How necessary is the glucose test? - Page 3

[Flor]

I have gestational diabetes and I have absolutely no symptoms. In fact, I have it pretty badly. I am a healthy weight, have only put on 12 pounds (at 30 weeks) and my baby is not measuring big at this point. So, when I found out I have it, they said I'd be one of those people who just tweek your diet and exercise and everything is fine. Even though I follow the diet PERFECTLY, and I am on a way lower carb diet than most people with GD, my numbers keep going up. Not because I'm not doing everything right, but because my pancrease is freaking out with these pregnancy hormones. Wednesday I start insulin injections. Even at this point, when my numbers spike, I have no symptoms. I feel totally fine. I wouldn't have any clue that my baby is being flooded with glucose if I hadn't taken the test. My risk factors were that Im 35 (didn't have any problem in previous pregnancy) and I have some family members with type 2, but I assumed it was because they had terrible diets.

[Flor]

Also wanted to add, that my OB is in no way freaking out over the diagnosis. She keeps telling me "This is normal pregnancy stuff" like a cheerleader, even though I'm freaking out. She isn't planning any changes to the birth other than checking baby's blood sugar after birth.

[Sukhada]

I did the screening for GD this pregnancy, but will not do it again in the future. I didn't have any risk factors, but ended up screening high. Then I was obligated to take the 3 hour diagnostic test by my midwife or risk losing my midwife. I had already tweaked my diet and had done some home blood testing that indicated my sugars were fine so I didn't think I should have to do the test. For the majority of people, GD can be managed with diet and exercise anyway. In the end, I took the test and my sugars were well within normal. Had I failed the test, I could have lost my midwife and my dream of a home birth. I certainly wouldn't have risked a home birth if I had GD that could not be managed through diet and exercise. However, it seemed to me that my midwife felt that the diagnosis itself might be enough to have my care transferred. The entire exercise was very stressful and I wouldn't elect to go through it again.

[lifeguard]

This conversation has been much better than I anticipated - I expected to read this & get angry at all the misinformation but I think it's been a pretty good conversation overall.

It seems to me that most people are more concerned about how they will be treated if given the label than anything else & I think that is more about who you have chosen as your care provider over anything else. This is my 2nd gd pregnancy & really I haven't had a terrible experience with care providers - slightly more monitoring than I would like but nothing invasive or upsetting has been pushed on me.

I really want to reiterate what pp have said that you may NOT experience other symptoms. I feel fine. I felt fine last time too. I get NO poor symptoms when my bg is high & my bg has too dangerously low before I feel bad. How you are feeling just simply is not good enough a measure.

As well, diet is not necessarily a big risk factor. With my first it probably contributed a bit but this time there was literally nothing the dietician could suggest to improve my diet. Many women develop gd without risk factors - they simply tell you you are at higher risk - they don't guarantee you will or will not develop it.

[Mummoth]

I have three risk factors... age, overweight and family history (grandparents siblings, so it's pretty far off) and decided against the test. I was actually planning on taking it this time because I'm a lot older this time around, and DH has type 2 so I know this baby will be more likely to have diabetes and I was thinking I might be able to improve it's chances of not having it if I try really hard not to have GD (keep your logic away from me!!)

The midwife asked why I don't just monitor myself at home, so that's what I've been doing. DH even had an extra monitor so  it's MINE now. I test about 5X a day, one day a week to see how I'm doing. I am to test the following day if I get any high numbers. I've done a few random tests at opportune times... like after the kids and I went for a slurpee. My average is 5.2, and I don't often see a number higher than 6 (anything under 8.0 is good)

Often I get suddenly exhausted and feel like I need to lay down, and one day I tested my blood sugar when I felt like that. It was close to the tipping point to being too low, 4.2! Anytime that feeling hits if I check myself, it's in the low 4's... I wouldn't know this about myself if I had taken the 1 hour screening test. I'm being more careful not to forget lunch now!

[jeninejessica]

I've chosen to do the test after thinking I wouldn't ever agree to it, for several reasons:

DH and I sat down and did some research, and contrary to what you would think, it seems like -most- people don't show any symptoms until the birth or around there. So you could very well have it, and not know. 

My doctor does the test with no preparation-- no extra drink, no fasting, so crazy restrictions- it's just done as part of a normal blood draw. 

I'm terrified of needles, but even worse with finger pricks- I get anxiety attacks even thinking about them- had my doctor insisted on the test being a prick, I would have said no, but was willing to compromise on the blood draw. 

I want to return home ASAP after the birth (hopefully within 12 hours), and logic serves that having the results from this test will make the ped feel better about releasing us early-- I'm willing to have blood drawn for that. 

I think it's all about weighing the pros and cons and how it will affect your pregnancy and your choices. For us, it was worth it. 

[scottishmommy]

I think the test is worth taking. I have no risk factors and have GD. Also, I think it's important to realize that managing GD can be more complicated than simply eating a good diet. Some carbs spike my blood sugar and some don't. It isn't just a matter of not eating sugar. You have monitor for weeks to get a sense of what is safe to eat. Honestly, the only thing that has changed as far as my care is that I started going to the midwives every week, and I have to show them my sugar levels. They don't do ultrasounds to check for baby size or anything. If my sugars are controlled there really isn't a problem!

[Mushy1127]

I play around with the idea of skipping it. I have one cousin with type I diabetes and that's it. I'm a healthy weight, 32, etc. I did have a 10 pounder last time. I've not yet done any sort of research on whether that alone is a risk factor.

I can say I was glad I'd had the test done with him. I did not even come close to scoring in the GD range and while not necessary, it was nice to know he was (and still is) just big.

Having said all of that... At no point for either of the GD tests I took was I *ever* told to fast before hand. I actually ate a poptart (no, hot tamale mama you are not alone) on the way to DS2's test and cookie dough to DS1 tests. I wonder if fasting or not fasting can have adverse effects? Anyone know?

[lifeguard]

mushy - having zero risk factors is no guarantee you won't develop gd, but having a larger baby is considered a risk factor. As for the fasting thing - usually they want you to fast 'cause the first draw is supposed to be a fasting one.

[Sukhada]

So, a non-fasting test is required for the screening glucose test. This test will not provide you with a diagnosis and many women will screen positive despite not having GD. It's usually a simple test involving one blood draw and either drinking a glucose test or eating a high carb meal. If you screen positive, you will be required to do the 3 hour fasting test which involves fasting for 10-12 hours and then getting three blood draws and drinking a much higher dose of glucose. This test can be quite uncomfortable - many people feel faint and vomit. Eating a high carb meal directly before doing the non-fasting test can result in your blood sugars being much higher than they normally would and can cause you to screen positive. This is why the non-fasting test is considered the "gold standard" for diagnosis diabetes, whether gestational or not.

And yes, managing GD is not simply about not eating sugar - it's about eating the right carbs in the right combination. A diagnosis of GD involves a consult with a nutritionist to develop a meal plan to manage it. If it's not managed with diet, then insulin is prescribed. Where I live, midwives can't manage patients who require insulin and thus any diagnosis of GD requires that they at minimum consult with an OB, an endocrinologist, and a nutritionist.

Edited by Sukhada - 9/4/11 at 9:58am