Question about A1C control for upcoming surgery

I will probable have 1-2 surgeries coming up depending on the rest of my test results. I am a Type 2 and on a pump For the past yr have been able to keep my A1C under 7 per the guidelines- last one was 6.4. Talked with the surgical PA today and he said he wanted my A1C lower than 5.8!.

I work in a hospital and asked the Diabetic educator if she had heard of such a thing...she said...nope. I never hear anyone requiring that low of an A1C for surgery. She has heard that the A1C cut-off to do non-emergent surgery in-house is 7.5.

The only thing we could think of had to do with the type of surgery...I might need a nerve transposition for my ulnar nerve and thought there might be a different guideline since the surgery will be on my nerves.....

I was curious if anyone has heard of the surgeon wanting a lower A1C than what is the standard.....and yes..I know...the lower the A1C the lower the risk of infection...blah blah blah. Just thought it was weird since the diabetic educator never heard of a surgical double standard like that.

I have never heard of that! 6.4% is a decent A1C.

Can you get through to someone else on the surgical team? Can the diabetes educator become an advocate for you and call the surgeon's office?

My A1C was 6.4% when I had shoulder surgery. I had to pass the presurgical physical they require, but even with diabetes, I was deemed to be fairly low risk.

I also had carpal tunnel surgeries in both my hands with similar A1Cs.

So - the PAs reply is very perplexing.

I'd seriously ask around some more . I've never been told a1c is an issue for surgery (not emergency ,2 of which being "out patient" even though I ended up being inpatient for the most recent one because my pancreas is a demon) and I've had like 5 in the last year or so? I mean mine's 5.7% , but 6.4% is STILL AMAZING and I don't see how it's a problem?

I'd talk to the surgeon but you may be onto something with the nerve issue, given that it's in an extremity? I agree that it seems like an odd recommendation, usually the only people who are recommended to aim for 5ish A1Cs are expectant T1 moms. Although it sort of makes me wonder if so many of them are able to do that, why more of us aren't allowed to aim tighter?

I would follow up with this surgical PA and ask him what is the medical basis for the 5.8% A1c. If it is some sort of policy, what is this policy based on?

Do you think you could drive down your A1c safely to < 5.8%? If you do then maybe you could turn this odd challenge into a benefit.

I also understand that variable A1c lab standards across the country produce variable results. And what if your red blood cells last a few more weeks than the average population? That would lead to a higher A1c, everything else held equal.