2 hour GTT?

[Pandme]

I'm way early in this pregnancy but its never too early for me to worry about this test since I hate it. But now apparently my office has eliminated the one hour and makes everyone take a 2 hour GTT where you drink 75 grams of the sugar drink. Anyone familiar with the thresholds? I always have issues at the one hour point but I haven't had GD. I also have small babies and measure small as well. I can't believe I managed to accidentally get pregnant when I never wanted to deal with this again.

[FLmomof1/1ontheway]

That test is rediciulous. Pregnant women metabolize sugar different and to make a pregnant women consume higher amounts of sugar then she would ever consume and see if her body can take is stupid! Maybe you should think about changing your care provider? With my last baby my midwife had me eat a regular meal that I would normally eat, then drew my blood an hour later.
I wish I knew the name of the test, but my midwife this time uses a new blood test. It looks at another part of your blood that tells them how your body is metabolizing sugars over a long period of time. Not just 2 hours after having you drink a weeks worth of sugar. It is much more accurate and there is no nasty drink to make you sick. Maybe research it or ask your provider. Good luck!

[katelove]

The one hour test is a screening tool not a diagnostic test. It is pretty pointless IMO.

The test the PP is referring to is the Hba1c which is a sort of average of your BSLs over the last 2 months. Unfortunately it isn't useful as a diagnostic for gestational diabetes. GDM usually develops around 26-28 weeks gestation. Add 8-9 weeks to this and you are 36-37 weeks pregnant. Not much point diagnosing GDM at term when it's too late to do anything about it.

The GTT is certainly not without it's faults but it is the most reliable diagnostic we have at the moment. The only real alternative IMO is to assume you have GDM and act accordingly - check your BSL four times a day (before breakfast and 2hrs after each meal) and adjust your diet to maintain them below the target numbers.

[Pandme]

Yes, but is anyone at all familiar with this new 2 hour GTT? 75 grams of sugar, not 100. Two hours, not three. I'm wondering about the new thresholds. But I haven't seen anyone else talking about this supposedly new, improved test. My providers, like I said, eliminated the 1 hour screening tool. Everyone has to take this 2 hour test and if you fail even 1 hour, you have GD. I find that incredibly strict.

[katelove]

Yes, if the 2hr glucose level is >11.1mmol/L (there are online conversion tools if your physicisn still uses g/dL) you have GDM. The Australasian College of pathologists protocol doesn't require a level to be done at 1hr so I don't know what level is being used by your lab for that one.

The reference ranges for both diagnosis and managemt have recently been lowered as tighter glycemic control has been found to improve outcomes. This is happening across the board. Not just for GDM but for patients in ICU etc as well.

And yes, there also seems to be a move away from the use of screening tools, such as the GCT and risk factors, and testing everyone instead. I imagine it is partly cost driven (in the case of the GCT) and partly in response to the increasing rates of diabetes amongst all population groups.

[Pandme]

Thanks. You are most certainly correct as to why this is being done. My irritation lies with the fact that while I struggle with the one hour number sometimes, i most definitely do not give birth to GD babies. However, the stress and anxiety of having to plan my day around meals, snacks and finger pricks will almost certainly make me a total jerk to deal with for everyone unfortunate enough to have to do so. I tried doing it last time so I wouldn't have to take the three hour again. I became obsessed with low numbers to a competitive degree. My midwives begged me to take the three hour again so we could just stop dealing with it and I passed well.

For some people I guess it's no big deal. But for someone like me it can take over your life. I have a busy family and have no wish to plan my day around the clock in 2-3 hpur increments.

[Quinalla]

Why not just decline the test? It sounds like it is a huge headache for you! I'm assuming it isn't that simple, but if it is, maybe that's your best bet.

[Pandme]

Wish I could because I definitely would but they won't allow me to. I would have to switch practices. They have a protocol they have to follow.

[coati456]

Here is a blog post about a conference on diagnosing gestational diabetes. It's a lot to go through, but I think it has some of the information you're looking for.

http://evidencebasedbirth.com/diagnosing-gestational-diabetes-the-nih-consensus-conference-day-1/

[Pandme]

Thank you, the cutoffs were what I needed. The fasting is three points lower and the two hour is a point or two lower but the one hour was the same. Historically, the one hour is my problem number tho with a lower sugar count, it might be ok.

[Quinalla]

Originally Posted by Pandme 

Wish I could because I definitely would but they won't allow me to. I would have to switch practices. They have a protocol they have to follow.

Bummer! I hope it works out for you, are they willing to retest you at a later date again so you can get out of the stress if you happen to fail again? I can totally understand getting obsessive about it, I probably would too in that position.

[AshleeRose]

My evening job is for a lab, and we do the 3 hour GTT test all the time (we have a HUGE OB/GYN dept in the clinic). Moms are always failing the first hour, even if by a few points, and then they are stuck coming back for the three hour. I also personally had to do this with my first two kiddos (here's to hoping I will pass the 1 hour with this pregnancy!) The "normal" reference range for the one hour is pretty strict. I think your clinic actually may be saving moms a lot of time with skipping right to the 2 hour GTT! Fewer needle sticks and fewer visits for those who have to take two tests vs. one.

The 2 hour basically skips right to the information to properly diagnose the condition, not just screen to see if it's a possibility like the 1 hour. I think lots of moms who did have GD also do this test after giving birth to see if they are still having issues.

I totally understand the stress of having to fast first and make time to come in, though. If you still have to take it...is there a lab open on the weekends that you could go to? We have that here at my clinic, and moms are so thankful to not have to mess with their busy week in order to get this test done.