GD Test - Glucola drink vs Jelly Beans - Page 2

[SublimeBirthGirl]

I'd tell the in-laws to shove it up their asses. Then again, I'm not much for letting other people run my life.

[mwherbs]

so to answer your original question- yes you need to be fasting because if you are taking in more than the sugar they want you to it can falsely elevate your blood sugar--- the other thing you need to know about a glucose test is that the week before you take the test you should be carb-loading -- here is a copy of the instructions-- something you should know before hand- when they studied the glucose testing in general there is a 25% false positive rate- and it gets to be even higher if the person does not carb load before the test-- if you fast for too long before the test (I think 14 hrs is pushing it) your body will trigger a glycogen dump to maintain functions and your blood sugar will also test high-- having caffeine will do a similar thing -- fasting means fasting---- there are other tests for blood sugar one of them being an after a meal test- but that is not the same as what your doctor has sent you to have-- I think that this is a very poor way to screen for true diabetes- and there should be a recommendation for non-pregnancy screening of women to find the true diabetics before they are pregnant- because diabetes is what is associated with anomalies and still birth- not gestational changes in blood sugar.----

"Patient Preparation
For 3 days prior to the test, patients should eat an unrestricted diet of 150 or more grams of carbohydrate and be permitted unrestricted physical activity. Patients should be instructed to eat and drink nothing except water for at least 8 hours and not more than 14 hours before the test. Patients should also be advised to discontinue, whenever possible, all nonessential medication that can affect glucose metabolism at least 3 days before testing."
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here is a link to a more recent study done in Canada --

http://www.pubmedcentral.nih.gov/art...i?artid=143544

[mwherbs]

you know I wanted to send this along just to say- we really don't know what we are doing with all of this-- here is a French study that says higher carb intake was associated with less macrosoma -----

J Am Diet Assoc. 2001 Aug;101(8):897-902.
Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes.
Romon M, Nuttens MC, Vambergue A, Vérier-Mine O, Biausque S, Lemaire C, Fontaine P, Salomez JL, Beuscart R.

Service de Nutrition, Faculté de Médecine, Lille, France. [e-mail]

OBJECTIVE: To study the influence of energy and macronutrient intake on infant birthweight in women with gestational diabetes mellitus undergoing intensive management. DESIGN: This prospective study evaluated the impact of intensive management of gestational diabetes on maternal and fetal morbidity, and addressed the relationship between food intake and infant birthweight. SETTING: Fifteen maternity hospitals in northern France. SUBJECTS: Ninety-nine women with gestational diabetes or gestational mild hyperglycemia diagnosed between 24 and 34 weeks of gestation were surveyed. After 1 was excluded because of a premature birth and 18 were excluded as underreporters, 80 women were included in the final analysis. Diet intake was assessed by a dietary history at the first interview, and by two 3-day diet records at the 3rd and 7th week after diagnosis. RESULTS: In a forward-stepwise regression analysis (controlling for maternal age; smoking; parity; prepregnancy BMI; pregnancy weight gain; gestational duration; infant sex; fasting and 2-hour postprandial serum glucose; insulin therapy; and energy, fat, protein and carbohydrate intake during treatment) infant birthweight was positively associated with gestational duration (beta = +0.34, P<.002), and negatively with smoking (beta = -0.27, P<.02) and carbohydrate intake (beta = -0.24, P<.03). There were no large-for-gestational-age infants among women whose carbohydrate intake exceeded 210 g/day. CONCLUSION: For women with gestational diabetes undergoing intensive management, higher carbohydrate intake is associated with decreased incidence of macrosomia. APPLICATION: These findings suggest that nutrition counseling in gestational diabetes must be directed to maintain a sufficient carbohydrate intake (at least 250 g per day), which implies a low-fat diet to limit energy intake. A careful distribution of carbohydrate throughout the day and the use of low-glycemic index foods may help limit postprandial hyperglycemia.

PMID: 11501863 [PubMed - indexed for MEDLINE]

[blissful_maia]

I'm not going to debate the merits or drawbacks of the test or your choices (as so many have done here), but rather just answer your original question: I'm not sure why your doctor is having you fast. Usually for the 50g challenge test, you just eat as normal and then do the test (with the glucose syrup). This is one of the reasons it is highly inaccurate, because there is a wide range of things you may have eaten that day that could affect your blood sugar. Usually, our clients only fast if they do not pass the challenge test and go on to do a glucose toleranse test (GTT).

At our practice if a woman chooses to do the OGCT, we ask them to eat 50g of sugar in the form of either Smarties or Reese's Pieces (one whole box plus 10 from another box = 50g) one hour prior to the test.

[mwherbs]

Originally Posted by blissful_maia

I'm not going to debate the merits or drawbacks of the test or your choices (as so many have done here), but rather just answer your original question: I'm not sure why your doctor is having you fast. Usually for the 50g challenge test, you just eat as normal and then do the test (with the glucose syrup). This is one of the reasons it is highly inaccurate, because there is a wide range of things you may have eaten that day that could affect your blood sugar. Usually, our clients only fast if they do not pass the challenge test and go on to do a glucose toleranse test (GTT).

At our practice if a woman chooses to do the OGCT, we ask them to eat 50g of sugar in the form of either Smarties or Reese's Pieces (one whole box plus 10 from another box = 50g) one hour prior to the test.

----


I replied as well-- there is a fasting- glucose screening test--- and no matter how you do it after a meal or with 50, 75 or 100 gram test, carb load for atleast 3 days prior to the test------

[khaoskat]

Originally Posted by mwherbs

----


I replied as well-- there is a fasting- glucose screening test--- and no matter how you do it after a meal or with 50, 75 or 100 gram test, carb load for atleast 3 days prior to the test------

Thanks ladies, I just wanted to make sure that the fasting wasn't going set me up for automatic failure, as I really doubt I could make it though the 3 hour test.

I really do not do good with the orange. With PG #1 - about 10-15 mins after drinking it, the only reason I didn't puke is I have a gag reflex that kicks in and I usually end up swolling the vomit before it gets any further than my throat.

PG #2 - MC at 9 1/2 weeks
PG #3 - I was barely able to get 5 ounces in before I started gagging on it and feeling like puking.
PG#4 - I was barely able to get 3 ounces in before I started gagging and want to puke.

I cannot even drink Orange Crush Soda, I barely tolerate orange juice, unless it is really watered down and very very ice cold to almost frozen.

I could probalby handle it if it were another flavor, except maybe flat tasting cola as I don't like the taste of that much either.

Melissa S.

[Jane]

I've seen both fruit punch and orange flavors. Maybe you could call the local labs and see if anyone has fruit punch flavor and get a written order to take to that lab. You don't have to do it at the office, you can do it at the lab.
We do that for moms that are not close to the MW's office, are a very, very hard stick, or need to do it at 8 am instead of 10 am.

[hippeemommy]

Originally Posted by YumaDoula

My thought as to why they want you want you to fast and eat/drink nasty tasting things to see how your body will react is: in order to torture you and because they can.

I have got to ask, do you seriously believe this? There is evidence based research behind this testing, and altho unpleasant for one morning/afternoon/whatever it can provide important findings.

[the_lissa]

There is not evidence based research behind this testing at all. That is my big problem with this test. Testing and/or management has been shown to not improve outcomes at all. Also, the test is not reproduceable, which makes it scientifically worthless.

Fasting and ingesting that much sugar is not healthy or way to test normal blood sugar fluctuations.

Google Henci Goer and Gestational Diabetes or Glucose Tolerance Test.

Sadly, a lot of standard ob care is not evidence based.

[mwherbs]

Originally Posted by the_lissa

There is not evidence based research behind this testing at all. That is my big problem with this test. Testing and/or management has been shown to not improve outcomes at all. Also, the test is not reproduceable, which makes it scientifically worthless.

Fasting and ingesting that much sugar is not healthy or way to test normal blood sugar fluctuations.

Google Henci Goer and Gestational Diabetes or Glucose Tolerance Test.

Sadly, a lot of standard ob care is not evidence based.

The research by the Japanese and a few others is pointing to genetic traits that influence size- and yes the same thing that makes for a bigger baby also makes for the potential for diabetes and heart disease later in life-- because it is a genetic trait is probably why even women who have been given insulin and restrictive diets do not have babies much smaller than untreated women(3 -5 oz). There is even a French study that shows women who have been diagnosed with GD had less incidence of macrosomic babies when they ate around 250gms of carbs a day- and the women who ate 210 or less carbs a day were more likely to have macrosomic babies-- some of the same researchers in 2006 did a baseline study on ketones in the blood- because renal threshold is too high - in any case women who were identified as GD had more frequent ketone elevations and evening meals where the time of greatest elevation in ketones they also found that women who were dx as gestational diabetic also ate less food then the controls.

[the_lissa]

Interesting. That makes sense.

[khaoskat]

I have had 3 full term births, 2 of which were macrosomic babies w/o a GD diagnosis, even though I did test.

DS1 = 9 pounds 2 ounces 23 inches at birth
DS2 = 9 pounds 15 1/2 ounces 22 1/2 inches at birth

DD1 = 7 pounds 6 ounces at birth (This child also had 2V cord, had a significant slow down of growth after 31 weeks of gestation which was NOT diagnosed by the Midwife or OB in charge of my car. Between 31 and 35 weeks, there was only 2 weeks worth of growth seen, but because she was already on the large side, the slow down was not noticed because at 35 weeks she was measuring on target for a 35 week baby, whereas at 31 weeks she was measuring 2 1/2 weeks ahead. Had this not had the issues, I believe she would have probably be closer to 9 pounds at birth.)

This new pregnancy is already see'ing a very slow slow down in growth, again not being diagnosed. At 13 weeks, the baby was measuring 3 days smaller than it should have. At my 20 week US, baby was measuring 4 days smaller. I had intended to ask the OB at my last visit, but had too many other things on my mind, so I will ask the CNP at my next visit about it. This is also why I am paranoid, because my 20 week US took 9 minutes or less to complete and was billed out as a "detailed" us not the normal 20 week routine US.

[pamamidwife]

I wouldn't trust those "smaller" growth estimates at all. IMO, I don't think that it's accurate, evidence-based or even something that should be looked at. Even fundal height measurements after 30 weeks are not accurate with weeks - and there has to be some leeway for different providers measuring. Having the same fundal height two or even three visits in a row does not mean your baby has stopped growing.

Ultrasound growth estimates and fundal height measurements are not supposed to be RIGHT ON with your dates. They are all ESTIMATES. Intrauterine growth restriction can ONLY be diagnosed with repeated ultrasounds measuring the head to abdomen ratio - not estimates based on weight or weeks.

I just have a huge disagreement professionally with what you're being told / led into / treated with. I'm sorry. I won't comment any more on this thread because it literally makes me shake my head with confusion. I can't even believe women are told that they're "measuring ahead" with a 2-3cm difference from weeks.

[flyjawn]

Originally Posted by blissful_maia

At our practice if a woman chooses to do the OGCT, we ask them to eat 50g of sugar in the form of either Smarties or Reese's Pieces (one whole box plus 10 from another box = 50g) one hour prior to the test.

hey i'm taking that test right now! ooops i'm not pregnant though.

mmmmm smarties.

[mwherbs]

Originally Posted by khaoskat

I have had 3 full term births, 2 of which were macrosomic babies w/o a GD diagnosis, even though I did test.

DS1 = 9 pounds 2 ounces 23 inches at birth
DS2 = 9 pounds 15 1/2 ounces 22 1/2 inches at birth

DD1 = 7 pounds 6 ounces at birth (This child also had 2V cord, had a significant slow down of growth after 31 weeks of gestation which was NOT diagnosed by the Midwife or OB in charge of my car. Between 31 and 35 weeks, there was only 2 weeks worth of growth seen, but because she was already on the large side, the slow down was not noticed because at 35 weeks she was measuring on target for a 35 week baby, whereas at 31 weeks she was measuring 2 1/2 weeks ahead. Had this not had the issues, I believe she would have probably be closer to 9 pounds at birth.)

This new pregnancy is already see'ing a very slow slow down in growth, again not being diagnosed. At 13 weeks, the baby was measuring 3 days smaller than it should have. At my 20 week US, baby was measuring 4 days smaller. I had intended to ask the OB at my last visit, but had too many other things on my mind, so I will ask the CNP at my next visit about it. This is also why I am paranoid, because my 20 week US took 9 minutes or less to complete and was billed out as a "detailed" us not the normal 20 week routine US.

a 13 week ultrasound can be off about 1 week either way- now they can use Biparietal diameter (BPD) from 12 weeks on. that your ultrasound was only off 3 days sounds pretty accurate to me. And by 20 weeks the accuracy of an ultrasound can be off about a day short of 2 weeks either way-so if it is only off by 4 days also sounds like they have a good fix on dates and that the baby is fairly consistent in growing also encouraging -- are you planning on having a some vascular imaging?

here is a fairly technical web site that has info about ultrasound measures and accuracy --http://radiology.creighton.edu/fetalbio.htm
----------------------------------------------------------------------

one of the best measures of fetal well being is consistent movement and reaction to sound- reaction to sound and external stimulus means that the baby is not in survival mode but can use higher brain function -- one long time practicing very experienced midwife uses fetal movement charting - by moms from 24 weeks on- in a lecture I heard of hers she says that at her clinic she reduced her still birth rate to 0 -- if there is a change in movement she does a non-stress test if that comes up low then she transfers care to a hospital provider-- she also said that starting kick/movement counts at 40 weeks doesn't help at all because what she uses the counts for is a change in activity - reduction of movement from a known baseline-

[khaoskat]

Well, I have told them all along my EDD is off by 1 week, because I knwo when DH and I had free time to be together.

I am just a bit more paranoid after last time because of the difference in size.

As far as I know there will be no further US's, except for the "for fun" one I am paying out of pocket for....

We were billed for the "detailed" US, which going through the diagnostic code books, is supposed to be an indepth fetal survery measuring organs and stuff, but we didn't get that. Our US lasted no longer than 9 minutes once the tech got started (I watched the video and the time difference from start to stop on the machine and also the amount of time the VCR showed for tape useage). She didn't bother to look at fetal organs or anything, except to note yea we have that organ...she didn't look for any defects or issues with the organs. That is the only thing I miss about my old OB/Midwife practice....your US there is around an hour long and very detailed - the tech actually measures the organs, etc.

[rmzbm]

Originally Posted by SublimeBirthGirl

I'd tell the in-laws to shove it up their asses. Then again, I'm not much for letting other people run my life.

:

[mwherbs]

It probably is that they followed up on what they couldn't see with the 13 week ultrasound - at a 13 week some markers for abnormalities may show up- at 20 weeks others may be found--here is some info from another web site on ultrasound--

"11-14 weeks, mainly to look for an increased nuchal translucency and absent fetal nasal bone for the detection of chromosomal anomalies. With the documentation of an absent nasal bone and a thickened nuchal translucency in the fetus the chance of Trisomy 21 is much increased. More recently the presence of triscuspid regurgitation are also looked at to increase the detection rate."-----"A repeat scan at about 18 to 20 weeks will still be necessary for such anomalies as cardiac, spinal, intracranial and facial abnormalities." this is from his FAQ section
this web page is Joe Woo's general page-- scroll to the bottom to click on the FAQ section- there are things on the main pages that may be helpful for you as well
http://www.ob-ultrasound.net/index.html

9 minutes is long enough to get a look at these things --the tec is not the one who will read the ultrasound- all that the tec would need to do is get a good view so that the doc reading the ultrasound (viewing the tape) would be able to eyeball problems if there are any- now if a difference shines out they make time a longer time to set a measure
given your level of concern I would not be surprised the doc doesn't send you for another ultrasound sometime in your 3rd trimester-
also you may want to talk to a genetic counselor
here is a link for NSGC
http://www.nsgc.org/

[naturegirl7]

I haven't heard of the jellybean test - my former OB office/MW did the test with a king sized snickers bar or the nasty drink.

you can ask for (or demand) a post pranidal test. It is after eating a normal meal and is what is used for diabetics. It is way more accurate.

My other MW only did post prandial tests - not the GD test cuz she felt it was boogus and ridiculous. Post prandial tests are way more accurate - but also don't come back with all the false positives for GD - which equals less money for the OBs in the long run. If you test positive for the initial GD test, then you have to go for the 3 hour test, plus you are "watched for complications" and can be used to label you high risk and to encourage inducing, C/S, etc - all which adds up to $$$$$