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How necessary is the glucose test? - Page 2

post #21 of 50
I had GD with my first pregnancy and was diagnosed early with this pregnancy as well. Other than being slightly overweight (I wear a size 12), I have no other risk factors. My mother had normal size babies and was never tested for GD. Me and Sibs were 6-7 lbs each, however her pregnancies were very different than mine (for one, she smoked through her pregnancies). I also had no symptoms of GD and was shocked when my 1hr result was 197.

I have never doubted the diagnosis -- once I started monitoring my sugars, I could see clearly how certain foods (even healthy foods, like oatmeal with fruit for breakfast) send my blood sugar into a dangerous range. It was a lot of work and a lot of diet control to manage my sugar during the last pregnancy-- ending with a full term 8.13 baby. I thankfully delivered in a very baby-friendly hospital whose protocol for managing that was to check baby's sugar (right before nursing) until it was greater than 50 three times in a row. There was no alarm that it was low, because baby was just about to eat. It took 5-6 checks before that was true, but no other interventions were offered/suggested.

I contrast this experience with a friends, also low risk for GD who controlled her sugars poorly, had a large baby born by c/s at 36 weeks who spent 4 weeks in the NICU. She never breast fed after the first few days (partly because of lack of motivation, partly because she didn't have a home pump and didn't want to be at the hospital every 3 hours). I see her obese 11 year child (which is not solely related to the GD, but I certainly believe that is a contributing factor), and wonder what the future holds for his health and am sad he got a poor start in life.

I must be the only one on MDC who likes candy and sweets(maybe that is my risk factor for GD?) A box of Hot Tamales, a Starbucks pumpkin spice latte (oh how I miss you!) are tremendous, yummy glucose loads, equivalent to the dreaded glucola. If I didn't have GD I would be eating crap like that on a regular basis -- and I think that would be detrimental to my child.

I did once check my BG between pregnancies after eating a tremendous amount of candy. It was 92. My HbA1c at my first prenatal visit was 5.2% (excellent). My blood sugar one hour after eating 1/2 cup steel cut oats with 1 cup whole milk (for the fat and protein to slow absorbsion of glucose) the other day was 184. My glucose metabolism is different during pregnancy. I don't know why people are so resistant to that idea -- a lot of hormonally controlled things are different for me during pregnancy. My sex drive, my acne, my sense of smell, my sleep cycle, my thermoregulation and more . Just like some people have a great sex drive and awesome skin, some people don't.

I accept that it is safer for me and my babies to carefully monitor my blood sugar at least 4 x per day. If I didn't believe that I had GD I would not carry my monitor with me, interrupt my work, socialization, etc to continue to check my BG -- and that is why "checking things a few times at home instead of doing the glucola" is a terrible idea in my opinion. I need the constant feedback from the meter to help me shape my food choices. Fruit in morning after breakfast = out of control sugar, fruit after lunch = no big deal.

I am extremely suspicious of people on this thread who say things like "GD is a completely unstudied diagnosis." I don't know what they mean by this. There are thousands of pages of studies and millions of dollars of research that have been poured into this. Is it the research I would do? Not always. But it is heavily-studied, if not well-studied.
post #22 of 50
Quote:
Originally Posted by Mamatoabunch View Post
http://www.gentlebirth.org/archives/gdhgoer.html

Here is the article by by Henci Goer.
This article is 14 years old. And some of the papers she quotes are now 30 years old. There has been a bit more work done since then.
post #23 of 50
I've had gd with two pregnancies and assume I will have it with #3.

I had no risk factors with my first pregnancy (well, I was over 30, 32 to be exact, but that's it). At the time I was running 3-6 miles most days, was at a healthy weight, etc. There are no symptoms for gd. The diagnosis took me completely by surprise.

When people (on MDC) say there is no such thing as gd, I'm puzzled and annoyed. I understand that some women are probably borderline and can control their blood sugar levels with diet and exercise. Fine. But in my case, even small amounts of carbohydrates sent my blood sugar to extremely high levels. I needed insulin to control my blood sugar levels (in spite of excercising regularly and following the low-carb diet). Even with insulin my dd was close to 9lbs.

I never see anyone who was diagnosed and treated for gd recommending Henci Goer. Also, if Henci Goer's theories are gospel truth, why are there no other sources that show scientific evidence supporting her theories?

To the OP: if you did not have gd with your first pregnancy and didn't have a 9+lb baby, you're probably fine.
post #24 of 50
One of my best reasons for advocating for testing for GD (not necessarily the way that it is currently done in an office setting) is because out of control blood sugar can cause high blood pressure.

With my 2nd my blood pressure started climbing at about 24 weeks...by 30 weeks it was 140/90 and my midwife was getting concerned. 30 weeks is also the same time that I was diagnosed with GD...I failed the test, literally, by just 1 point. A different day would have yielded different results...and I very well could have passed. However, I'm SO thankful for the diagnosis. After just 2 weeks of modifying my diet and exercise my blood pressure had dropped to a consistent 110/70 and it stayed that way for the rest of my pregnancy. I did have to take a small amount of glyburide to keep my fasting levels down, but other than that it was totally manageable and I felt 300 times better once I started the diet. And let me say too...my diet before the diagnosis wasn't bad...I had my occasional splurges, but overall it would've been considered healthy.

I had horribly high BP at the end of my first pregnancy and in retrospect I'm sure that it would have been MUCH better had I been following a better diet. (My diet at that point was pretty crappy.) I failed my 1-hr, but passed my 3-hr at 24 weeks with that one...but I'm sure that testing at a later date would have given a much different result being as how my baby did have several "symptoms" of a GD baby (difficulty breathing, low blood sugar, CRAZY jaundice...).

I do understand that the test isn't fun and I think the 1-hr test is pretty much worthless, but I do believe that GD DOES exist and that treating it has many benefits for both mom and baby.
post #25 of 50
ive never taken one
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post #26 of 50
Quote:
Originally Posted by katelove View Post
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.
Thanks for the explanation, katelove!
post #27 of 50
Quote:
Originally Posted by EllisH View Post
Thanks for the explanation, katelove!
My pleasure
post #28 of 50
Hmmm ... interesting responses. If I may project my own feelings about GD onto others on MDC, I think that the reason many of us sound skeptical of GD is because it is used as an excuse to push unnecessary interventions on women who don't need them.

My story is that I barely passed the 3-hour with my first, but I now believe that I did develop GD during that pregnancy. I was eating a ton of desserts and drinking chocolate milk, etc. (shudder) and during the last week my blood pressure went up a bit (into the 130s/80s range) and risked me out of the birth center. Had I known then what I know now, I would have been on the GD diet and probably would have had my birth center birth.

With my second pregnancy, I declined the GTT and did home monitoring, and the reason I did that is because I didn't want the GD label. I modified my diet, exercised regularly, and kept my blood sugar under control for the remainder of the pregnancy. I gained less weight (25 lbs v. 35 in my first pregnancy) and did not have the blood pressure spike toward the end. I had my baby at home with a midwife, again because I did not trust that an OB would have our best interests at heart and treat me like an individual who (a) has small babies, even with GD and (b) worked her ass off to keep her numbers perfect from 24 weeks on. I did not want to be pushed into induction or to have a big red "C" on my forehead. I also did not want my baby to be stuck a dozen times for nonexistent low blood sugar or to have supplementation pushed on us by paranoid nurses. I went into labor at 38w6d and had a 6 lb. 14 oz. perfect baby boy after less than 7 hours.

If doctors didn't freak out about GD to the extent they do, or could somehow distinguish between patients who truly have a problem and those who just need to stop eating so many carbs during pregnancy, I would be a lot more inclined to go along with their testing regime. In fact, I could say the same thing about a lot of things -- postdates, blood pressure, body weight, and so on. I take GD seriously, but I'm not about to put myself or my baby at risk for unnecessary interventions because of someone else's paranoia. I don't remember the stats about what the GD label does to your chances of interventions, esp c-section, but as I recall it was pretty significant. Maybe it's the case that those numbers correlate with non-compliance, but I wasn't going to take the chance.
post #29 of 50
Quote:
Originally Posted by purplestraws View Post
One of my best reasons for advocating for testing for GD (not necessarily the way that it is currently done in an office setting) is because out of control blood sugar can cause high blood pressure.
This is interesting. I didn't do testing with my 1st, and I had a 7.5lb baby BUT my BP climbed pretty darn high. I would eat protein and that seemed to lower it, but it would go right back up. I was eating a ton of ice cream and vanilla milkshakes at the end of my pregnancy, and now I'm wondering about the supposed correlation you mentioned. I'm open to doing a more "normal" test where I can eat some food instead of drinking crap.

And for the person who said they must be the only mama on MDC who eats sweets, no you are not! Sometimes I see that trend as well, but I have been on a home made cinnamon roll binge the past few days! I have actually been noticing that I need to slow down on the sweets. I don't usually crave them, but this pregnancy I do.
post #30 of 50
Thread Starter 

 What a fantastic dialogue here. You have all given me much to consider, and I think I will weigh my options with my OB before I decide what to do. Thank you, Thank you for all the input!

post #31 of 50

I don't know what it is that i get while pregnant, but technically, it is not GD. However, it mimics all the symptoms of GD. (Big baby, blood pressure, polyhydramnios, etc.) ending with a rather scary situation with my third child including hemhoraging from a distended uterus and a nearly 11 pound child. (Not necessary a complication, but considering he was over two pounds larger than my next largest child, definitely out of the ordinary for me.) So this pregnancy, right from the beginning I did a lot of research on eating like I was diagnosed with GD. So when I hit about 28 weeks and my midwife offered me the test, i declined, because it would not have made a difference in the way I was eating/exercising, and I am one of those people who has a REALLY hard time getting back on the wagon, but not such a hard time staying on the wagon, so I was afraid the glucose drink would mess up my good eating habits. So that is why I declined it. I continue to eat low sugar, high protein, watching my carbs especially in the morning. I am due tomorrow and my midwife says my fluid is great, I am measuring one cm small, and she estimates my baby between 7.5 and 8 pounds. (I guess we'll find out soon!) I think there is a lot to be said for knowing your body. But the first time? I can definitely be hard to know. However, if you do have it--or, like me, something that mimics it--I think carefully managing it is well worthwhile.

 

I don't know that that really answers your question.:D

post #32 of 50

with DD my OB didn't have me do it, he said since there's no diabetes in my family and I hadn't had a lot of weight gain and didn't have sugar in the urine there was no real reason to screen me. he said if I did start gaining a lot of weight or had sugar in my urine then he would do the test then. 

post #33 of 50
Quote:
Originally Posted by katelove View Post

Quote:
Originally Posted by Mamatoabunch View Post
http://www.gentlebirth.org/archives/gdhgoer.html

Here is the article by by Henci Goer.
This article is 14 years old. And some of the papers she quotes are now 30 years old. There has been a bit more work done since then.


Share w/ us, I'd love to see links on that work.

post #34 of 50

So... if I did the glucose test and they diagnosed me with GD, wouldn't they just have me monitoring my blood glucose at home with a glucometer and eating accordingly??  If that's the case, then why can't I just skip the glucose test and monitor my blood glucose at home as though I have GD?  That's why I don't understand why the 3 hour GTT is so much better.  If the outcome is the same (monitoring levels regularly at home), why can't I just do that?  I'm not talking about randomly checking my blood sugar here and there.  I'm talking several times a day over a week (and if that is fine, maybe do it again a few weeks later).

 

Thoughts?

post #35 of 50

My OB does the test itself using a glucometer.

post #36 of 50
Quote:
Originally Posted by katelove View Post

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.
 

it seems to me that learning your bodies "trends" are more useful than "one off levels" i decided to ask for a meter to get to understand my body better rather than just getting a 3 hour or the like. i have learned a lot and part of that is about getting real time feedback on better or worse food choices. 

 

i dont think the issue is if i or the doctor can get me to spike, but if i am getting to high as i go about my life. i test fasting one and two hour, and have learned alot and also learned to keep it in the zone i want.

post #37 of 50

I declined it last time and will again, and if I ever thought I was developing symptoms of GD, I just tested my blood sugar with a blood sugar monitor. My DH is diabetic though, so those things were pretty available to me. I tested my blood sugar once a week upon rising and after a meal for the last 12 weeks of pregnancy, and they were always normal. I just have heard there's so many false positives, so it seemed silly to do it.

post #38 of 50

tracymom01 got it right with her comment:

 

   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 bedone via patient history, clinical risk factors, or laboratory screening (the oral       glucose tolerance test.

 

also check out  http://texanesemama.blogspot.com/2011/08/prenatal-glucose-test-is-it-necessary.html

post #39 of 50

I did it with my first pregnancy and it was fine, so I'm skipping it this time.  

post #40 of 50

Hi, I havent read the other posts, but yes there may be other signs of GD such as glucose may show up in your urine.  Did you pass the test last time?  The results will likely be the same.  I refused mine this time.  I am very healthy, my test was negative last time, and there is no family history of diabetese or GD so I felt good refusing it and my Dr and midwife agreed.

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