Glucose Test?

[bmcneal]

I went in for my 18 week appointment yesterday, and something the OB said has me confused, and I'm not sure what, if any, sense there is to what she is wanting me to do. So I thought I would ask here, since y'all are more experienced than me for stuff like this.

I was telling her about my previous pregnancies (a different doctor, it's a practice of four, and I hadn't met her yet), and she commented about the size of DS (10 lbs, 7 oz). She asked if I had diabetes with him, and I said that they had tested, both during my pregnancy, and after delivery, and it came back normal, that no, I did not have diabetes. She then said something to the extent of, "I bet you did, but the test didn't pick it up. So to be safe this time, I'm going to go ahead and have you take the glucose tolerance test now. If it comes back normal, we'll just go ahead and do it again at the normal time. Maybe you can have a baby-sized baby."

Now, I am not completely opposed to taking the test, although I'm not terribly fond of the Glucola (who is?? ) but I'm seriously wondering what the point of taking it now is, especially if they are going to have me take it again anyway at the normal time? Is there a benefit to doing it now, that I can't think of? I'm thinking about just declining it this early, and taking it at the regular time, but if there is a legitimate reason for doing it now, and/or doing it now and then doing it again later that I can't think of, I'll do it. Just, the more I think about it, the more I think she wants me to have a RCS, rather than a VBAC (she made a comment about how, "VBAC is especially high risk, but it's promising that you've had a successful one already.)

[rnra]

The benefit to doing it now would be that, if you have gestational diabetes, it may be caught earlier.  Then you can work on keeping it under control earlier, which means that you and baby will be exposed to the effects of high blood glucose for less time.  This could lead to a better outcome for both of you.  If you have it and it isn't caught this time, testing again after a few weeks could present an additional opportunity to find it.

[phathui5]

Gestational diabetes is not diabetes. Diabetes during pregnancy is legitimately dangerous, especially when uncontrolled. Gestational diabetes tends to grow slightly larger than normal babies, but does not have an associated risk of other complications.

Heart & Hands by Elizabeth Davis has this to say about the gestational diabetes test:

"The midwife's greatest concern is that if a mother in her care has an abnormally high glucose screen, conservative medical protocol may define this woman as high risk and no longer suitable for home birth, or, at best, will funnel her into a regimen of risk screening that may negatively affect her experience of pregnancy and ability to labor with confidence."

Anne Frye calls the GD screen a diagnosis in search of a condition. It gives you a label that makes your doctor more likely to push more interventions on you and it, by itself, does not post health risks to mom or baby.

As a mom, I have personally always declined gestational diabetes screening. 

[katelove]

Originally Posted by phathui5 

Gestational diabetes is not diabetes. Diabetes during pregnancy is legitimately dangerous, especially when uncontrolled. Gestational diabetes tends to grow slightly larger than normal babies, but does not have an associated risk of other complications.

That's not entirely true. Babies of mothers who have GDM have an increased risk of respiratory problems, jaundice and polycythemia as well as increased chance of hypoglycaemia after birth. They are also at increased risk of developing diabetes later in life.

To address the OPs question - there is little point in testing for GDM at 18 weeks as the hormones which cause insulin resistance are not usually present in sufficient levels to cause a problem until after 26ish weeks. If, however, there is reason to think you may have Type Two diabetes, then it would be worth testing early.

[LDoulaSteph]

Another option would be to purchase a glucometer from your pharmacy, you can get them for $30 (the strips are the expensive part) and test yourself daily before and after you eat. You can record the results or your doctor can simply download them from you glucometer. This way you'll have some info on your average sugars before going ahead with the test for gestational diabetes at the usual time you would in pregnancy.

[JoyfamMama]

Originally Posted by LDoulaSteph 

Another option would be to purchase a glucometer from your pharmacy, you can get them for $30 (the strips are the expensive part) and test yourself daily before and after you eat. You can record the results or your doctor can simply download them from you glucometer. This way you'll have some info on your average sugars before going ahead with the test for gestational diabetes at the usual time you would in pregnancy.

Yes, that's a great option, also, just asking for a FASTING blood sugar draw is usually enough to tell them whether or not they might need to check further. It is maddening to me why doctors often want to do the most extensive/invasive tests first, rather than trying the less extensive ones and working up...

[hollydolls]

I had a large baby the first time around (9lb, 9oz) and didn't have GD. I declined the test the second time as I didn't have any risk factors beyond a big baby the first time and had a 7lb, 5oz baby. If you have reason to believe you have GD and you or the baby could benefit from the screening, go for it. If you're just doing it because of your provider's remark, I'd skip it. It seemed a little disparaging!

[dayiscoming2006]

I think that is annoying that your care provider made that remark. I would be concerned with his attitude. If you did the screening last time and it came back normal and everything was fine with baby other than being larger than average, then I wouldn't worry about it. I would decline doing the early test. 

[skycheattraffic]

My doc always does a fasting glucose test at intake to have a baseline and asks for the urine dip (for sugar and protein) at each visit. The GD screening is done at the usual time and I'm sure more fasting bloodwork would be ordered if the urine dips came up positive. I would refuse the early GD screening since it won't really be necessary and offer to do fasting blood draw or go the glucometer route.

[sweetlowmom]

Hi ladies, just to chime in here ... I am a Type 1 diabetic, so as some of you have noted, it is a very different situation. That said, the effects are the same: hyperglycemia potentially making the baby too big. That is the most well-known effect. What happens is that when you don't have sufficient insulin, or you have insulin-resistance, your blood glucose goes up. Baby automatically gets all this extra glucose, and because Baby's pancreas works just fine, it shoots out a lot of extra insulin to bring his blood sugar back into range. The problem is not only that this extra glucose and extra insulin cause Baby to gain weight, but also that Baby ends up being hyperinsulinemic - meaning, used to having lots of extra glucose around, and so used to pumping out more insulin. When the baby is born, all of a sudden he is not in that high-glucose environment but his pancreas hasn't adjusted yet, and so he keeps pumping out the insulin, and his blood sugar can crash. Not healthy! The other issue is that there are a host of associated long-term issues: obesity, metabolic syndrome, etc.

Having chatted with MANY diabetic women, I know that it definitely is not always the diabetes that causes big babies; lots of times it's just genetic. That said, the earlier you know if you do have GDM, or are even slightly insulin resistant, the earlier you can take action (mainly, cut the carbs! at least all the refined ones) to avoid these poor outcomes. There are some issues with the accuracy of the OGTT, especially in women who follow lower-carb, "paleo" style diets, but whoever had the idea to get a glucometer was right on! Note that both the fasting numbers AND the postprandial (after-eating) numbers are important, as often these postprandial numbers are overlooked and can be high, thus causing all of the effects listed above. The earlier you can get it under control (IF it is an issue), the better!

Good luck and keep us posted!!