Gestational Diabetes test, refuse it?? - Page 2

[NatureMom2Two]

There are two test commonly administered to screen for GD and one is fasting while the other is not. It does not matter which test is used, though most doctors in the US prefer the nonfasting for reasons of patient comfort.

The test is non-invasive and carries no known risks.

I have a healthy BMI of 19, and have never been overweight. My family is 100% organic, macrobiotic and vegan. I work out six times a week, and I cycle semi-professionally. At 22 weeks, I was given a routine GTT, and failed. Badly. Anything over 140 is a "fail," and my numbers? 460. I had no symptoms. I went in for the three hour test (because everyone, midwife included, was sure the first test was in error), and I failed that, too. I was referred to a doctor specializing in gestational diabetes, who coordinated care with my midwife. They quickly discovered I was in the early stages of a type of diabetes known as Latent Autoimmune Diabetes of Adults. The onset is so gradual, that many people only know they have LADA after going into DKA (a type of serious diabetic complication wherein the body shuts down due to high blood glucose). Obviously, during pregnancy, this can be all the more serious, and most infants would not survive the long term elevation in blood sugar, or would experience serious child-birth related complications. In short, that routine test saved my life. I would NEVER advise a woman, no matter her lifestyle or health habits, to forgo that test. My friend, actually, counseled me not to have it, saying it was just another way of turning pregnancy into a medical condition requiring management, and that I did not need it being so low risk for GD. Thank God I didn't listen!

Incidentally, I continued care with my midwife, and gave birth at an area birthing center with no internal monitoring, and no other interventions of any kind. It was a beautiful birth. I was able to walk around, lay in the jacuzzi tub, and then delivered naturally in a short, easy labor. My baby was perfectly healthy. Her sugars were a bit low after delivery but, after nursing immediately after birth, she was just fine. Getting diagnosed did not change my birth plan or care. In fact, if I had not gotten diagnosed, I would have certianly required a ton of monitoring and probably a c-section due to diabetes-related complications!

Edited by NatureMom2Two - 7/24/11 at 7:50am

[birdhappy85]

Oh okay, great to know! Thanks, Jaimee!

NatureMom2Two - Your story is a great example of why even when we might be doing everything right and feel like we have no reason to worry about something being wrong, we still should exercise caution. I'm glad you were able to find out you had LADA before any complications developed!

I'm still on the fence about taking the test, lol. I'll talk to my midwife about it soon. I see her a week before I'm scheduled at the clinic for the test.

[KayPea]

Originally Posted by birdhappy85 

Hmm. The clinic where I'm having my GD test done told me I didn't have to prepare for the test in any way. I specifically asked if I need to fast, and they told me no... Is that typical for this test? They suggested maybe I don't eat a lot of carbs in the prior day, stick to protein-rich foods, but that was about it.

That's how it was when I had the GTT last time around (2.5 years ago) but, like Jaimee said, my midwives told me that here in BC Canada they are phasing out the screening test (the one-hour, non-fasting one) because of it's high rate of false positives. They also phased out the three-hour test, in favour of this single test, the 2-hour diagnostic GTT. 

Hopefully you'll get a negative with your one-hour test and that will be that! Good luck!

[IwannaBanRN]

Originally Posted by Jaimee 

Yes, the typical 28 week test in the US does not require fasting.  If you fail this test and are asked to take the 3 hour test, then you will need to fast.  http://www.americanpregnancy.org/prenataltesting/glucosetest.html.  Because of the high rate of false positives on the first test (15%) some places have adopted a different version of the test to begin with.  It sounds like that is the case where Kirsten lives.  The test she took is more accurate, but obviously much less pleasant as well.

I beg to differ. The two times I took the test for my babies (two different OB offices, two different towns) they required that I fast an hour before taking the drink and not to eat until after the appointment, which is an hour after taking the drink. So, that is a two hour fast. Maybe not an all day fast or 12 hour fast, but still, not able to eat or drink anything 2 hours before the appointment.

[birdhappy85]

How accurate is this test if the instructions going into it aren't even standardized? Ay ay ay!

Just kidding. Totally kidding!

[Jaimee]

Becky, that's why I said the "typical" 28 week test.  It does differ place to place.  And yes, you drink and then wait an hour without eating before getting your blood drawn, but I wouldn't really consider that fasting.  At any rate, I have to agree with BirdHappy... it's not standardized and it's not very accurate.  Again probably why Canada opts for the fasting, 2 hour GTT instead. 

[IwannaBanRN]

Alright..........

[Jaimee]

  Becky... sorry if my post sounded a bit harsh... I didn't mean it to!

[IwannaBanRN]

Originally Posted by Jaimee 

  Becky... sorry if my post sounded a bit harsh... I didn't mean it to!

lol Not at all. I just felt a little foolish.

[LunaLady]

My midwife doesn't require the GD test to be done, so I opted out of it. I have owned a blood glucose meter for a couple years, now, so I have been keeping an eye on my sugars the whole time I've been pregnant and I haven't had any issues. My fasting numbers (in the morning) are usually around 80-85 and my 1 hr post meal numbers are usually 90-100 for a meal without any carbs and 100-110 if there are carbs in there. We are for the most part grain free in our house, so perhaps that has helped. I am overweight, which is a 'risk factor' but I eat super healthy. I abused my body pretty bad for about ten years with eating disorders and my weight management has never been the same - regardless of what I eat. I have only gained about 10 pounds in this pregnancy (now at 25.5 weeks) so that feels pretty good :)

[A-time-to-live]

So I had the 1-hour non-fasting gestational diabetes screening test today.  I felt so ill (light-headed, shaky, confused) that I didn't feel safe driving and had to get my husband to come pick me up.  Does anyone know if this kind of reaction suggests that I do have gestational diabetes?  I'm sure I will hear from my midwife the results but I"m feeling very anxious about it.

[Jaimee]

A-time-to-live, no it is not necessarily indicative of GD, though of course there's a chance it could be.  That drink is so foul- full of food dye, chemicals, and unnatural glucose at levels you would never ordinarily ingest (at least not without other foods at the same time) that nausea, dizziness, and vomiting are all common side effects.  I would bet you're just fine and your body is simply protesting the nastiness of the drink, but it doesn't mean that your body wasn't also able to metabolize the sugar properly.

[Blayzes Mommy]

Generally I'm an in and our blood patient .. I chalk it up to years of experiance getting poked and prodded.. lol.  But for the 1 hour test I took Not only did I get abit lightheaded.. but the nurse had to lay me down to finish takeing my blood,  the first vein just stopped giving...this was also a first time for me... So I ended up with band-aids on both arms... lightheaded, I ate some pretzels, and drank water... a sip of apple juice made me wanna vomit.  And I've been one of the uncommon, no morning sickness ect period.  So I don't think your reaction is likely abnormal.  I haven't gotten my results back yet, they tend to wait a few days before calling to say it's negative but call me quick if something doesn't stack up right.  I also Got a nice RHO shot in my butt as a parting gift!  ( I'm RH negative, and my hubby is positive)  I wouldn't worry any more or less because that test made you icky... I've heard the other ones can be even harder on the body.  I'm seriousely thinking about looking into a meter for the next time, to hopefully avoid this test in the future.  It's probably alot more accurate over-all.. and now that I've really thought about it... Why don't they just have pregnant women use one as standard protocal?...

[1love4ever]

I refused it, doc had no problem with it.  You will have symptoms such as keytones in your breath just like anyone else with diabetese as well as they will pick up something in your urine I believe.

[Thesan83]

      Quote:

I'm seriousely thinking about looking into a meter for the next time, to hopefully avoid this test in the future.  It's probably alot more accurate over-all.. and now that I've really thought about it... Why don't they just have pregnant women use one as standard protocal?...

I've been wondering the exact same thing.

I considered refusing the GTT since I don't have any risk factors and was convinced that it was going to be a non-issue for me. But I ended up taking it anyway and failed it by a few points. So now I'm on the special diet and testing my blood sugar four times a day. With as tightly as they're asking me to control my numbers (at least, in comparison to what a non-pregnant diabetic is asked to do or even what's considered "normal" in non-pregnant people)...I'm surprised that doctors don't ask all pregnant women to monitor their blood sugar. I mean...if it's really THAT important for it to remain in this tight little range, and if insulin demand (and potentially resistance) actually does increase three-fold in the third trimester...then all kinds of women could be passing the GTT at 26 or 28 weeks only to have high blood sugar at 32 weeks.

Really, it's got to be about money. Putting every pregnant woman on home monitoring in the third trimester would be super expensive in comparison to the benefits.

You will have symptoms such as keytones in your breath just like anyone else with diabetese as well as they will pick up something in your urine I believe.

Some women with bad GD dump sugar in their urine. But not all. And ketones aren't by themselves indicative of diabetes. They occur whenever you're burning fat...which happens in some diabetics due to low carb intake. You'll produce ketones on the Atkin's diet, for instance. They're supposed to be bad for babies, so GD patients are tested for them to make sure that they're not restricting their diet too severely.

[birdhappy85]

I spoke with my outpatient midwife last week and she said it's completely up to me whether or not I want to take the GD test. I decided to opt out, and she was entirely supportive. So at my OB check-up with the clinical midwife I see today, I'm declining the test. Instead, I'm just going to get a random glucose test and all of my 3rd trimester labs done a little early so everything will go through insurance right now. Easy peasy. I hope the clinical midwife is as supportive! But regardless, I feel that I made the best choice for me right now.

[Chena4]

My midwife said that I  could refuse it but I could have test my levels 4x a day for 2 weeks.

[nmouse]

I just did my 28 week check with my midwife, where for 7 days I checked with my home bg monitor my fasting and then 1 and 2 hour post-meal blood glucose. There were a few higher numbers, but mostly everything was low. Since i did the testing alongside of logging my meals, my midwife was able to help me figure out that raisins in my oatmeal first thing will drive up morning blood sugars, and that I should swap out the fruit that I eat with meals for veggies, since I'm sensitive to fruit sugars, but keep fruit plus protein for between-meal snacks so I get the vitamins. We think this will help keep blood sugar more steady even though none of my numbers looked like GD to her. 

To me this is way more helpful than drinking artificial sugar drink after a fast, and also more effective at catching any dangerously high sugars since I am testing more often. Also I have to confess I kind of love using my home bg monitor, because I can see right away what my own body is doing without having to wait or wonder. 

[LunaLady]

Originally Posted by nmouse 

I just did my 28 week check with my midwife, where for 7 days I checked with my home bg monitor my fasting and then 1 and 2 hour post-meal blood glucose. There were a few higher numbers, but mostly everything was low. Since i did the testing alongside of logging my meals, my midwife was able to help me figure out that raisins in my oatmeal first thing will drive up morning blood sugars, and that I should swap out the fruit that I eat with meals for veggies, since I'm sensitive to fruit sugars, but keep fruit plus protein for between-meal snacks so I get the vitamins. We think this will help keep blood sugar more steady even though none of my numbers looked like GD to her. 

To me this is way more helpful than drinking artificial sugar drink after a fast, and also more effective at catching any dangerously high sugars since I am testing more often. Also I have to confess I kind of love using my home bg monitor, because I can see right away what my own body is doing without having to wait or wonder. 

This is what I did, too. I only did four days, though, I think. Nothing was over 115, even 1 hour after meals, so I assume I'm good. I have a midwife appointment next week and I'm going to show her my numbers then. 
 

[Jaimee]

Originally Posted by LunaLady 

This is what I did, too. I only did four days, though, I think. Nothing was over 115, even 1 hour after meals, so I assume I'm good. I have a midwife appointment next week and I'm going to show her my numbers then. 
 

With my first I received prenatal care at a FSBC and I asked my mw if I could do this instead of the test and she said no.  In order to maintain their licensure they had to have all of their patients take some form of the test OR be treated as if they had GD for the rest of the pregnancy.  Of course FSBC are under more constraints than other types of practices.