How necessary is the glucose test?

[kgreenemama]

I hated the glucose test when I was pregnant the first time. Not only did it make me feel sick all night, baby was bouncing all over his womb. I also have aversions to sweets during pregnancy, and just choking down the juice was torture.

So, my question is, if a woman were prone to gestational diabetes, wouldn't she have other symptoms? How terrible would it be to decline the glucose test and risk not knowing one had GD?

Anyone out there glad they had the test because it revealed GD?

THANKS!

[tracymom1]

I had the test with my first and I failed it. I had to go for the 3 hour GTT and that revealed that my sugars were actually on the low side.

IMHO, having worked in Ob/Gyn, seeing so many women "fail" the 1 hour and then pass the 3 hour with flying colors, unless you have pre-determined risk factors for diabetes I do not see a reason to have the 1 hour GTT performed. Blanket testing for every pregnant woman is just absurd. Why should every single woman be tested for something if they are not symptomatic, have no family history and are otherwise healthy?

This was taken from the VERY mainstream WebMD site:
Pregnancy and Gestational Diabetes Screening
All pregnant patients should be screened for gestational diabetes during their pregnancy. Screening may be done via patient history, clinical risk factors, or laboratory screening (the oral glucose tolerance test.

Needless to say, I did not test with pregnancy #2 and will not this time around either. If you have high risk factors, go for it.

[Mamatoabunch]

I skipped it after my first pregnancy 17 years ago.

[~Demeter~]

I didn't do it my last 2 pregnancies. My first 3 I passed the 1 hr but felt awful afterward... there are alternatives to drinking the glucola though if your doctor is interested in alternative ideas.

[EllisH]

I was on the fence whether or not to take it. Problem is that there may be no other symptoms than a baby that weighs (too) much, so it is good to know whether being pregnant made you worse at processing glucose.

I decided to get a home glucose test. That way, I don't have to down an artificially large amount of glucose and I get the real life view on my glucose situation. I measured a few times in the morning (sober), a few times one hour after a normal meal and a few times one hour after a sweet attack (high-glucose meal or having eaten too many chocolates). It gave me a good view on my glucose tolerance (OK) and it also confirmed that eating high-glucose meals isn't healthy (as gd is not black-and-white: a lot of glucose is bad for you / the baby even if on the high end of normal and not the result of gd).

I looked online for the normal ranges in these situations; don't have the website (my dh looked for them), but it's pretty uncontroversial.

[nova22]

I had the standard fast & glucose drink test during my first pregnancy and I haven't had it since. I don't have a high opinion of that testing method; it's completely unnatural and I don't feel like a pregnant woman should fast and then overload her body with sugar, it's bound to cause serious discomfort at best. There are some people who go so far as to say Gestational Diabetes doesn't even exist, and I'm not totally convinced that they're wrong.

In my first pregnancy, I did the regular test, failed, and had to go back for the three-hour test. I passed with flying colors.

I didn't have any test at all during my second pregnancy.

During my third, I fasted for an hour and then had a candy bar before having blood drawn.

During my fourth, fifth, and sixth (this pregnancy), I ate normally and then told my midwife exactly what I'd eaten. She did a finger prick. Results were normal.

If I ever end up with a health care provider who is not willing to do a modified test, I will waive it altogether. The only reason I take it in the first place is because there are so many diabetics in my family; if my risk were lower I wouldn't do it.

[leahmn12]

I have gestational diabetes with this pregnancy and both of my other pregnancies. I have no risk factors. I control it very well by eating very healthfully and monitoring my blood glucose with a meter. This time, as soon as I had my first OB visit, I asked to skip the glucose tolerance test and just get a meter. He agreed. I don't know why anybody couldn't just do a few standard blood glucose tests (fasting first thing in the AM, and one and two hours after eating a normal meal- called post-prandial blood glucose tests). If the values are normal, according to your physician's guidelines, then I'd say you probably have nothing to worry about. If they're questionable, a test called A1C can give you a six-month average of your blood glucose. I agree that inundating your body (and baby's body!) with unnecessary sugar doesn't make much sense.

[L&K'smommie]

I would also ask if they may be open to alternative methods. My MW just has me eat a large breakfast and then does the blood draw an hour after that. She feels that the glucola just overloads your body in an unnatural way and is not accurate as far as determining GD.

If you have no past history or family history I wouldn't feel bad declining it.

[Aleka333]

I didn't take the test and this is my first pregnancy.
thought it was strange to screen everyone for it... it's not something my mother or any my sister-in-laws ever had done, and I don't have any family history with GD or any type of diabetes.
my midwife didn't care either way, and when I asked her about it, I could kind of tell she thought it was unnecessary. But I decline most tests.

[StillWaters]

The three-hour test made me sick, sick, sick. It was sheer torture. I am never doing that again.

[luckiest]

Like a couple of PPs, my midwives had me eat a normal breakfast and tested my blood sugar with a glucometer an hour after I finished eating. The glucola is kind of an insane practice - why would you overload your system with sugar and use those results to determine how your body processes sugar in your daily life? Hopefully you aren't consuming 100g of sugar on an empty stomach regularly. It makes so many women sick and dizzy, there's no way it's good for mama or baby.

If you're concerned I would ask for the "real-life" test with a glucometer, otherwise I'd be tempted to skip it, especially if you have no family history of diabetes.

[katelove]

If you have any risk factors then I would ask for the 3 hour test. I wouldn't ever bother with the 1 hour test, it is a screening tool it isn't diagnostic. In fact the hospital where I had my antenatal care doesn't do it at all. If someone has risk factors then they offer the 3 hour diagnostic test.

If you do have risk factors then it is worth doing IMO

- as a PP mentioned, sometimes the woman will not experience symptoms
- macrosomia is not the only potential problem uncontrolled GD can cause for the babe
- GD increases a woman's risk for DM Type II. I, *personally*, would want to know if my risk was increased so I could modify my lifestyle risk factors accordingly and be aware of early symptoms of DMII so I could start treatment immediately.
- home glucose monitoring is not a reliable way of diagnosing GD. As unpleasant as many people find it, the 3 hr test is the best diagnostic we have at the present time.

[MyFullHouse]

I've done the test five times now (six, if you count the only 3-hour I've done). The last 3 times, I've used a 50g glucose healthy breakfast.

If my hcp "required" me to use the glucola drink, I think my view might change. I distinctly remember feeling awful after those, and I'm not sure I'd believe it was worth the effort.

Personally, I want to check on how my sugar is doing, and getting one blood draw appeals to me more than getting my own glucose monitor. But getting my own glucose monitor appeals to me more than doing a 3-hour glucose test, if it were to have come to that this time. Everyone has their own individual limits.

I think the fact that my first two babies were such different sizes (7lb9oz then 9lb2oz) plays into it. I have no reason to think any of my pregnancies is going to be the same as the previous, so it makes me feel better to "check in" on them.

Also, I don't do any blood draws before that (unless otherwise indicated). So this trip to the lab was for more than just glucose testing.

The fact that I could get it done at 7am, not have to go hungry, not have to drink the icky stuff, and only have to deal with 1 needle the whole time really makes it no big deal in my book, and gives me some peace of mind.

If circumstances were different, I'd have to reweigh all the factors, and might come to a different conclusion.

[msmiranda]

Originally Posted by katelove

- home glucose monitoring is not a reliable way of diagnosing GD. As unpleasant as many people find it, the 3 hr test is the best diagnostic we have at the present time.

Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.

[EllisH]

Originally Posted by msmiranda

Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.

I'd be keen to hear why as well. After all, diabetics depend for their life on that test. I'd say that a one-off test would not give the full picture either (?).

[cristeen]

I really suggest reading up on GD. And apparently there are several people on this thread even that could use some boning up on the subject. Henci Goer has some great online articles on the subject.

I didn't do the test. I refused with both pregnancies. The first time, they tried to scare me into doing it, using "big baby". The 2nd time, I chose my care provider a bit more carefully and made it clear during the initial interview that I wouldn't be doing it. Since she was of the same mindset (and taken some of the same classes) as me, it wasn't an issue at all.

GD is a completely unstudied diagnosis. There is no evidence of it's existence. And being labeled GD does nothing to improve outcomes, but it can definitely lead to more interventions. Make your choices fully informed.

[Ola_]

This is very interesting as it's something I was planning to decline, but still researching.

[Mamatoabunch]

http://www.gentlebirth.org/archives/gdhgoer.html

Here is the article by by Henci Goer.

[phathui5]

I took the standard overly sugary soda when I was pregnant with my 10yo and "passed."

With my 7yo, I did the test, but used 1/2 banana and a pint of orange juice, "passed" again.

I chose not to do the test with my 3rd and 4th children. It wasn't something that I was concerned about and I was more comfortable declining things.

[katelove]

Originally Posted by msmiranda

Please explain why home monitoring is not reliable and why the 3 hour test is. This is the first time I have ever heard anyone say this.

Originally Posted by EllisH

I'd be keen to hear why as well. After all, diabetics depend for their life on that test. I'd say that a one-off test would not give the full picture either (?).

Home monitoring is not as sensitive as the 3hr GTT. The home monitors are intended to be an adjunct to treatment not a diagnostic tool.

In the presence of GD a woman's BGL will rise higher and drop more slowly following a glucose challenge than in a woman who does not have GD. That's why 3-5 blood tests are done during the test. And lab machines not bedside (or home) monitors are used to analyse the samples. The large glucose load combined with more sensitive testing tools allows this to be seen clearly. Eating normal food and testing randomly is less likely to produce changes which will be identifiable by a home monitor as pathological.

The GTT is not 100% sensitive either, meaning that it will fail to diagnose a percentage of women who do it. However random home monitoring is *less* sensitive, meaning that it will fail to identify even more women.

If a woman desperately didn't want to do the GTT then, I guess, the home monitoring would be better than nothing but she should be advised of the decreased sensitivity and the implications of that. Personally I don't see the point of a testing regime which requires more effort for less result. However, as with all things, it's a matter of weighing the pros and cons. We just need to move away from the idea that we're comparing apples with apples when choosing which test to go for.

ETA - My DH read this post and he added that the lab test of blood is much better at giving a *true* BGL. The home monitors are influenced by a variety of components within the blood and were designed more to show trends over time rather than one off levels.

In terms of treatment for pepole with diabetes they also have the advantage of being cheap (relatively), portable and easy to use. All these things are factored in when considering anything ffor long-term home use. Often, a degree of reliability or sensitivity is sacrificed for the other factors I mentioned.