The New Gestational Diabetes Support Thread - Page 14

[Thesan83]

I see a lot of problems in this article.

First, the one hour test is not typically done fasting as this article suggests.

It also suggests that no pregnant woman should ever be fasting for 8 to 12 hours. But that's ridiculous. The vast majority of all pregnant women fast this long every night while they sleep with no ill effects. And if fasting that long is putting a woman into serious starvation mode and making her hyper sensitive to sugars in the morning, that's something that she should know -- something that a GTT would tell them and monitoring would let them keep on track of -- so that she doesn't get up every morning, eat pancakes with maple syrup, and drive up her blood sugar.

It suggests some alternatives. The two hour PP being my favorite of the ones provided. But it has it's problems, too, just like a standard GTT. Anyone who has actually been through a GD pregnancy will tell you that not all carbohydrates are the same. I can eat fruit without any problems, but an equal amount of carbs from grain will spike my blood sugar.

This is why, for the most part, doctors prefer glucola. It's standard. It's a known quantity.

Also, I think you can easily miss problems by testing just at a two-hour period. For a diagnostic test, your blood sugar should really be monitored more frequently than that. At the least, at a one hour period and then again at two (just like they do with a GTT). If I only looked at my blood sugar at two hours after meals, I'd have never known that I had a problem. Mine spikes between 45 minutes to one hour after eating. And if I had only looked at my fasting number, I really would have never known!

The random blood sugar test is useless, in my opinion. Doesn't tell you anything.

And the A1C, while helpful in maybe spotting pre-existing diabetes that had gone undiagnosed, is likewise utterly useless for diagnosing GD which only develops part way through pregnancy. The A1C will tell you what's been happening for the past three months, and by the time GD would be reflected in that number, it would be far too late to do anything about it.

The article also suggests walking 1 to 3 miles during your GTT. But no lab worth their salt will let you do that since it violates the test parameters.

Anxiety, stress, and illness do have a temporary effect on blood sugar...so that is true. But it is unlikely that a person with a normal insulin response is going to see enough effect by merely fretting over their test to fail it by a considerable margin on that basis alone. Not unless there's some other confounding factor at work in addition. Age, race, activity level, and diet do have an effect too. But they are accounted for in that those things are all typically considered "risk factors" for developing GD.

The article quotes a doctor as complaining that the "pregnant body is not recognized as being different from the non-pregnant body and is therefore not expected to function within different parameters of normal." Which is not true. There ARE different levels used for GTTs done on pregnant and non-pregnant people. And the differences between the normal blood sugar levels of a pregnant and non-pregnant woman are known and applied to how GD is currently treated and diagnosed. (Blood sugar levels, according to a study my GD nurse recently cited to me, in non-GD women tend to be lower than what that person experienced before pregnancy since the baby is now using a portion of the sugars they are consuming as well.)

The same quote also lists a lot of factors that could result in a "false positive," most of which are things that really ought to be monitored anyway. Decreased insulin production or increased insulin resistance is a problem no matter what's causing it.

There IS a good point in there, however, about the lack of consistent standards in testing. Too many labs do it differently.

Then there's the factoid: "75% of patients shown by the GTT to have impaired glucose tolerance never actually develop diabetes" which the author contends means the test is only 25% accurate. But that's like saying that blood pressure readings must be inaccurate because only a small portion of those people who test high go on to develop heart disease. Impaired glucose tolerance can stay at a non-diabetic level for years and never become full-blown diabetes, especially if the person takes steps to avoid it.

In any case, I don't see how that's related to detecting GD anyway.

And the line that made me sit down long enough to type this all out: "At the end of the day, there’s still the controversial debate: is there such thing as gestational diabetes after all?"

YES. There is. 

Originally Posted by Devaskyla 

Saw this article today & this seemed an appropriate place to post it in case anyone thought they might be wrongly diagnosed or wanted to find other ways to check their diagnosis.

The Inaccuracy of the 1 hour Glucose Tolerance Test

I was "borderline" with the 1 hour test in my first pregnancy, but using a glucometer I'm finding that my numbers are actually low or low normal.

[lifeguard]

thesan - very good information - well written. The BIG thing I learned with gd is that every body responds differently & like you highlighted simply testing once or only at the one hour mark will NOT show you what is going on. I really like your point about using the glucola - I did not tolerate fruit at all & some grains were ok but others most definitely were not, but others found the opposite.

Ultimately having the gd diagnosis is frustrating & inconvenient but the diet changes are not bad changes to make & more than one of us has found it has lead to a positive life change.

[emmaegbert]

I also agree with Thesan's response above.

In fact, we decided not to do the GTT with my third pregnancy, but I self monitored, lots of monitoring at first (1 and 2-hour, and fasting) and then as we figured out what my numbers were, cut back to daily fasting and a once-a-day 1-hour post-prandial, shifting which time of day.

I ate a strict diet that controlled my blood sugar- because though my GTT with my second was really only a "borderline" result, I was quite shocked (and sad) to learn that my blood sugar numbers were higher than normal after eating healthy, nourishing, normal foods.

I was very fortunate to be able to have midwives who treated me as a normal patient, and very fortunate to be able to control my blood sugar through diet, and to have the kind of care and birth that I wanted despite the GD. I also t believe that I learned a lot about my body and what is good and healthy for me through managing my GD, and that in the long run, this will be really a benefit for my health, as well as for both my babies.

The one thing I agree with in this article is the following:

"The test results for the 1 hour GTT vary significantly and are highly questionable, yet your test results can be the difference between a low-tech and high-tech pregnancy and birth."

However, unfortunately I think that leads some natural birth proponents to discount the results, questionable though they might be, of the various tests one can do for GD. This, I think, is the wrong message to take from all this.

[emmaegbert]

ok, and those are some seriously old citations that the author of that article is using. not that there might not be good info in old medical/scientific research, but there have been some major advances in understanding diabetes since the 80s.

[jbk21]

I agree with what everyone here has said.  I think natural birth proponents too often discount the test as well- like emmaegbert said, and then end up not getting tested!  I think that is a dangerous decision to make.  GD doesn't necessarily have symptoms, at least not that one would notice apart from "regular" pregnancy symptoms.  I also think that sometimes those who do test don't necessarily test positive- for instance my friend was tested at 23 weeks.  Standard protocol is 24-28 weeks.  So who's to say she didn't get tested too early?  There is not enough consistency..... And as for the alternative tests (of which I was a supporter of- I did the alternative this time!) allows for too much flexibility.  I know someone who ate a pb&j sandwich and a glass of milk.  I know that a lot of women with GD would have high numbers after that meal, but I'll *bet* that I could have eaten it and passed with flying colors.  But I have GD.  It's all about how different carbs affect different people....  So I think allowing mothers to choose their meal doesn't account for that- someone could eat a bunch of fruit and have no issue, the next person could do the same and have a high reading. 

[Seana]

Hey guys--I need some encouragement, or butt-kicking, or something.  I was diagnosed with GD in July, (I guess they tested me early because  my last baby was big?)  and I was working really hard to do everything I could to keep my numbers under control.  I lost 10 pounds from my pre-preg weight, and I've been SO HUNGRY!  Finally, it wasn't working, so I got on insulin, which resulted in getting dropped by my homebirth midwife.  I am so tired of this diet, and upset that I have to have this baby in a hospital, that I'm just having trouble sticking to my diet now and I've been "overeating" lately.  I need to get back on track, because I still need to avoid a C-section, or having my vagina totally obliterated,  or obviously, the baby having issues, but I'm so tired and discouraged and sick of my 'safe' foods.  If I can wrangle my freedom of hospital choice from Tricare, I shouldn't have a 'terrible' hospital experience, since the place I want to go allows laboring in tubs even for GD moms, and encourages breastfeeding to stabilize the baby before trying any of the weird stuff like formula, etc.   The weather was bad for a while, which made it hard to exercise, but It's warmed back up again.  I need to just get out of this slump before the baby gets too big.  After all, as my ever-helpful mom pointed out, "If you have a gigantic girl, we can't dress her in cute outfits!"  (Do I have the worst attitude of anyone here?  I feel like I'm always complaining, but being constantly hungry makes me constantly grouchy!  The rest of you seem to be much more...emotionally mature). 

[L'lee]

Hi, unfortunately it looks like I should jump in here with you... I'm 31 weeks, and although I declined the GTT testing, I've been monitoring on my own and it looks like some of my results are a little high. Ugh. I don't particularly care about being officially diagnosed, as much as I want to learn what I can to have consistently better levels. I've been monitoring fasting and 2 hours after meals for the past few days and learning about what I can and can't eat. It is nice to see people on here talking about low(er) carb and not worrying about low fat, because it seems to me that a low fat diet might not be a good idea even though that is suggested in the handout my MW gave me. That makes more sense for someone with type 2 diabetes who is trying to lose weight, but not a pg mama! I also agree that the carb levels on the handout seem too high. I don't eat gluten, so it is easier for me to cut down on grains than otherwise. So far I seem to be OK with fruit but not grains, except in small quantities with lots of other protein/fat.

It is frustrating reading on here and in other places how much variation there is in what numbers are seen as acceptable, and the variation in treatment! Most of us are nowhere near the levels you would see in a truly diabetic person, and yet there is all of this increased risk of interventions!

I like to read about nutrition, so I feel like I've got a good knowledge base to start with, luckily! I want to remind myself of the glycemic index, and plan to print out a chart to refer to, because I know that can be helpful for evaluating carbs - have others found this helpful? I need to read the "old thread" still, so maybe there's some info there. I like to use fitday for looking at the nutritional profile of foods and recipes and this has been very helpful for looking at my meals and trying to evaluate the number of carbs along with the protein and fat content of my meals. Things like nuts really are more fats that proteins and it is helpful to be able to see this. In some ways having reason to track my diet might be a good thing for me anyways, since I gained 30 lbs during my last 8 weeks of pregnancy last time (and my weekly Blood sugar readings were normal!), and I don't want to do that again!

One question I have when reading through these posts - why are people so worried about how high the spike is after a meal? I was under the impression that the dangerous part of high blood sugar was that when you have a consistently high level for a long time, that's a problem for the baby, but a short spike isn't a big deal (unless, obviously it is VERY high) - so is this wrong? 

[lifeguard]

emma & jbk - great points. I really love the discussions coming here 'cause I think it is important. I have definitely noticed  shift here in that they seem to have completely ditched the 1 hr & are using the 2 hr - which although more time consuming is a good move imo. It is too bad there is not more consistency with approach but hopefully with more knowledge/research the consistency will follow.

seana - I think we have all had these times. It is incredibly frustrating. How are your numbers going even with your diet inconsistencies? I found once I was on the insulin it did give me a little more leeway & that was less stressful. Fwiw - my numbers were much more controlled with dd than with ds & she was bigger so it's not as linear as they have you believe. I also have had vaginal hospital births with each that I am content with (even with the few interventions I had) so please try to be positive.

L'lee - good for you for being proactive. It definitely is a learning curve to find what works for your own body - it certainly seems to be an individual thing. I personally haven't found the glycemic index to be helpful but others may. I focus on macro-nutrients in my diet so I am very aware of whether things are fats, carbs or proteins. The trick I have learned is that you can basically ignore the other two & just classify something by it's main macro (ie. nuts are a fat, disregard the little bit of protein) - the exception is something that is higher in protein but also has a fair bit of carbs (greek yoghurt) because I need to be so careful with my carbs. I really think the low-fat thing is just part of our culture's obsession with fat. As long as you are sticking to healthier fats I haven't found restricting them is helpful & in fact fat & protein slow down carb absorption which is helpful with gd.

You're right that long highs are definitely more of a concern but you also want to be keeping your bs as level as possible. You don't want to be seeing high or low swings - but keeping within a stable range is the healthiest.

So I saw my family doctor today for dd's first appt. I have my 6 week follow up in 2 weeks & it turns out she wants to do the full 2 hr gtt again -sigh. Part of me almost wishes I'd finally get a diabetes diagnosis so I never have to do this awful test again!!! I don't get why they can't just accept a log of numbers? I realllllly like my doctor but sometimes the protocols get irritating. At the same time it will be interesting to see the results as the last time we did it (outside of pregnancy) I was right on the border but I'm now down 40lbs (& will hopefully be down a few more in 2 weeks) & that "should" help my numbers. We'll see.

[L'lee]

Originally Posted by lifeguard 

You're right that long highs are definitely more of a concern but you also want to be keeping your bs as level as possible. You don't want to be seeing high or low swings - but keeping within a stable range is the healthiest.

Thanks, that makes a lot of sense! Good reason to avoid carbs without protein/fat/fiber!

I have been keeping track of the macronutrients, but I've found some interesting variations in how my body deals with different carbs, so I don't think it's as simple as "how many carbs". Especially most veggies, but also I seemed fine with raspberries.

Good luck with the test! I'd think you could try to replicate it yourself by eating a carby meal and then testing yourself. Have you still been eating a lower carb diet, or have you increased that since having your baby? 

[lifeguard]

All carbs are definitely not created equal. For me fruit is pretty much completely out. I am continuing with my low carb diet - I have a good chunk of weight I want to lose & I am doing everything I can to reduce my chance of developing diabetes.

[Seana]

In general, I can get away with more now that I'm on insulin, but it still seems to vary, and the recommended foods don't necessarily seem to apply to me.  Sometimes I can get away with wacky stuff, like two slices of pizza, othertimes, not.  4 small apple slivers with some all-natural pb as a snack did NOT work well, but I can apparently eat 1/2 a package of tofu and 1/2 a cabbage in one sitting and still be under 100 at an hour.  Craziness! 

[diana peeti]

Originally Posted by Seana 

Hey guys--I need some encouragement, or butt-kicking, or something.  I was diagnosed with GD in July, (I guess they tested me early because  my last baby was big?)  and I was working really hard to do everything I could to keep my numbers under control.  I lost 10 pounds from my pre-preg weight, and I've been SO HUNGRY!  Finally, it wasn't working, so I got on insulin, which resulted in getting dropped by my homebirth midwife.  I am so tired of this diet, and upset that I have to have this baby in a hospital, that I'm just having trouble sticking to my diet now and I've been "overeating" lately.  I need to get back on track, because I still need to avoid a C-section, or having my vagina totally obliterated,  or obviously, the baby having issues, but I'm so tired and discouraged and sick of my 'safe' foods.  If I can wrangle my freedom of hospital choice from Tricare, I shouldn't have a 'terrible' hospital experience, since the place I want to go allows laboring in tubs even for GD moms, and encourages breastfeeding to stabilize the baby before trying any of the weird stuff like formula, etc.   The weather was bad for a while, which made it hard to exercise, but It's warmed back up again.  I need to just get out of this slump before the baby gets too big.  After all, as my ever-helpful mom pointed out, "If you have a gigantic girl, we can't dress her in cute outfits!"  (Do I have the worst attitude of anyone here?  I feel like I'm always complaining, but being constantly hungry makes me constantly grouchy!  The rest of you seem to be much more...emotionally mature). 

Hi Seana, I know how you feel about the attitude. Thankfully I've made a positive turn around recently. I had GD last pregnancy and it led to all the interventions on the planet and I was so fearful of getting it this time I dropped 40 pounds and tried to eat the diabetes diet as soon as I found out I was pregnant. But closer to the date of my GTT I started binging due to the stress of failing it. I was so angry, I knew I had GD because I felt so thirsty all the time. I even contemplated putting a container into my hand bag to pour the liquid in when I did the test ha ha. I was desperate not to be diagnosed with GD. Because I don't want another c-section! I want a natural birth.

Anyway I felt my body failed me and I was angry at myself, angry at my husband angry at the world why do I have to miss out on all the yum food, like I need another stress in my life. I had a cry and a sulk and realised after a few days that I can't change the fact and the only thing I have real control of is my attitude (as hormonal as I am!).

So now I'm focusing on the fact that this diet is really good for my body, for my baby, I was a slightly chubby child and that wasn't fun so I really don't want to put my daughter at risk of obesity and can't wait to dress her up:), I'm looking at heaps of fashion mags to see what nice clothes I can wear in my slim body after I have this bub, I'm thinking about how great it feels to be light and healthy, I'm remembering how disappointed I've been this past 18 months because of how my first birthing experience went and how it is in my power to change that, I'm thinking I have had the chance to experience the most amazing foods in my life ( a lot) now I'm having a break from them and can have some again after baby, something else to look forward to, I'm thinking about how I'm lucky to be pregnant because I know a few women who can't get pregnant.

I'm sorry that your hungry all the time that's not great. I've had major sugar withdrawals in the last week going onto the diet talk about headaches and grumpy. But I know it will pass. 

I have 13 weeks to go how long do you have?

I hope some of what I've said is helpful. I know each person goes through their own journey to positivity and when your not in that place another persons positive attitude can make you sick lol. But seriously maybe tomorrow I won't feel so great or next week. My son slept thru the night last night can't remember the last time he did so I feel like a different person this morning.  Good luck!

Edited by diana peeti - 11/8/11 at 11:25pm

[Seana]

Thank you!  That was a good pep talk!  It's much better hearing it from someone actually "in the trenches"!  I'm due Jan 20.  (ready to be done with this whole GD experience but really hoping the baby can come on it's own time!) 

[Thesan83]

Just wanted to pop by and let you all know that I had my baby boy on Sunday the 6th. I even got the natural, intervention free hospital birth I was aiming for.

He was 7 lbs, 2 oz and had no blood sugar issues at all. Perfectly healthy!

This thread helped me SO MUCH during my pregnancy. I don't think I would have been able to get on top of my diet and get my numbers controlled in half the time that I did without you guys. At first, I felt so ashamed! I didn't want to tell anyone or talk about it at all. I felt like a failure, like I must have done something wrong. It was nice to come here and see that I wasn't alone. And seriously...these support threads have so much awesome info on GD in them. I learned way more here than I did at any of my appointments at the diabetes clinic. I'm so glad that I was able to make my body the healthiest place possible for my little guy to grow. That I was able to give him such a solid start. And that I learned a lot about food in the process. I was telling my midwife after I was done laboring that I think everyone should have to be diabetic at least once in their life! It really changes your outlook when you walk through the grocery store and see how much sugar and carbs are everywhere.

Best of luck to those of you still working toward your due date!

[lifeguard]

Congratulations Thesan!

[Seana]

So happy to hear that, Thesan! That definitely is encouraging news! Congrats! (Eat something fun for me!)

[emmaegbert]

Thesan, congrats! I really agree with your attitude and in the end, I decided that it was a good thing I got my GD dx with my second baby for all those reasons.

[samie1400]

We also had our little guy almost 2 wks ago. Unfortunately I had to get c section because water had broke and way past 24 hr mark so risk of infection and not enough progress. Baby did have low sugar so he had to be monitored and put on IV. Hes ok now. I'm sad that I wasnt able to have a natural birth but very glad to finally meet our little boy. Hopefully next time around will be smoother.

[Seana]

I ended up getting a great OB off-post who let me go all the way to 42 weeks before scheduling an induction, and I finally went into labor the night before! She was tiny 6# 13oz) and we had a really nice, intervention-free birth. I am so glad things turned out so well! She did well on all the NSTs and ultrasounds, which is why the OB wasn't pushy about inducing, but still, I feel lucky to have found a dr willing to be so laid-back.

[butterfly_mommy]

That is wonderful Seana! it is so great to have someone in the medical field that is open minded. 

So I took a 75g 2 hr OGTT today. I had GD with my first pregnancy but passed my test in my second pregnancy at 22 weeks however my DS was 9lbs 11oz but healthy. I had been monitoring my blood sugars at home and they have mostly been good when I am eating on a GD type diet but tend to go a bit higher when I indulge in a higher carb meal. I was hoping to avoid the test and just be referred to the clinic but they wanted the test results so I decided to do the 2hr instead of the 1hr and then have to do another test. I tested on my glucomter after each blood draw and according to my glucometer my fasting was good 5.0 (90) but my 1hr 10.9 (196) and 2hr 9.4 (169) which in Canada to fail you need to be >5.3, >10.9, >9.4 so if my meter is correct I failed but just a bit over.

The main thing that I worry about besides baby's health is losing my midwife as I really want a VBA2C and I know that will be a lot harder to fight for with an OB.