Gestational Diabetes test, refuse it?? - Page 3

[LunaLady]

Originally Posted by Jaimee 

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.
 

I don't know what FSBC is, but I just have an independent midwife - she's not associated with a hospital, birth center or anything. 
 

[berry987]

Now I'm kind of wishing I refused it! (although I'm going to an OB this time around so I'm not sure she would have let me remain in her practice). I eat a very low carb diet (primal) and my GTT came back at 190. So now I have to go for the 3 hour test. My OB said that since I've been following such a low carb diet, my body may not have been accustomed to metabolizing glucose and when I chugged the disgusting soda it went straight to my bloodstream so it's probably a false-positive. I read somewhere else that low-carb diets result in an unusually high false-positive rate. WHen I asked her how I won't just fail the 3-hour then, she suggested I eat carbs for two days leading up to the test so my body will be accustomed to them. Awesome. 

I realize GD is very serious for some people, but most people control it with diet anyway - and I'm already eating a better than GD diet....so I'm not really sure what knowing will do for me (besides make me test 4x a day for the rest of my pregnancy). 

[Paigekitten]

I got it last pregnancy because I was measuring large for my dates.  With this one I declined because I had already put myself on a high vegetable high protein diet, so it's not like I would have made any dietary changes if it was positive.  If I was measuring big again, or my pee sticks weren't perfect, I'd probably do it. I might just get a glucose monitor though, just in case, I dunno yet.

[Jaimee]

FSBC= free standing birth center, which is a center staffed by mw's (usually CNM's), not connected to a hospital.

[jbk21]

My FSBC is staffed by CPMs/LDMs mostly.    But what you said is true.  Sometimes there's even a resident doc!  Pretty cool, and I hope there are more and more FSBCs being built around the country.  

I am doing the alternative GD test, which is a fasting finger poke followed by a high-carb breakfast and blood test 2 hours later.   I'm happy to have an option other than glucola, and am a little nervous about the test, to be honest.  I've had glucose in my urine two times.  Once was trace, once was really high.  I think it's because I eat so very little sugar that if I do, my threshold is really low.  My Mw isn't concerned at this point since I am measuring fine and gaining a reasonable amount of weight.

Originally Posted by Jaimee 

FSBC= free standing birth center, which is a center staffed by mw's (usually CNM's), not connected to a hospital.

[Jaimee]

Originally Posted by jbk21 

My FSBC is staffed by CPMs/LDMs mostly.    

That's cool.. I much prefer a CPM.  But, that has not been the case in three of the four states I've lived in recently (TX, MD, and IL) b/c these states (and unfortunately many others) do not license CPM's so FSBC's need to be staffed by CNM's and most times do need to be overseen by an OB (this would depend on the state licensing requirements).  The FSBC where I had my dd was in AZ, which does license CPM's, but the birth center was still staffed by CNM's.  Anyway... not really relevant to the OP's question. 

 

[jbk21]

Totally, just adding another answer to LunaLady's question.  She's in WA I believe, and I'm in OR where CPMs abound, thankfully.  I hope other states catch on :-)

Does anyone else have the option of an alternative GD test?   I know with my CNM (hospital based) in Ohio she couldn't do anything but the glucola test.   nevermind!  I thought I had read this whole thread but apparently missed the first page where everyone discussed alternative tests :)   Whoopsies!

Originally Posted by Jaimee 

That's cool.. I much prefer a CPM.  But, that has not been the case in three of the four states I've lived in recently (TX, MD, and IL) b/c these states (and unfortunately many others) do not license CPM's so FSBC's need to be staffed by CNM's and most times do need to be overseen by an OB (this would depend on the state licensing requirements).  The FSBC where I had my dd was in AZ, which does license CPM's, but the birth center was still staffed by CNM's.  Anyway... not really relevant to the OP's question. 

 

Edited by jbk21 - 8/12/11 at 12:18pm

[cameragirl]

With the last pregnancy, the lab required fasting for the GTT. I had hyperemesis and could not fast and drink the glucola without throwing up or gagging the whole time. My OB at the time told me that fasting wasn't required, and to just have a protein meal before the test. This time, I'm going to ask about alternatives. Having 15% false positives is a high error rate, and drinking 50g of sugar at a time does not accurately show how the body responds to a normal amount of sugar. Aside from that, Glucola is gross. If you do have to take the test, get orange flavored and make sure it is really cold. You have to chug the drink, and the colder it is, the less you can taste it.

[jbk21]

This is great advice!  It totally doesn't show a normal response, especially for those of us who go easy on sugar to begin with.  Seems like a pretty archaic way to test for GD... 

Originally Posted by cameragirl 

With the last pregnancy, the lab required fasting for the GTT. I had hyperemesis and could not fast and drink the glucola without throwing up or gagging the whole time. My OB at the time told me that fasting wasn't required, and to just have a protein meal before the test. This time, I'm going to ask about alternatives. Having 15% false positives is a high error rate, and drinking 50g of sugar at a time does not accurately show how the body responds to a normal amount of sugar. Aside from that, Glucola is gross. If you do have to take the test, get orange flavored and make sure it is really cold. You have to chug the drink, and the colder it is, the less you can taste it.

[case360]

Hi!  I just wanted to let you all know that I talked to my midwives about the GTT and how I wanted to refuse the test.  I have no familial history and do not drink/eat that much sugar.  So, as an alternative, when I went in for my second blood test (to check my iron levels) I went in two hours after a normal meal and they tested my glucose levels.  I have not gotten the results back yet, but wanted to let anyone who was anxious about taking the gestational diabetes test that there are other options.

[jbk21]

Hooray!!! 

Originally Posted by case360 

Hi!  I just wanted to let you all know that I talked to my midwives about the GTT and how I wanted to refuse the test.  I have no familial history and do not drink/eat that much sugar.  So, as an alternative, when I went in for my second blood test (to check my iron levels) I went in two hours after a normal meal and they tested my glucose levels.  I have not gotten the results back yet, but wanted to let anyone who was anxious about taking the gestational diabetes test that there are other options.

[justamama]

I'm taking it this time only because I've noticed this pregnancy that I'm a bit more sensitive to getting dizzy and such if I don't eat at just the right time. Then again, my symptoms are those of LOW blood sugar, but still. I know with the hyperemesis bothering until very recently that my diet has sucked so I still want to double check.

[Flor]

I did not have GD with my first pregnancy. I am a healthy weight, exercise, and eat a healthy diet AND I have gestational diabetes. I had no symptoms and was sure I would pass. After a week on the GD diet, my numbers are still going up and I have to go talk to another doctor about insulin next week. I'm 29 weeks now and it is supposed to get harder to control as the pregnancy continues.  I would not have known. I was/am flooding my baby with glucose and that feels terrible.

[Flor]

Also, the way it was explained to me, is that it is not suppose to mimic the body's response to a normal amount of sugar (my thought-- well, then I'll just never eat 50g of sugar at once!), it is suppose to be exaggerated because as the pregnancy continues, your body has a harder time making insulin. It is supposed to show how your body would react to less sugar when your body is making less insulin. Does that make sense? So what your body does at 28 weeks to 50 grams it would do at say, 32 weeks to much less sugar. 

[jbk21]

Interesting info!  My GD test (opted for the meal) is tomorrow morning.  I'm hoping everything is okay- I've had glucose in my urine twice.  

Originally Posted by Flor 

Also, the way it was explained to me, is that it is not suppose to mimic the body's response to a normal amount of sugar (my thought-- well, then I'll just never eat 50g of sugar at once!), it is suppose to be exaggerated because as the pregnancy continues, your body has a harder time making insulin. It is supposed to show how your body would react to less sugar when your body is making less insulin. Does that make sense? So what your body does at 28 weeks to 50 grams it would do at say, 32 weeks to much less sugar. 

[Jaimee]

Originally Posted by Flor 

Also, the way it was explained to me, is that it is not suppose to mimic the body's response to a normal amount of sugar (my thought-- well, then I'll just never eat 50g of sugar at once!), it is suppose to be exaggerated because as the pregnancy continues, your body has a harder time making insulin. It is supposed to show how your body would react to less sugar when your body is making less insulin. Does that make sense? So what your body does at 28 weeks to 50 grams it would do at say, 32 weeks to much less sugar. 

I'm still skeptical of this explanation given to you.  No one normally ingests 50g of glucose in a matter of minutes.  Glucose is not the sugar that is found in most foods- it is a monomer of other forms of sugar like sucrose.  Sucrose and fructose (found in fruits, is a monomer like glucose) must be converted into glucose in the body to be used/stored.  The body has many metabolic controls for these processes, which further help control the levels of glucose in your blood.  So even if the amount needed to affect your body decreases as you progress in your pregnancy, it's still not natural to ingest straight glucose and the body can easily over react to it when it would not over react to other forms of sugar ingested.  I stand by alternative forms of the test to increase accuracy.

[Thesan83]

I think alternative forms of the test are fine, so long as they provide a strict enough challenge. And as long as blood sugar is monitored at more than just a one hour period. Plenty of people don't spike at one hour, especially with food.

But I do take issue with the whole "50g of glucose is unrealistic" idea. I felt that way when I first learned about the test. But then I actually had to start on the GD diet, and I realized...50g is nothing. All carbs ultimately break down into glucose. And it is SCARY how easy it is to rack up 50g of carbs. That's just 2 flour tortillas. 2 slices of white bread. A tiny serving of pasta. Most people are probably eating WAY more than that at any given time unless they're already eating a diabetic diet.

The test doesn't expect the body to react to straight glucose the way it would for food, in any case. The target they'd want you under for a meal with equivalent carbs is lower. And in a perfectly normal person, it shouldn't make any difference. Straight glucose in a normal person should stimulate insulin production like crazy. And if it doesn't, you might not be full blown GD, but you ARE experiencing increased insulin resistance. Which could present a problem if you're eating any carb heavy meals. The only way to know for sure would be to monitor.

I don't think the test is perfect. But, I also don't think too many people being diagnosed as GD is a problem. Eating well and watching your sugars may be a pain, but it won't do any harm. The real issue, to my mind, is that it's treated as a high risk diagnosis by so many doctors and sets up so many potential interventions, even when it's borderline or mild.
 

Originally Posted by Jaimee 

I'm still skeptical of this explanation given to you.  No one normally ingests 50g of glucose in a matter of minutes.  Glucose is not the sugar that is found in most foods- it is a monomer of other forms of sugar like sucrose.  Sucrose and fructose (found in fruits, is a monomer like glucose) must be converted into glucose in the body to be used/stored.  The body has many metabolic controls for these processes, which further help control the levels of glucose in your blood.  So even if the amount needed to affect your body decreases as you progress in your pregnancy, it's still not natural to ingest straight glucose and the body can easily over react to it when it would not over react to other forms of sugar ingested.  I stand by alternative forms of the test to increase accuracy.

[Jaimee]

Originally Posted by Thesan83 
But I do take issue with the whole "50g of glucose is unrealistic" idea. I felt that way when I first learned about the test. But then I actually had to start on the GD diet, and I realized...50g is nothing. All carbs ultimately break down into glucose. And it is SCARY how easy it is to rack up 50g of carbs. That's just 2 flour tortillas. 2 slices of white bread. A tiny serving of pasta. Most people are probably eating WAY more than that at any given time unless they're already eating a diabetic diet.

ITA that most of us are getting way more sugar than we realize (unless you're paying very careful attention).  But what I'm saying is, no one is ingesting 50g of glucose in 5 minutes when they are eating foods.  When you ingest sugar or carbs in food, you're also getting fiber and other things that cause the body to metabolize the sugar differently. 

... in a perfectly normal person, it shouldn't make any difference. Straight glucose in a normal person should stimulate insulin production like crazy. And if it doesn't, you might not be full blown GD, but you ARE experiencing increased insulin resistance.

But for 15% of perfectly normal people it does make a difference b/c this is the false positive rate of the one hour test.

Anyway, this is certainly not my birth-hill to die on.  There are other issues I care much more deeply about, but I do feel that it is a piece in the entire problem of maternity care in the US.

[Jennifer B]

Does anyone have SPECIFIC information on alternatives?  My doctor *may* be open to me doing an alternative to the drink, *if* I can find specific information to present to him.  I have web searched for hours but have found only generic references, not specific information. 

[jbk21]

I'm going to start a new thread about GD so I don't detract from the OP but I'd love to hear more from you wonderful, intelligent ladies if you don't mind.  I got a borderline reading today.... More details in my new post.