Is this true about the GTT?

[thefreckledmama]

I'm 27 weeks. Today at my prenatal appt I was supposed to have done my GTT, but decided against it because: a.) I'm sick with a heinous cold and wasn't about to knock my body further down by ingesting that much sugar, and b.) I wanted to discuss the possibility of using a glucose meter to monitor my blood sugar for however long my OB wanted instead of doing the GTT. When I brought this up to her, she said if I did that, I would have to test my blood sugar the rest of my pregnancy 4x a day. She told me the reason the GTT is used is because it can PREDICT if I will develop GD at any point later in my pregnancy, which is why I can do the GTT once, but I would have to monitor my blood sugar continuously until the end.

I don't know why, but that just doesn't sit right in my brain, and I wanted to hear from other birth professionals.

Thanks!

[blissful_maia]

Sort of makes sense to me. The GTT is an attempt at getting an actual number re: how your body metabolizes sugar. They give you a standard, measured dose of sugar and x amount of time later they take your blood and see how much is in your bloodstream. If you were to do your own testing, just eating your normal diet, this wouldn't really show quantitatively how your body was metabolizing sugar.

That being said, I think the GTT is a bogus test. Why is your OB trying to get you to do something that is not evidence based if you don't want to?

[MsBlack]

frankly I think that is ridiculous of her to say...there is no proven benefit to routine GTT.

Maybe you could tell her that you'll do 4x day glucose testing 1 day, every 2wks to be on the safe side.

[DreamsInDigital]

Originally Posted by MsBlack

frankly I think that is ridiculous of her to say...there is no proven benefit to routine GTT.

Maybe you could tell her that you'll do 4x day glucose testing 1 day, every 2wks to be on the safe side.

:

[mothercat]

The one hour GTT is a screening test. It doesn't actually diagnose anything. However, if your BS is elevated then you are considered to have failed the test and need the 3 hour to actaully diagnose GD. There are a pretty good number of "failed" 1 hr. GTT with normal (3 of 4 values) on the 3 hr. Otherwise known as false positives.

My other suggestion is to ask your doctor how she manages women with GD. Usually this starts with diet modification. Good quality protein, stay away from white carbs, lots of fruits and veggies, complex carbs. All the protein and the complex carbs help to stabilize the blood sugar. It is the big swings in BS that cause problems, plus consistently high levels of blood sugar aren't good for the baby. However, most women diagnosed as GD are no where near the same category with BS as women who are insulin dependent diabetics.
Tell your OB you would be happy to follow the GD diet and skip the whole GTT thing. The GD diet is how pregnant women should be eating anyway.

[blissful_maia]

Originally Posted by mothercat

The GD diet is how pregnant women should be eating anyway.

:

This is what I tell clients!

[mama_ani]

Originally Posted by blissful_maia

:

This is what I tell clients!

What is the GD diet? I'll be debating whether or not I'll do the GTT at my next appointment and think that just eating the GD diet would make more sense than to subject myself & the baby to the test since I have only one risk factor.

[Reha]

I'm not saying that the diet outlined above isn't a great choice for pregnant women (heck, for all of use, even!), but I have heard of some providers advocating what is essentially a 'starvation diet' (reducing calories, not just advocating a healthy diet), so I don't think all GD diets are equal.

With that said, The Cochrane Review concluded in 2007 that there is “insufficient data for any reliable conclusions about the effects of treatments for impaired glucose tolerance on perinatal outcome”. They have listed insulin and diet therapy for gestational diabetes under the category of “Forms of Care Unlikely to be Beneficial”.

[rajahkat]

They have listed insulin and diet therapy for gestational diabetes under the category of “Forms of Care Unlikely to be Beneficial”.

So essentially, why test for it then? Right? Were there any forms of care listed as likely to be beneficial?

[Reha]

Originally Posted by rajahkat

So essentially, why test for it then? Right? Were there any forms of care listed as likely to be beneficial?

Do you mean any forms of care for GD or just in general?

[rajahkat]

Gd.

[Reha]

http://www.cochrane.org/reviews/en/ab003395.html

and if you want to pay for access:
http://mrw.interscience.wiley.com/co...674/frame.html

[blissful_maia]

Originally Posted by rajahkat

So essentially, why test for it then? Right? Were there any forms of care listed as likely to be beneficial?

Why do many, many medical practitioners continually practice many forms of care unlikely to be beneficial? Or even proven harmful? :

[Reha]

Originally Posted by blissful_maia

Why do many, many medical practitioners continually practice many forms of care unlikely to be beneficial? Or even proven harmful? :

Habit? Fear? Not wanting to shake status quo? :

[mothercat]

GD diet

Originally Posted by rajahkat

They have listed insulin and diet therapy for gestational diabetes under the category of “Forms of Care Unlikely to be Beneficial”.

I have not looked at the entire Cochrane review for this, but does any know if they specified the type of diet that was recommended.

Here's my thinking: Women who are overweight to obese are assumed to be GD. They may be, but it may be that she has metabolic syndrome /PCOS /insulin resistance. A high protein diet acts in the body the same way that Glucophage (Metformin) does by overcoming the insulin resistance.

Personally I am very fond of the book Protein Power for high protein diet guidance. There are several worksheets in there that help you figure out your carb tolerance and protein needs based on body composition. They also don't push the supplements and special additives that Atkins does. It just teaches you to eat better so it is easier to stick with in the long term.

I'm not very fond of RD's telling women to cut calories and using a high complex carb diet. For a woman who has a metabolic disorder, that diet has the opposite effect.

[heathenmom]

Originally Posted by mothercat

Personally I am very fond of the book Protein Power for high protein diet guidance. There are several worksheets in there that help you figure out your carb tolerance and protein needs based on body composition. They also don't push the supplements and special additives that Atkins does. It just teaches you to eat better so it is easier to stick with in the long term.

I'm not very fond of RD's telling women to cut calories and using a high complex carb diet. For a woman who has a metabolic disorder, that diet has the opposite effect.

I Protein Power! Going by my experience, RD's are NUTS (yes, I know that's a gross generalization ...) I was diagnosed with gd in my last pregnancy. I started the pg at 274 lbs. By the time I was diagnosed, I had gained about 10 lbs.? In my initial meeting with the RD, there was another gd mom who weighed literally 100 lbs. less than me. The RD put us on the same diet -- including caloric intake. I knew it was bogus, but did what I was told (basically to prove them wrong . I ended up losing 8 lbs. in 1 week. They could not understand why a 280 lb. pregnant woman was losing weight on a diet of <2000 calories/day. Instead of upping my protein levels, they told me to start eating ice cream and cookies. I.am.not.kidding. At that point, I figured I was better off eating what I knew was a healthy diet, monitoring my own blood sugar, and faking my food diary. So I did. Miraculously, I managed not to kill either myself or my baby.

[NamastePlatypus]

Originally Posted by blissful_maia

Why do many, many medical practitioners continually practice many forms of care unlikely to be beneficial? Or even proven harmful? :

Don't get me started on THAT one: