Can someone explain the test for GD? - Mothering Forums

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Old 02-17-2009, 05:33 PM - Thread Starter
 
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I consulted with a homebirth midwife earlier in my pregnancy (I'm 12w2d today) and she said she didn't do any of the special tests for GD and just monitored blood pressure and other symptoms. She believed that the tests OBs administer only lead to many people being managed as having GD when they really don't. She said the test consists of loading you up with a LOT of sugar and then seeing how your body handles it. And that many people just cannot handle that sort of sugar load because it just is not natural to their body or their body is not accustomed to it, because they never ingest that much sugar at one time at any other moment in their life.

I opted against going with the midwife even though I really want a homebirth because we just don't have the $4000 fee that we would have to pay out-of-pocket. I found a natural birth-friendly OB/nurse-midwife practice that is in my HMO network, and am going with that.

I am concerned about what the midwife told me, and have not stopped thinking about it since. I really don't eat a lot of refined sugar anymore. I rarely, rarely even drink pop. And I have always been sensitive to my sugar intake, and so overall I just avoid it. It's a sensitivity that has always seemed normal to me, because -- like the midwife -- I believe our bodies just aren't meant to deal with sugar (and by that I mean refined sugar, not natural sugars like fruit), especially a lot of it at once. But the other night DP and I went to Denny's and I stupidly ordered this fusion drink which was a mix of flavored syrups, Sprite, and juice. I know better, but it looked really, really good. It made me feel sooooo crazy. All foggy-headed and sick to my stomach. A little shaky. And it gave me a headache, too. That sort of thing is how I would always respond to heavy sugar loads before I was ever pregnant, but it seemed a little more intense this time.

So is that what I will experience when I take the GD test? And will I then be labeled as having GD? Even though not being able to process huge doses of refined sugar very quickly seems like a perfectly normal response of the human body?

What do you think?
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Old 02-17-2009, 06:37 PM
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I actually agree with the midwife. The fact is, there are lots of signs for GD AND they always test your urine for sugar at every prenatal visit. I think the test has a high rate of false positives and isn't conclusive enough to make the torture of getting the test (it really does suck) worth it.
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Old 02-17-2009, 06:54 PM
 
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Henri Goer goes over the pitfalls of the GD test in one of her books. I personally don't do the test either.

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Old 02-17-2009, 06:59 PM
 
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I actually agree with the midwife. The fact is, there are lots of signs for GD AND they always test your urine for sugar at every prenatal visit. I think the test has a high rate of false positives and isn't conclusive enough to make the torture of getting the test (it really does suck) worth it.
ITA! I personally don't get it - considering there are so many other signs that something is not right.

Even if you do decide to do the test there are options besides that horrific drink they hand you. You can load up of fruit and juice exactly an hour before the test, assuming you have fasted before that. A morning test would be the best for that situation.

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Old 02-17-2009, 07:12 PM
 
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The test makes me feel horrible. With my first preg I had a 1hr test which was high, then a 3hr which was normal, then another 1hr which was normal. This time, I had a 1hr that was high, then a 3hr that was normal, then another 3hr that was borderline and now I'm stuck with a GD label and I am monitoring my blood sugar 4x per day and eating very carefully.

Every time I took that test I felt completely sick. If your OB will work out a different way to evaluate you, I would go for it.

But, I don't know if its really true that there are "lots" of symptoms of mild GD. The whole point of the 3HR test is that it shows whether your body is able to effectively manage the blood sugar levels *even when* they are excessive. I am not saying the test is a good thing, but they are intentionally taxing your endocrine system to see if it can handle the extra sugar load. Most people's can (like, 96% of pregnant women).

I didn't have any "symptoms" and I still don't. Symptoms of mild GD are things like: being thirsty (plenty of pregnant women are), having a larger-than-average baby (well, half of people do, right? average is just, well, average). I do have a lot of risk factors for developing GD, hence all the testing. The part I'm still unclear about is why the big high risk label if I am managing with diet- If my blood sugars stay at pretty much normal levels, whats the big deal? If only it was that simple- that the test would allow me to know I don't handle sugar/carbs well and can eliminate them from my diet. For some people, diet doesn't work, and I think that is a different situation, but once you have the label, many places treat you as one big disaster waiting to happen, and there is no differentiation between cases.

Luckily I am also seeing a HB MW who feels fine about me using diet for control and considering myself normal. What a relief.

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Old 02-17-2009, 07:25 PM
 
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I have done the glucose tolerance test twice, and was fine with it even though I don't drink a lot of sugary drinks. I do eat a lot of carbs. Basically, they give you a drink that's kind of like a soda and has the calories of a soda, but it is dextrose (a form of glucose) instead of sucrose. High fructose corn syrup or sucrose in soda have a similar glycemic index since they both contain fructose sugars, and the glucose molecule has to be stripped off from the fructose molecule, which is processed in the liver (as far as I understand) So dextrose will affect your blood sugar more quickly and they want to see how your body processes this load to determine if you are showing signs of gestational diabetes. That way, they know your baby will be big, and they can go ahead and schedule the c-section right away--that's a tongue in cheek comment, but not necessarily a joke. I heard this several times in my first pregnancy. Even though I passed the first test (where I didn't fast before hand, but did sit quietly for an hour), I was borderline, and she did a fasting blood draw later, concerned I had GD. And she talked about a c-section and scheduled an induction.

When I had the test in my second pregnancy, I had to fast for 12 hours, drink what was basically 35g-40g of glucose, and then sit quietly for an hour. My thought was how often would I really do this? I tried to forgo the test altogether, but the OB practice started freaking out (the nurse did, at least), so I drank the glucose and then strolled around for most of the hour.

I do know that a lot of people complain about the drink making them feel nauseated, especially if they've been fasting. I hate to eat sweet things for breakfast, which I think is kind of a natural response after having been fasting overnight--I seem to crave protein. So I felt like even if I did have GD, it would be managed through diet and exercise, and I was already trying to eat plenty of protein, fiber and fat with my carbs, and exercise. If you eat a handful of dates for breakfast every day, and sit on the couch for an hour afterwards, you might want to know if this is causing a problem, but if you are already avoiding refined sugars or high glycemic index foods, and are getting some exercise in, I think the test has the potential to create issues. JMO.
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Old 02-17-2009, 07:34 PM - Thread Starter
 
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See, that's the thing I don't understand. Why are they purposefully taxing your system? What is the point? If I'm smart, I won't be exposed to buttloads of sugar at any other time during this pregnancy -- and possibly during the rest of my life! -- except if I take this silly test. I guess I just don't understand. Refined sugar is just not a natural part of the human diet. The fact that such a large percentage of people can tolerate mass amounts of it at once seems extraordinary to me, and I don't think that example of the body's resilience should be set out as the 'norm' to achieve. I mean, over 95% of people can probably perform feats of super human strength under adrenaline-fueled emergency life-or-death situations (for instance, my not even 5' tall grandmother lifted a truck off my grandfather when it crashed on top of him in an accident) but I don't think that should be thought of as the norm and those individuals who can't perform to that standard labeled with a disease that needs to be managed.

Sheesh! I hope I can opt out of this test.
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Old 02-17-2009, 07:42 PM
 
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All I can say is YUCK!!!!

That test seriously made me feel so terrible for about 3 days. Even thinking about taking it again makes me want to puke. If I can opt out this time I am, I am going to tell my doc how wretched it made me feel. It gave me the worst stomach ache and headache for days.

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Old 02-17-2009, 07:44 PM - Thread Starter
 
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Originally Posted by Viola View Post
That way, they know your baby will be big, and they can go ahead and schedule the c-section right away--that's a tongue in cheek comment, but not necessarily a joke. I heard this several times in my first pregnancy. Even though I passed the first test (where I didn't fast before hand, but did sit quietly for an hour), I was borderline, and she did a fasting blood draw later, concerned I had GD. And she talked about a c-section and scheduled an induction.
Yeah, this is the thing I'm worried about. Like, the road to a c-section starts right here. Did you show up for the induction or have a c-section? How did it work out?
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Old 02-17-2009, 08:00 PM
 
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See, that's the thing I don't understand. Why are they purposefully taxing your system? What is the point? If I'm smart, I won't be exposed to buttloads of sugar at any other time during this pregnancy -- and possibly during the rest of my life! -- except if I take this silly test.
I don't know, but my thought is they see it as a either or type of thing. Either you have a medical condition that might require treatment, or you don't and they can cross it off the list of possible complications. It's possible that there have been mothers who weren't aware of it, didn't modify their diet at all and had problems. By diagnosing this condition, they can avoid that. Sometimes mothers do get gestational diabetes that is not controlled with diet and exercise, and need insulin. They might want to rule that out. It's kind of like a stress test you might get for your heart and lungs.

My OBs did not counsel me on diet or exercise during either pregnancy. It seems like the midwife has a better idea, to talk about things such as this, and also to monitor sugar in the urine, but doesn't see the point in stressing out the system for a medical diagnosis if there are no other indications. To me it seems about identifiying and diagnosing a possible pathology because it is something a medical doctor might want to know and that will affect the protocol s/he uses. I was considered a high risk patient and my insurance company was charged the high risk price, even though I had no complications and no special care. A lot of it seems to be more about classification for medical records, not necessarily about what is most useful to the patient/client. Not that it can't be a valid and useful test, I won't go that far, but I agree it just doesn't seem warranted most of the time.
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Old 02-17-2009, 08:02 PM
 
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Yeah, this is the thing I'm worried about. Like, the road to a c-section starts right here. Did you show up for the induction or have a c-section? How did it work out?
I cancelled my induction. She scheduled me for an induction at 40 weeks during my 28 week appointment. I only knew because when I went out to the desk, one of the women said my name and then said, "Oh, I just finished scheduling your induction?" I thought she was mistaken, but then later I realized the OB had scheduled it that far in advance. She didn't tell me until about 10 weeks later, when I was 38 or 39 weeks along. I called her the night before, and cancelled it, first asking if there was any medical reason, and she said no, it's just she thought I would have a big baby.

She also got concerned when I suddenly seemed huge to her, and sent me down for a fasting blood sugar draw. When that came out OK, it actually seemed to calm her mind. When I told her that I wanted to avoid induction because of increased c-section risk, she acknowledged the risk, but said that there would be no "heroics" no pushing for over 2 hours, no vacuum extraction. If I had any sign of problem, she would do a c-section. As you can imagine, I was not chomping at the bit to go in for an induction. I went into labor 4 days after my due date, and she wasn't on call so I got a different doctor who didn't seem to think pushing for over 2 hours was that big a deal. He also gave me oxygen when the baby's heart rate was not coming back with the end of contractions, and that seemed to help.

That was my first pregnancy. My second doctor didn't talk about c-section at all, but everyone I knew personally who used him, had one. He didn't palpate my uterus and tell me if I was breech or not, which my first OB did. She made sure I knew that I would have to have a c-section if my baby was breech, and the baby was breech for awhile, but I did stuff at home to help her to turn, and she did.
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Old 02-17-2009, 08:30 PM
 
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I had to take that test when I was pg with DS. It was flat out awful and probably the worst part of my entire pregnancy! Come to find out I was nowhere close to having GD, it's just that when they tested me intially, my blood sugar level spiked really high and then dropped very quickly. I've always had issues with low blood sugar - ever since I was a teenager! Duh, I could've told them that without sitting around for 4 hours not being able to eat or drink anything but water and have my blood taken. I HATE needles, too!!

I felt like hell for a couple of days afterwards. I couldn't even go back to work after I had the testing done. Too lightheaded and felt too yucky to work.
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Old 02-17-2009, 09:49 PM
 
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Old 02-17-2009, 10:02 PM
 
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All I know is that it's disgusting. It doesn't make me feel woozy or anything (I can actually ingest a horrifying amount of sugar before I start to feel icky. I've also been a sugar junkie, to varying degrees, since childhood. I'm not sure if there's a cause and effect there, or which way it goes.) It's just absolutely gross to drink. I like sweets. (When I was a receptionist, I once finished off a half pound box of chocolates by 5:00. They were given to me by a customer at 2:00.) That drink is just soooo vile.

They keep wanting me to be GD. I swear they do. I'm obese, and my last three babies were all over 10 pounds (dh and his brothers were all big, too). They have their hearts set on a GD diagnosis, but...there's never been any reason to suspect it. I think I'm going to skip the GD test this time. It's sooo awful, and it really doesn't seem very useful. I'm not into drinking all that sugar (when I'm trying so hard not to ingest large amounts of sugar while I'm pregnant!), and it's just one more time when I need to find a sitter for the kids, and more blood draws (I'm anemic, so the blood tests kind of annoy me), etc.

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Old 02-17-2009, 10:07 PM
 
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See, that's the thing I don't understand. Why are they purposefully taxing your system? What is the point? If I'm smart, I won't be exposed to buttloads of sugar at any other time during this pregnancy -- and possibly during the rest of my life! -- except if I take this silly test. I guess I just don't understand. Refined sugar is just not a natural part of the human diet. The fact that such a large percentage of people can tolerate mass amounts of it at once seems extraordinary to me, and I don't think that example of the body's resilience should be set out as the 'norm' to achieve. I mean, over 95% of people can probably perform feats of super human strength under adrenaline-fueled emergency life-or-death situations (for instance, my not even 5' tall grandmother lifted a truck off my grandfather when it crashed on top of him in an accident) but I don't think that should be thought of as the norm and those individuals who can't perform to that standard labeled with a disease that needs to be managed.

Sheesh! I hope I can opt out of this test.
So- the thing is, after I got that borderline bad result on my 3hrGTT, I started testing my blood sugar. I DO NOT eat boatloads of refined sugar. I honestly can't remember the last time I willingly drank a soda (other than the glucola). But- say I eat the equivalent of 1/4 dry steel-cut whole oats (unsweetened) with ground flaxmeal, 1/2 an unsweetened grapefruit and an egg. 1 hour later my blood sugar is WAY higher than what (they say) a normal pregnant person's would be. If I eat 1/2 a raw pepper, 1/4 of an orange, and an egg, I am on the line. If I have miso soup with bok choi and tofu served with 1/4 cup of cooked brown rice (that is a very tiny bit of rice, by the way, if you measure it), again, my BS is way above what its "supposed" to me.

I don't have a lot to go on with these levels- maybe they are really conservatively low and I shouldn't stress about it. But assuming its true that other people's bodies process that 1/4-cup of cooked brown rice without a 50-point rise in their blood sugar, I have to accept that my body (during this pregnancy, by the way, not the last, and not when I am not pregnant) is obviously really sensitized to sugar- to the sugars that my body makes out of the totally natural, unrefined carbohydrate molecules I am eating in the form of organic brown rice, fresh fruit, steel-cut oats, milk, things like that. Its not *caused* by my diet, but is caused by placental hormones interfering with my normal endocrine function. However, knowing this, I am really restricting my diet.

Of course, we could have found this out by blood glucose testing and skipping the whole glucola challenge. But the medical practice I am seeing for my co-care doesn't want to do that much testing (4 finger pricks every day for at least a week or so I'd guess) on all their patients. So they use the glucola. If your doc will accept self-testing and a diet diary to see what your blood sugars look like, I would definitely do that. Or, if you really don't think its an issue and they don't care about declining it, go ahead.

Frankly, for me I'd rather know so that I can modify my diet and do what I can to "take ownership" of this. Sometimes I wish I just didn't know. But I do. As long as things keep going well and my BS stays normal and I don't need meds, etc, I will forgo the size checks, NSTs, etc. I will not consent to induction, planned c-section. But, I know that is where the hospital-based care providers will go with this knowledge, unfortunately- its not really on my chart to empower ME and my self-care.

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Old 02-17-2009, 10:08 PM
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Besides the fact that the drink is disgusting, I have a mild case of hyperemesis and while things are much improved by 28 weeks, I do get nauseous when nothing is in my stomach, so the partial fast and then several hour wait for the blood test is painful to me. It's not the sugar that makes me queasy, it's just having an empty stomach. It's horrible. I'm never doing it again.

I have blood sugar on the lower side of normal every time anyway.
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Old 02-17-2009, 10:13 PM
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The test makes me feel horrible. With my first preg I had a 1hr test which was high, then a 3hr which was normal, then another 1hr which was normal. This time, I had a 1hr that was high, then a 3hr that was normal, then another 3hr that was borderline and now I'm stuck with a GD label and I am monitoring my blood sugar 4x per day and eating very carefully.

Every time I took that test I felt completely sick. If your OB will work out a different way to evaluate you, I would go for it.

But, I don't know if its really true that there are "lots" of symptoms of mild GD. The whole point of the 3HR test is that it shows whether your body is able to effectively manage the blood sugar levels *even when* they are excessive. I am not saying the test is a good thing, but they are intentionally taxing your endocrine system to see if it can handle the extra sugar load. Most people's can (like, 96% of pregnant women).

I didn't have any "symptoms" and I still don't. Symptoms of mild GD are things like: being thirsty (plenty of pregnant women are), having a larger-than-average baby (well, half of people do, right? average is just, well, average). I do have a lot of risk factors for developing GD, hence all the testing. The part I'm still unclear about is why the big high risk label if I am managing with diet- If my blood sugars stay at pretty much normal levels, whats the big deal? If only it was that simple- that the test would allow me to know I don't handle sugar/carbs well and can eliminate them from my diet. For some people, diet doesn't work, and I think that is a different situation, but once you have the label, many places treat you as one big disaster waiting to happen, and there is no differentiation between cases.

Luckily I am also seeing a HB MW who feels fine about me using diet for control and considering myself normal. What a relief.
Actually I said there are a lot of *signs* and symptoms of GD. One sign is a predisposition for it, which you have. According to the American Pregnancy Association, the signs and symptoms are:

* Sugar in urine (revealed in a test done in your doctor’s office)
* Unusual thirst
* Frequent urination
* Fatigue
* Nausea
* Frequent infections of bladder, vagina and skin
* Blurred vision

The main ones that I'd consider huge factors would be the sugar in the urine and a predisposition. It's not that I think the test shouldn't be done on anyone, it's that I think it shouldn't be done on EVERYONE.
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Old 02-18-2009, 03:47 AM
 
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Thanks Talula Fairie for clarifying what you meant. Yes, I have 2 risk factors (strong family history of TypeII diabetes and a mom who probably had GD with me). With my risk factors, I didn't think it was a good idea to decline it.

I have heard/read that people can also have no risk factors and can have none of the symptoms and still have GD, and the docs, as we know, like to cover their butts and err on the side of overtesting, not underdiagnosing. Seems they also often err on the side of overtreating and mistrusting women to manage their health and bodies, but thats also not specific to this condition.

I hate the test. Its unpleasant and clearly unrealistic for many of us. But, I can see why the medical establishment does it the way they do. I can also see why people decline it. If I have more babies (not planning more children, at least not biological ones, but it could happen right?) I think I would just skip the testing and go right to self-monitoring.

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Old 02-18-2009, 11:11 AM
 
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Gee, the test I took was so benign. It was essentially half a cup of cola and hardly tasted sweet to me. I don't like sugary drinks and I found myself worrying about it for nothing. I guess the type of drink varies?

Reading the comments here is what made me worry about taking the test so much. Then, when I actually took it... it was like nothing. I even had my husband taste it first because I was worried about how much sugar was in it and what I would feel like afterwards. It looked like Pepsi and tasted half as sweet. Very strange compared to the stories here...

Edit: And I was't told to have an empty stomach. Just not to eat sweets for breakfast.

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Old 02-18-2009, 03:07 PM
 
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Gee, the test I took was so benign. It was essentially half a cup of cola and hardly tasted sweet to me. I don't like sugary drinks and I found myself worrying about it for nothing. I guess the type of drink varies?

Reading the comments here is what made me worry about taking the test so much. Then, when I actually took it... it was like nothing. I even had my husband taste it first because I was worried about how much sugar was in it and what I would feel like afterwards. It looked like Pepsi and tasted half as sweet. Very strange compared to the stories here...

Edit: And I was't told to have an empty stomach. Just not to eat sweets for breakfast.
I guess you are lucky. The one-hour test I took was a bottle of gross orange-flavored soda stuff with 50g glucose. Nothing to eat and a blood draw (not finger prick) one hour later. Not pleasant but not *so* bad. The really bad test for me was the 3hr test (which I've taken several times) requires at least an 8hr fast ahead of time, is the same SIZE bottle of soda but 2x the sugar and you have to drink it in under 5 minutes with the lab tech watching you, and then you stick around for 3 more hours and can't eat until the whole thing is over (total fast then is minimum of 11 hours, which is really particularly unpleasant as a pregnant woman in my opinion). You have 4 blood draws- immediately before drinking the drink, and then at 1hr, 2hr, and 3hr.

(oh, and I actually hate soda, most especially orange soda, so having to down a bottle of soda in 5 minutes is gross to me regardless of the circumstances- but the super-super sweet one in the middle of an 11-hour fast is honestly for me disgusting. And I do feel sick for the whole time and usually most of the afternoon as well).

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Old 02-18-2009, 03:53 PM
 
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The one-hour test I took was a bottle of gross orange-flavored soda stuff with 50g glucose. Nothing to eat and a blood draw (not finger prick) one hour later.
That's the test I've done (don't know how much glucose is in it, but that's probably right), and it's gross. The 3 hour would probably drive me crazy. I also tend to get a little lightheaded if I go too long without eating when I'm pregnant (or not pregnant, for that matter). It doesn't have to be much - even a small handful of walnuts or something - but I can't imagine going 11 hours with only that gross drink...

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Old 02-18-2009, 04:23 PM
 
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When it comes down to it, the 1-hr challenge is not a scientifically sound test. (read Goer's chapter in Thinking Woman's Guide, or either or both of her articles linked on her website (www.hencigoer.com)).

With this pregnancy, I "failed" the 1-hr and ended up taking the 3-hr. Both experiences were horrid.

If the OB you're seeing now is not open to alternative protocols (there are options besides the artifical glucola drink, discuss just how much fasting they want you to do (and don't fast TOO much!), or see if you can do a series of finger-prick testing at home) then the other thing I advise is to take the 1hr as early in the 'testing window' as possible. Something "they" don't tell pregnant women (and I think also many doctors don't realize) is that baseline blood sugar levels rise normally over the course of pregnancy. So you may easily pass at 24 weeks but be closer (or over) the threshold at 28 weeks.
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