Short answer: many people with diabetes have knee or hip replacement safely, in Colombia and elsewhere. Most surgeons will want evidence that your blood sugar is under reasonable control before they operate, usually a recent HbA1c (A1c) result, because poorly controlled diabetes is linked to higher risks of infection and wound problems. Cutoffs vary by surgeon and hospital, so ask for theirs early and plan your timeline around it.
This guide explains why the number matters, how to build a preparation timeline with your home doctor, what to ask about medicines and fasting (without telling you how to change them), and how to travel with diabetes supplies.
Key takeaways
- Ask each surgeon early for their A1c requirement and how recent the test must be. Thresholds differ between surgeons and hospitals.
- Blood sugar control matters because high glucose is linked to more infections and slower wound healing after joint replacement.
- Improving A1c takes time, because it reflects roughly the past two to three months. Build that into your booking timeline.
- Changes to diabetes medicines around fasting, surgery and travel days should come only from your own clinicians, in writing.
- Pack double supplies in your carry-on, protect insulin from heat, and plan for time-zone changes with your care team.
Why blood sugar control matters for joint replacement
A joint replacement leaves a large implant inside the body. Infection around an implant is one of the most serious complications after knee or hip replacement, and treating it can mean more surgery and a long recovery. Research has linked diabetes, and especially poorly controlled blood sugar, to a higher risk of infection and wound-healing problems after joint replacement.
High glucose can affect how well white blood cells fight bacteria and how quickly tissues heal. That's why surgeons look not only at whether you have diabetes, but at how well controlled it has been and how your sugars behave around the time of surgery.
A1c (also called HbA1c or glycated hemoglobin) reflects your average blood sugar over roughly the past two to three months. It's a snapshot of longer-term control, not of a single day.
A1c cutoffs: what surgeons look for
Many orthopedic surgeons and hospitals use an A1c threshold as part of their pre-surgery screening. If your result is above it, they may ask you to postpone surgery and work on control first. There is no single universal number: different surgeons, hospitals and published guidelines use different cutoffs, and some also look at day-of-surgery glucose or other markers.
Published studies and guidelines have proposed a range of cutoffs, and the evidence on exactly where to draw the line is still debated. Rather than aiming for a number you read online, ask your surgeon for theirs and ask your home doctor what target is realistic and safe for you. Lowering A1c too quickly, or with frequent low blood sugars, carries its own risks.
Ask each surgeon: What A1c do you require? How recent must the test be? Will you accept a result from my home lab? What happens if my glucose is high on the day of surgery?
Treat the cutoff as a minimum, not a target. If you're close to the line, talk with your home doctor about whether more time would lower your risk, even if you technically qualify.
Building a timeline with your home doctor
Because A1c reflects a few months of control, a plan to improve it needs months, not weeks. Build your surgery date around your health, not the other way around.
- NowGet a current A1c and share itSend it to the surgeon with your case file and ask for their threshold before you book anything non-refundable.
- Planning monthsWork on control with your home teamYour primary doctor, endocrinologist or diabetes educator adjusts your plan. Ask how long they think you'll need.
- RecheckRepeat A1cTime it to meet the surgeon's "how recent" rule. Send the new result and confirm they're satisfied.
- Before flyingGet a written peri-op planFrom your home clinician and the Colombian team: medicines, fasting, travel days and who to call.
- Back homeFollow-upSugars can run higher for a while after surgery and with less activity. Book a check-in with your diabetes clinician.
Other conditions often travel with diabetes, such as kidney disease, heart disease, nerve damage in the feet, or circulation problems. Your surgeon and anesthesiologist will want to know about all of them, along with your full medication list.
Medicines, fasting and travel days
Fasting before surgery, long flights, time-zone changes and reduced activity can all affect blood sugar. Some diabetes medicines need to be adjusted or paused around surgery; for example, some newer medicines in the GLP-1 and SGLT2 classes have specific pre-surgery guidance. Don't change any medicine on your own; this is exactly what your clinicians should plan with you.
Questions to take to your home doctor and the anesthesiologist in Colombia:
- Before surgeryWhich of my medicines should I continue, adjust, or pause, and starting when?
- FastingWhat do I do about my medicines and low blood sugar while fasting before surgery?
- Flight daysHow do I manage meals, medicines and glucose checks across time zones, there and back?
- After surgeryWho manages my glucose in the hospital, and when do I go back to my usual routine?
- Sick-day planWhat should I do if I can't eat, vomit, or my readings are high or low after discharge?
You have signs of very low or very high blood sugar that don't respond to your usual plan, confusion, vomiting that won't stop, or fever with a red or draining wound. Call 911 in the US or 123 in Colombia.
Packing diabetes supplies for a surgical trip
A surgical trip is longer and less predictable than a vacation. Plan for delays and for being less mobile than usual.
Diabetes travel checklist
- At least double the supplies you expect to need, split between your carry-on and a companion's bag
- Medicines and insulin in original labeled packaging, with a copy of prescriptions
- A letter from your doctor listing your diagnosis, medicines and devices (pump, sensor, pen needles)
- Insulated cooling case for insulin; never in checked luggage, where temperatures can swing
- Glucose meter, test strips, sensors and spare batteries or chargers, plus a backup meter if you use a sensor
- Fast-acting glucose for lows, and snacks for delays
- Sharps container or a plan for safe needle disposal
- A written record of your usual doses and pump settings for the hospital team
Medellín and other Colombian cities can be warm, and coastal cities hotter still. Keep insulin out of direct sun and hot cars, and ask your lodging about a refrigerator before you arrive. If you wear a pump or sensor, ask the device maker and airline about airport screening.
Plan your supplies for the trip you might have, not the trip you hope for.
Questions for the hospital about glucose care
Hospitals handle glucose during and after surgery in different ways. Ask before you commit so nothing is improvised on the ward.
Ask the hospital or surgeon
- Who manages my glucose in hospital: the surgeon, an internist, or an endocrinology service?
- How often will my blood sugar be checked before, during and after surgery?
- Can I keep my insulin pump or continuous sensor on, and who adjusts it?
- Will the staff caring for me be able to communicate in English, or should I bring an interpreter?
- What is your plan if my glucose is high on the morning of surgery?
- Will my discharge summary include glucose readings and any medicine changes?
Add all of this to your case file and discharge packet. When you get home, your diabetes clinician should see exactly what happened in hospital and what changed.
Frequently asked questions
Will a surgeon in Colombia operate if I have diabetes?
Many will, provided your diabetes is reasonably controlled and your other health conditions are stable. Each surgeon sets their own requirements, so share your A1c and medical history early and ask for theirs in writing.
What A1c do I need for knee or hip replacement?
There is no single universal number. Surgeons and hospitals use different cutoffs, and some also look at glucose on the day of surgery. Ask each surgeon for their threshold and how recent the test must be.
How long does it take to lower my A1c?
A1c reflects roughly the past two to three months, so meaningful change usually takes months. Your home doctor can tell you what is realistic for you and when to retest.
Should I stop my diabetes medicine before surgery?
Only if your clinicians tell you to. Some medicines need to be adjusted or paused before surgery, while others continue. Get a written plan from your home doctor and the anesthesia team.
Can I bring insulin and supplies on the plane?
Generally yes, in your carry-on. Keep them in original labeled packaging, carry a doctor's letter and prescription copies, and check your airline's and departure airport's screening rules before you fly.
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