below 68-69 required for surgery? I know it’s hard to know but how accurate are estimates?

Hence my thread title, I may be asking the impossible
 
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Hi @IBEX82 It isn't possible to be accurate partly because the estimate from the BG meter is + or - 15% (That is the standard of accuracy they are manufactured to. Then add in that the BG test level depends upon when you test - it will be different before meals than after meals , after exercise or in the middle of the night. Finally at present if your HbA1C was tested now, after 8 weeks, between a 1/5th and 1/3rd of your blood cells would still be from before you started.
Lets consider worst case after a total of say 9 weeks: Current prediction at current levels worst case = 1/3rd 82 + 2/3rds of 53.5
Giving a worst case prediction of 65 - so you should be OK but not much leeway!
 
IBEX82 said:
What are the chance of a hba1c below 68-69 required for surgery? I know it’s hard to know but how accurate are estimates?
Click to expand...
The estimates aren't always accurate, and in your case your hba1c will be higher than the predicted ones, because the hba1c is a build up of the past 3 months of blood glucose, and you've been on intensive treatment for 1 to 2 months.
Your Libre only has the information for the past 4 weeks and doesn't know about your higher numbers before that.

However, the hba1c result has a heavier weight from the last part of those 3 months, and your results over the past month look very good!
IBEX82 said:
What are the chance of a hba1c below 68-69 required for surgery?
Click to expand...
I'd wager a pretty high chance, and I'll have my fingers, toes and eyes crossed for you!
 
This is super helpful and it definitely helps manage my expectations.

I appreciate until I have the test it is mostly guesswork
 
Love this response, thank you so much. At least the good numbers hold a heavier weight. I’d take 67 to be honest, anything else will be a bonus.

Test is the 13th and appt on 16th to discuss result so… I’ll take any crossing of fingers, thoughts, vibes… anything going really

Buuuut… even if not.. my control has to be better than it was, and maybe just more time is needed for the fuller picture
 
IBEX82 said:
maybe just more time is needed for the fuller picture
Click to expand...
Even if you turn out to be just over the threshold, they might agree to do the operation based on your Libre results if they show a good time in range.
Definitely something to argue if needed.

The reason they don't want to operate with a high hba1 is because high blood glucose poses a serious extra risk, especially with healing and possible infections.
Even if your hba1c should still be just over the magic number, your Libre graphs will show that your daily BG is now in a range considered safe for operations, and you can explain perfectly well why the hba1c will take some time to catch up with the improved situation. The outcome of this approach will mostly depend on the person you speak to, I fear.
IBEX82 said:
Buuuut… even if not.. my control has to be better than it was
Click to expand...
And please keep it like this for a long time!
 
Sound advice as always. Here’s hoping.. my op date isn’t until July so my specialist wanted test next week and then again 3 weeks later - by that point we’ll be much further in.. but I also think you raise good points about my libre data.

I have a feeling it might be a case of ‘the rules are the rules’ so hopefully if I don’t make it the first time, I will the second.

Keep them eyes crossed
 
alex1965 said:
just to be a smart Alex,
in answer to your question "how long is a piece of string"
it's twice the distance of either end to the middle
you're welcome
Click to expand...
I needed this laugh - thank you. It helps with the stress of waiting
 
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