Does gestational diabetes exist?

[nova22]

What do you think? I am almost to the point in my pregnancy when I am supposed to take the test, but I'm researching and researching it because I'm not convinced it's a real disorder.

[alegna]

IMO, from my research, no. I read plenty that added up to it not existing and no good real information that it was an actual condition. I think that a few "real GD" cases are probably just actual diabetes.

-Angela

[nova22]

Do you have any book/website recommendations you can pass on?

[L'lee]

Popular topic!

I believe that it *does* exist, but that it is WAY overdiagnosed and 95% of the "cases" are really NOT GD - or at least should not be treated as such other than maybe changing diet for the better, which is healthy for all of us anyways.

My grandmother had GD with her last pregnancy (and a 13 lb baby because of it), and she was not diabetic for years after her pregnancy. Later in life, she was again diabetic, which I hear is common when people don't change their eating patterns. So, my family has experienced this personally.

I still will not take the GTT, but I did get a blood glucose monitor that I will use once or twice a week just to keep a record and monitor -- mostly because I find it interesting, not because I think I have a problem, but also in the case that I get transferred to the hospital for birth I don't want to be assumed to be GD! I also try to avoid most processed carbohydrates and sugars, and I stay aware of the composition of my meals in terms of starches.

Hope this helps!

[alegna]

Anything by Henci Goer on the subject is great.

-Angela

[Cyneburh]

I think it does exist but not to the extent that docs claim it does. It's way overdiagnosed and I think a large reason is that docs don't want to do nutritional counseling for all women. So they slap a label on a few and send them elsewhere for it.

[jenny-g]

What do you think? I am almost to the point in my pregnancy when I am supposed to take the test, but I'm researching and researching it because I'm not convinced it's a real disorder.

Of course it exists. I think the issue is that it's so prevalent due to the poor diets/exercise habits of most of the people in this country (well, and others I am sure!) I think it can be treated with diet and exercise, in most (not all) cases, as long as people are committed to the change and strictly follow a low GI diet along with exercise. Not a lot of people do that, including people who *think* they are eating naturally/healthily. My blood sugar was terrible when I was a vegitarian who ate "all natural" foods, cooking a lot of stuff myself. The whole low fat diet craze was one of the worst things to happen to women's diets in this country.

Diabetes isn't, like, this big ON/OFF thing- like, you're one blip above the cutoff and all of a sudden you have it. I think a lot of people have poor blood sugar control, and resulting inflammation/problems with it. It's a gradual sliding scale more than a you have it/you don't issue. Perhaps this is what you refer to saying if it is a "real" disorder. Believe me, diabetes is a REAL DISORDER, and a lot of people's blood sugar control seriously worsens during pregancy- and that's GD. It is something worth watching, because it is so easy to make it better, at least in mild/moderate cases, and the first line suggested cure- low GI diet/exercise - is healthy anyway!

There is an issue if you're borderline and, say, having a "diagnosis" of GD will shift you away from your midwives into the high risk OB group, for example. In that case, I think it's wise to follow a GI diet/exercise throughout the pregancy just as if you so have GD- and I think the test will reflect your better blood sugar control in that case. Also, if you test high, doing this and then getting re-tested is a good idea.

Someone on here was asking questions about GD- and their number after the 1 hour test was OVER TWO HUNDRED. That's serious. It's worth testing to catch, in particular, those cases. Diabetes has serious consequences for both you and your baby, (not just the baby size), and it's worth screening for.

[the_lissa]

ITA with Angela.

[maybebaby]

I take a middle ground on it. While I don't believe there's this horribly dangerous disorder where your blood sugar is 20-30 points above normal (what most docs would have you believe is "GD") I do happen to agree with Jenny that it's a good idea to rule out preexisting diabetes mellitus if you haven't before. Yeah, if someone has readings over 200, likely they had problems before and just didn't know it. And that kind of diabetes does have real risks to fetal development, etc.. I feel the GTT isn't the way to do this, however; testing your own blood sugar or having post prandial tests are far more accurate.

I just think there should be some leeway in the diagnostic criteria though. Too many women are being told they're GD when in reality they just have slightly elevated blood sugars. No research has shown slightly elevated blood glucose numbers have risks anywhere NEAR the risks of true diabetes. It's crazy that the cut off for GD is LESS than the cutoff for a diagnosis of true diabetes. I think the cutoffs should be the same.

The main problem with the way things are now is that you get this diagnosis of GD and suddenly you're "high risk" and all the scare tactics are used to make you comply with interventions you might have rather avoided.

So I guess the short answer imo is that "GD" isn't a true disorder, but that due to the diet and exercise patterns of many people there is a rising number of people with preexisting diabetes mellitus or with insulin resistance issues that should be addressed through diet and exercise. I don't believe (without indication for true diabetes) throwing insulin and birth interventions at the problem help at all.

[Lizzo]

I JUST had a disscussion about this last night!
I have a client (doula) who the OBs have DXd her with GD...but I believe she doesn't have it.
Interesting. I'll have to tell her about this disscussion.
I'm actually trying to find as much info as possible for her.

[psyche]

I just think there should be some leeway in the diagnostic criteria though. Too many women are being told they're GD when in reality they just have slightly elevated blood sugars. No research has shown slightly elevated blood glucose numbers have risks anywhere NEAR the risks of true diabetes. It's crazy that the cut off for GD is LESS than the cutoff for a diagnosis of true diabetes. I think the cutoffs should be the same.

The main problem with the way things are now is that you get this diagnosis of GD and suddenly you're "high risk" and all the scare tactics are used to make you comply with interventions you might have rather avoided.

:nod I agree with this. Last month I went through hellish stress while being diagnosed with GD. But when I looked into the diagnostic criteria in the midst of everything I discovered that the numbers my providers have to use (per the hospital with which they are affiliated) are really low. Given even the normal diagnostic numbers, I would have passed both my one-hour and three-hour tests. :irked:

Getting labeled as "GD" was all just a big cluster**** - While on the phone with my insurance company to make sure they'd cover the nutritional counseling and blood monitor, I found out that because I am now "high risk" I had to get my PCP to refer me to the midwife/OB practice I'd already been seeing. But, because they were from different hospitals, that meant I had to switch PCPs immediately and ask the new one sight-unseen for two referrals (to midwife & to dietician). Then I had to stress stress stress about the fact that I'm now "high-risk," with the added possibility of an induction if "they" don't like my numbers. (I'll hopefully be a VBAC, so induction is bad.)

The upshot of testing my blood every day? With some dietary modification (white rice and bananas are OUT), my normal numbers are a-okay but my morning numbers are a little high for their charts (hmmmm... all my glucose tests were in the morning), though a-okay for a normal person. FWIW, I am tested for diabetes with every normal "physical" I get because of a family hisory and always come out clean.

The only upside of everything is that I'm swimming or doing water exercise five times a week & I feel better than before.

So, basically, my advice echos the advice above to read Henci Goer's articles about GD. They're easily Google-able.

However, much depends on the rules under which your care providers have to operate. I have awesome CNMs, but they have to operate under the GD-diagnosis rules generated by the head-honcho of the obstetrical unit of the hospital. I've read anecdotes here about women who refuse the test & are then just assumed to be high-risk because their status is unknown. That's scary.

[sapphire_chan]

I read an article by Henci Goer on this, wish I could remember where, it was somewhere online at any rate. Anyway what I vaguely remember is that not only are the numbers for GD lower than the normal numbers, but pregnant women should also have slightly higher numbers than non-pregnant women. Also, the way they do the GD test pretty much guarentees an abnormal spike.

I'll worry about GD when medical professionals stop thinking of 9 lbs as a "large" baby.

[the_lissa]

Here are two Henci Goer links I like:

http://www.gentlebirth.org/archives/gestdiab.html
http://www.gentlebirth.org/archives/gdhgoer.html

[ChasingPeace]

Ok, I have some related questions about testing for GD. During my first pregnancy, I ate a high protein/healthy fat breakfast the morning of my one-hour test. After drinking the stuff, I walked briskly outside until it was time for my blood draw. My numbers were "excellent." So my question is--did I "cheat" the test? If I truly had GD, would these practices have masked it?

[maybebaby]

Darlene, I would not say you cheated...I mean, how often do you eat LOTS of sugar like that then just sit down for an hour? Probably what you did gave a more accurate result than it would have otherwise! And eating before, well some practitioners actually tell their patients to eat beforehand...so that's fine.

sapphire, lol yeah 9 lbs is NOT a humungo baby! My first (and I had the GTT and it was fine ;) ) was 8lbs15oz a week early (and if he hadn't peed on that nurse before getting weighed, it would have been 9 likely lol). Since then, my "big" babies are assumed to be caused by blood sugar rather than the fact that the women in my family just have big babies!

Plus, plenty of research has shown that maternal weight plays a much bigger factor in macrosomia than does elevated blood sugars. And I have that issue (the elevated maternal weight) :lol

[NaomiLorelie]

Darlene, I took the GD test in my last pregnancy and I was told I didn't have to fast.

[jenny-g]

Ok, I have some related questions about testing for GD. During my first pregnancy, I ate a high protein/healthy fat breakfast the morning of my one-hour test. After drinking the stuff, I walked briskly outside until it was time for my blood draw. My numbers were "excellent." So my question is--did I "cheat" the test? If I truly had GD, would these practices have masked it?

At least for my test, you did nothing outside the rules. I was told to eat normally- just nothing after the drink- and there was no stipulation as to walk or not walk.

Your technique may be very useful for those to do who are worried about borderline numbers! -j

[mamajody]

I know GD is real. Due to family risk factors I ok'd all the prenatal testing up to the point of the GTT. I was NOT going to take this one because I had ZERO risk factors. My doc. told me to eat normally, come in after work, and it would be no big deal so I took it. My sugar was actually 200 pts. over normal! I had no problems with insurance covering anything I needed, but I really hated the way I was thrown into the high risk category. I did not need meds to control it, but I had to strictly regulate portions and ratios of fat:carb. Even so i had high sugar a few times per week. I had to go through the whole induction process with 24hr. monitoring during labor, but here's the kicker.... I had a 7lb. babe. The doctor KNEW I wasn't going to have a large baby because she had noticed signs of possible GD when I was only 20 wks. I had already modified what was thought to be a good diet and yet I was still testing high at 30 wks. I made more changes, and yes I felt like I was a prisoner to food, but because of her careful monitoring i was able to have a pretty good birth. Yes I hated the monitor, but I avoided a c-section, and I was allowed to push my post. facing babe out naturally even though it took 3 1/2 hours, which was outside hospital parameters. My daughter had no complications, needed no supplementation with formula, and we were left alone to breastfeed with only 2 follow up heel sticks before discharge. It could have been so much worse If I hadn't listened.

[LeosMama]

I'm sorry to sound so harsh, but I think other mamas need to think about this:
Mamajody, it sounds like you were manipulated and controled the whole time just to cover their asses. You didn't need to be induced. You probably didn't even need to control your portions so carefully. But they got you to comply and follow all the rules and they tell you that you had a good birth because of your compliance, so you'll buy into it next time and tell all of your friends to comply.
Hearing the word 'allowed' in relation to your birth experience makes me shake my head sadly.

[alegna]

:yeah:

[jenny-g]

I'm sorry to sound so harsh, but I think other mamas need to think about this:
Mamajody, it sounds like you were manipulated and controled the whole time just to cover their asses. You didn't need to be induced. You probably didn't even need to control your portions so carefully. But they got you to comply and follow all the rules and they tell you that you had a good birth because of your compliance, so you'll buy into it next time and tell all of your friends to comply.
Hearing the word 'allowed' in relation to your birth experience makes me shake my head sadly.

Wow. What a statement. How on earth do you know???!?! The baby's size is only ONE component of what GD is about. There are many more issues (placental health is a big one, as are health problems for her). You have NO way of knowing what her situation was. I think that is a ridiculously snarky and judgemental statement to make. Having blood sugar 200 points above normal is VERY serious, and she should be congratulated for managing her GD with diet, which is not easy when it's so bad. How on EARTH do you know she didn't need to control her portions, when she obviously was testing her sugar and still getting high numbers?

Educate yourself about diabetes before you spout such nonsense. We don't know the details of her birth, and yes, inductions are often done when they aren't necessary, which is terrible. But we certainly don't know about the details in this case, and she obviously was very responsible and managed what could have been a devastating situation.

[maybebaby]

Jody, did your numbers go back down to normal after birth? Just curious...

Because I still have issues with the whole "GD" thing...Just wondering if you have insulin resistance issues or whatever. I think that's what researchers were finding instead of "GD", insulin resistance made more pronounced because of the stresses of pg, and which might be an indicator of diabetes later in life. I don't buy that it's JUST caused by pg, I think it just makes an existing problem more pronounced. I mean, 200 points over normal would be like 340 which are some scary numbers! Makes me just wonder if everything calmed down after you gave birth...

I do agree that docs use this kind of thing to make us fear birth and worry more than we need to. At the same time, some numbers need attention. This is why I think taking a week and testing your own fasting and post meal numbers a few times that week will give a more realistic number that YOU can do something about yourself before getting slapped with the "GD" label if you control well with diet and exercise. I think most women should do some random blood sugar testing in pg *themselves*, not regulated by some care provider who will then use those numbers to scare them into all kinds of things. Then if your numbers aren't responding to diet and exercise, sure, seek out further treatment if you need it.

I'm glad things turned out well for you Jody, but that's the exception to the rule. Most moms labeled GD would NOT be "allowed" to push that long and would have had a C section. And we don't know all the details, but sometimes inducing labor before baby has had time to position itself properly CAN lead to thinks like an OP presentation. I agree that numbers like yours needed looking at, but I hate that there are sooo many moms given this label and then having problems that are caused by the establishment/interventions rather than the "GD"...

[mamacatsbaby]

Jody, did your numbers go back down to normal after birth? Just curious...

Because I still have issues with the whole "GD" thing...Just wondering if you have insulin resistance issues or whatever. I think that's what researchers were finding instead of "GD", insulin resistance made more pronounced because of the stresses of pg, and which might be an indicator of diabetes later in life. I don't buy that it's JUST caused by pg, I think it just makes an existing problem more pronounced. I mean, 200 points over normal would be like 340 which are some scary numbers! Makes me just wonder if everything calmed down after you gave birth...

I do agree that docs use this kind of thing to make us fear birth and worry more than we need to. At the same time, some numbers need attention. This is why I think taking a week and testing your own fasting and post meal numbers a few times that week will give a more realistic number that YOU can do something about yourself before getting slapped with the "GD" label if you control well with diet and exercise. I think most women should do some random blood sugar testing in pg *themselves*, not regulated by some care provider who will then use those numbers to scare them into all kinds of things. Then if your numbers aren't responding to diet and exercise, sure, seek out further treatment if you need it.

I'm glad things turned out well for you Jody, but that's the exception to the rule. Most moms labeled GD would NOT be "allowed" to push that long and would have had a C section. And we don't know all the details, but sometimes inducing labor before baby has had time to position itself properly CAN lead to thinks like an OP presentation. I agree that numbers like yours needed looking at, but I hate that there are sooo many moms given this label and then having problems that are caused by the establishment/interventions rather than the "GD"...
:nod ITA.

You guys know what I was told when I brought up eating what I would normally eat then taking my levels? That they couldn't do it that way. :shake Whatever. I knew I was going to have to deal with some kind of silliness at some point. I won't go into the whole story again but the last doc I dealt with at my last prenatal kept trying to pressure me into the GTT and I had to end up just saying flat out that I just didn't want it. She finally let it go. If I feel the need, I will be testing myself.