Self blood glucose monitoring instead of 3 hr GTT - Mothering Forums

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#1 of 14 Old 07-10-2012, 09:06 AM - Thread Starter
 
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I declined the 3 hr GTT and instead monitored my blood glucose for a week +. I am about to go back to my provider with my results, and I want to be prepared. How will the results be evaluated? What will my provider look for to determine if next steps are necessary?  


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#2 of 14 Old 07-10-2012, 05:26 PM
 
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i guess it would really depend on who your care provider is and their thoughts on gestational diabetes. did you take the 2 hour glucose challenge test? i'm wondering why you decided to monitor your blood glucose. unfortunately i'm not familiar with using that method of screening, or is it considered a random or fasting blood glucose level?


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#3 of 14 Old 07-10-2012, 05:35 PM - Thread Starter
 
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I monitored fasting plus 2 hours post prandial for all 3 meals after failing the 1 hour screening. I am uncomfortable taking the 3hour because of how it has affected me in the past. I know there are a lot of MWs out there who do this as a substitute. I just was curious as to what they use as their evaluative criteria when reviewing the results so that I know what to expect from the discussion.


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#4 of 14 Old 07-10-2012, 06:15 PM
 
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interesting. something new for me to look into, i haven't seen this strangely enough, so maybe there isn't much research into it, although the whole gestational diabetes topic is pretty controversial with no clear answers. if i come across anything useful i will let you know!


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#5 of 14 Old 07-10-2012, 06:22 PM
 
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I don't know how your care provider will evaluate your readings as home glucose monitoring is not sensitive enough to diagnose GD. Did they suggest home monitoring as a reasonable alternative to the GTT?

There is another thread about this at the moment where the OP was considering not having a GTT and just behaving as though she had GD - following a diabetic diet and monitoring BSLs four times a day. IMO this required a commitment that most people, myself included, will not have so you'd need to consider whether you can do it, knowing that it may not be necessary, for the whole pregnancy. The other thing to ask your HCP is whether they are prepared to prescribe medication, should it be needed, without a GTT ever having been done.

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#6 of 14 Old 07-10-2012, 06:47 PM - Thread Starter
 
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Thanks, mandi!

 

katelove, I suggested it, and my OB acquiesced. She instructed me to eat normally for a week (no GD diet) and monitor to see if I am having glucose tolerance issues. Once she reviews a week's worth of data, then we'll determine if there is a need for further action. If my whole week's worth of numbers had been fine, then that would be the end of it. However, I have had some numbers that were a bit out of line, so I am not sure what our next steps will be, whether she will push for a 3 hour or just refer me to the GD clinic.

 

Regardless, the prescription of insulin, etc, is based on the results of self monitoring, is it not? They don't go straight to insulin if one is able to control blood sugar with diet/exercise, right? And that is determined through monitoring daily at home and reporting in to the case nurse, as far as I am aware, at least where I am located. The test allows a box to be checked, but it really does little toward practical management of GD.


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#7 of 14 Old 07-10-2012, 07:04 PM
 
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I had such a bad reaction to the 3 hour I would really never want to take it again in subsequent pregnancies, but I don't now how flexible my doc would be, plus I have family history of type II. She's usually awesome it's just "protocol" and I saw in another thread that insurance companies would require the 3 hour test to diagnose GD and cover treatment. Ugh.

Good luck! I am glad you didn't have to take that gross 3 hour test. Did you have risk factors or do you think she agreed because you didn't?



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#8 of 14 Old 07-10-2012, 07:13 PM - Thread Starter
 
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Frankly, I think we both were assuming that I would show nothing on the monitoring and it would be a non-issue. This is my 4th pregnancy, and it's the 3rd time I've either failed or barely passed the 1 hour, but I have never had GD (passed the 3 hour easily the first time, had a borderline number on the 1 hour the 2nd and was not referred), and I did not fail the 1 hour by much at all. I do have risk factors including LGA babies and AMA, and I have two family members with type II on my paternal side.

 

The insurance angle is interesting. I am curious if that is factual or not.


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#9 of 14 Old 07-12-2012, 05:55 PM
 
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Presumably she'd be looking for your fasting to be below 90-95 (though this number has been lowered in the last year and there is some debate about it), and your 2 hour post prandial to be below 120.  For your own information, you might also consider checking out your one hour post prandials.  I've been monitoring for the last couple of weeks and have found that while my 2 hour is always good, once or twice when I had something junky (like ice cream and cake at a birthday party) it jumped up to 160 which I was concerned about.  Good luck with whatever you decide!
 

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#10 of 14 Old 07-12-2012, 06:11 PM - Thread Starter
 
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Quote:
Originally Posted by azohri View Post

Presumably she'd be looking for your fasting to be below 90-95 (though this number has been lowered in the last year and there is some debate about it), and your 2 hour post prandial to be below 120.  For your own information, you might also consider checking out your one hour post prandials.  I've been monitoring for the last couple of weeks and have found that while my 2 hour is always good, once or twice when I had something junky (like ice cream and cake at a birthday party) it jumped up to 160 which I was concerned about.  Good luck with whatever you decide!
 

Thank you!  

 

My results were evaluated much as you mention above. While I had a few outliers, my OB was so incredibly reasonable and instructed me to monitor intermittently and change up my food choices (they all were post-breakfast) to keep them in line. She said that nothing she saw merited a referral since the bulk of my numbers were low, and the only thing a specialist would do anyway is recommend diet changes and continued monitoring. I was relieved that her thinking was so in line with mine! Now to find an easy alternative to cereal....


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#11 of 14 Old 07-13-2012, 11:12 AM
 
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glad it turned out okay!

 

so i have been checking the guidelines/research and have found that it is not recommended to check fasting and postprandial blood glucose levels as a way of screening for gestational diabetes because it is not accurate. it is however recommended after a diagnosis of gestational diabetes. i'm going to keep looking!


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#12 of 14 Old 07-13-2012, 11:24 AM - Thread Starter
 
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Right. I had already failed the 1 hour, so it was more like skipping forward, assuming I would fail the 3 hour test as well. Since initial treatment would require daily self-monitoring, then that is the direction we chose. Keeping to the guidelines provided by the ADA, since I seem to have some glucose tolerance issues in the morning, I will "treat" them by continuing to monitor and changing up my food choices. Same thing I would do if I failed the 3 hour GTT. One could argue that had I taken the 3 hour GTT and passed (as was statistically likely), I would be less aware of my situation and therefore more likely to experience some sort of complication.

 

I really find the whole thing interesting. If you fail the 1 hour test, obviously you tolerate a bolus of glucose is a way that is outside the "norm". But if you then pass the 3 hour test, somehow you are completely normal again, even if you have a number out of line on that test as well! I'd argue that regulating your blood sugar levels on a day-to-day basis is a much more responsible choice.


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#13 of 14 Old 07-13-2012, 02:21 PM
 
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^^^The 1-hour is a screening test, not a diagnostic test. It is designed to find people who MAY be a problem, so that further testing (i.e. the 3 hour) can be done, but has a lot of false positives. The 3-hour test is considered diagnostic. This isn't entirely uncommon in medicine. Getting your blood pressure checked is another example--if you have a high reading, more readings are done to determine if you warrant a diagnosis of high blood pressure. Getting your blood sugar tested by a nurse at a health fair is a screening test for diabetes, but it doesn't diagnose you. Etc. I'm not a particular fan of the OGTT myself and declined it too, but I did want to explain this general principle to clear up any confusion. 

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#14 of 14 Old 07-13-2012, 05:37 PM - Thread Starter
 
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Thanks for the clarification; I completely understood that in my decision-making but not everyone may. The ONLY reason to take the 3 hour OGTT is to get a formal diagnosis, IMHO. It really serves no purpose in management of glucose tolerance issues. It's also entirely possible to fail the 3 hour OGTT and then have no blood sugar issues for the remainder of your pregnancy as indicated by self-monitoring. Rare but certainly possible. Which is why I felt it unnecessary and went the direction I did instead. I think it IS important for anyone deciding on a course of action regarding the OGTT screening and potential blood sugar regulation issues to understand what the tests will and won't do and how that will or won't impact the rest of their pregnancy. For me, I was more concerned with identifying day-to-day issues and rectifying them than taking a diagnostic test and buying myself a label regardless of how it truly impacted the health of my pregnancy.


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