HB with GD (or suspected or borderline GD)

[emmaegbert]

Would love to hear success stories of other HB mamas who had diet-controlled GD, or even who had suspected or borderline GD.

I just had a 3hrGTT yesterday, one elevated level, one borderline level. Apparently thats not actually a GD diagnosis, and I am supposed to go back for ANOTHER one in 3 weeks to see. Sadly, that would be my third 3hrGTT and my FOURTH big dose of glucola with this preg. Its just so disgusting.

My HB midwife doesn't seem to concerned. She says, just comply with the testing (in case I need a transfer later I don't want to be in their system as "non-compliant"), meanwhile follow the GD diet anyway b/c its healthy, take the nutritional counseling I get offered through hospital practice, and start monitoring at home. She said if we all feel good about my levels, she's comfortable with HB.

Hospital/BC-based midwife (who I am seeing for co-care, she "sort of" knows but can't officially offer co-care, but it gets all my testing covered at 100%) adamantly *against* me doing testing of my own, thinks I am overreacting, wants me to follow GD diet, exercise more, and just retest, hoping I will come up neg.

If I think I might be negative, I guess its worth retesting to avoid an official label (without retesting, they will "assume" i have GD). But, ugh. Esp since I really don't intend to deliver with them... Meanwhile, I think I will feel a bit uncomfortable about the issue anyway the rest of my preg. I do think that testing myself may be the best thing to know what is really going on, and to take control of my own health, etc.

And I really want the HB to work out. I am not in panic mode or anything b/c I do think I can probably control with diet if I need to. Just still, not good news.

[bobandjess99]

I've had 2 uncomplicated UC homebirths with type 2 diabetes, not all that controlled, quite honestly. No problems here.

[DahliaRW]

I would just do the diet and not retest. Doesn't seem necessary as long as you are following the diet. ANd that much sugar in your body at once just isn't good for you anyways. Which is why I don't even do the GTT test (not to mention I can't keep the stuff down), though I would try it if I had any signs of possibly having GD.

[emmaegbert]

bobabdjess99- thanks for sharing that! its good for my mental state to hear success stories.

Originally Posted by DahliaRW

I would just do the diet and not retest. Doesn't seem necessary as long as you are following the diet. ANd that much sugar in your body at once just isn't good for you anyways. Which is why I don't even do the GTT test (not to mention I can't keep the stuff down), though I would try it if I had any signs of possibly having GD.

I've always known I will test, because I am in a high risk category for GD (mom had it with me, has typeII, strong family history of typeII). BUT, this would be my FOURTH test (my third 3hr GTT). Honestly not retesting is my instinct on this. I mean- how long will this go on? that glucola stuff is utterly revolting and clearly its not good for me- I feel terrible for the entire day of the test.

But, then, I am getting the MWs (both at hospital and the HB MW) telling me to follow the "rules" and retest, that otherwise I am automatically classified as GD. HB MW also says I can possibly be flagged as a "non-compliant" patient, and I don't want to be treated badly by the staff there IF I need hospital care. I guess I need to find out more about what GD classification could mean down the line at this particular hospital as well as the hospital that is closer to my house. I hate thinking this way, all these "what ifs" but I also would hate to be afraid not knowing what they might require for me and my baby if I did transfer.

Or maybe I should just not worry- if I end up at the hospital its because I need to be there, and I will just have to relax and realize that my birth experience and my baby's first days of life will be very medicalized.

[Mamabeakley]

I am pretty sure I would have failed the GD tests with my last pregnancy, because before I even got to that point it was clear to me that my body was not metabolizing sugars the way it normally does. I changed my diet, because eating even a little bit of fruit or sweetened anything before dinnertime was making me feel awful. My diet is pretty good otherwise - lots of veggies, whole grains, protein, etc. But I couldn't handle sweets early in the day at all, so I stopped eating them. It's too early to tell whether the same will hold true with my current pregnancy (I still feel awful all the time no matter what I eat ) but I am pretty sure that as long as what I am eating makes me feel good, my baby and I will be fine.

My CNM homebirth practice did do the tests as routine, but I asked what would happen if I declined them and they said "nothing" so I did. I know, though, that you are in a different situation, since you've already had tests.

Have you asked your hospital MW what being labled "non-compliant" means - like, what happens, specifically?

Also, if you want to do home testing, it's really none of her business. Just don't tell her you're doing it unless you want something she has to offer (like medication.)

[emmaegbert]

Ladies- thanks again for your input.

Next appt with the hospital MW I just need to ask her every question under the sun about what it would mean to be GD or suspected GD and how much prenatal testing is routine (I don't want to do lots. I already have declined quite a few that were optional. The GD screening is not optional at the hospital).

The hospital MW is pro-HB but is not allowed to officially "know" that I am planning it and still provide care. I like the MW program there and don't want to make problems for the MWs, also I'd like to stay with them for prenatal care b/c I'd rather not see and OB to whom I would actually have to lie about my HB plans, unless I really have to. So part of it is me complying with what SHE is required to do for me while I am under her care, if that makes sense? She works under the rules of the OBs. I don't feel adversarial with her or anything, but there is an aspect of "working the system" going on here. No hospital practice around here gives official co-care or backup care for HB. This hospital is covered at 100% for me and is also one of the best for being pro-mom and pro-baby.

Anyway, I will make it clear to her that I want to do the minimum testing to know I am healthy and comply with rules, and no more. Unfortunately doing another GTT if I can "pass" may be the easiest way to do that.

[Mom2SammyJoe]

This seems so odd to me to do the 3hr so many times. I am a nurse for an OB, and if someone is "borderline" we test them with a finger stick at each office visit, hopefully one hour after eating. If these levels are elevated, then we send them on for diet counseling and home monitoring. If the home levels are elevated even with dietary modification, then the patient may go on for medications, insulin, etc.
I also have to say that the office I work for is very by the book ACOG oriented.
It seems like monitoring at home would be the best thing to do, more accurate and realistic than another 3 hour GTT.

[DahliaRW]

If I had risk factors I would for sure choose to do the screening (the first, not necessarily the third).

If you end up transferring to the hospital, you can't be guaranteed you'd be treated nicely regardless. Some are great about HB transfers and others are rude. I don't see bieng "non-compliant" with a GD test at that point really being an issue.

It seems that following a diet and monitoring your blood sugar would be sufficient. If you were diagnosed with GD, that's what they'd have you do anyways, so I don't get the need to retest if you're willing to do that.

[emmaegbert]

Its very interesting to hear that other practices use very different protocols. I will ask about this some more at my visit. I do keep thinking that this seems like A LOT of glucola to be drinking! The HB MW assures me she doesn't worry that much with the results from the GTT because its so unrealistic to what is normally happening in my body and life.

I am going to get a monitor tomorrow and see what I can find out on my own.

True, they might give me a hard time no matter what if I xfer. And, what I keep thinking is, I will only transfer if I actually need their medical interventions, so I can expect to get the works if I do. But, I've heard from several HB midwives that they are quite good to the HB patients at this hospital- not "officially" the backup hospital but basically pretty supportive.

[RachaelsMommy]

If it was me, I'd probably just do the test again. That way if you do end up in the hospital you won't be classified as GD or non compliant. You would probably have a better chance of having a more natural birth (depending on whatever circumstance caused a transfer in the first place) with less interventions.

[emmaegbert]

Originally Posted by RachaelsMommy

If it was me, I'd probably just do the test again. That way if you do end up in the hospital you won't be classified as GD or non compliant. You would probably have a better chance of having a more natural birth (depending on whatever circumstance caused a transfer in the first place) with less interventions.

Thanks, yes, this is how I should approach it if/when I retest. Not all worked up about it, and assuming I'll "pass". Its just such a GROSS test. Oh well. I am sure having to go to the hospital (not the clinic) every week at the end would be way more inconvenient, stressful and time consuming, actually.