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#1 of 16 Old 12-05-2014, 08:05 PM - Thread Starter
 
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Glucose test

Has everyone done their glucose test (or alternative blood sugar check) by now? The last week has been a bit crazy for me since I did the one hour glucose test last Friday and got the results Monday morning. I failed big time with 183. Passing would be 140 or below. I went into the test with anxiety about passing since I have been measuring ahead for my last 2 appointments, and the baby's weight and abdominal circumference were in the high 90's percentile at my 21 week ultrasound. The midwife was not concerned about the big measurements alone, but wanted to see the glucose results to complete the picture.

My mom is a dietitian and diabetes educator, so I talked to her about the test and made sure what I ate the day before (which was Thanksgiving) as well as breakfast the day of would not have any effect on my results. She also told me that a lot of pregnant patients she sees are referred after failing the one hour test with such high results that the doctors think it's too much of a risk to the baby to do the 3 hour test, which is twice the amount of glucose. Before even getting my test results, I had decided that I was going to refuse the 3 hour test if I failed the 1 hour. When I called to talk to the nurse and explain that I didn't want to do the 3 hour test and would prefer to just move right to self monitoring and diet, she said, "Oh good, you were only 2 points away from our 185 cutoff for an automatic gestational diabetes diagnosis." So I got set up with a class on GD, a referral to an endocrinologist, and an order for blood sugar monitoring supplies.

I've been really grateful to have my mom as a resource through this. My results were posted online early Monday morning before I woke up, and by the time I got to work a few hours later, I was already set up with and implementing a GD diet and exercise plan. I didn't get my testing supplies until Tuesday night, but had been following the diet strictly to that point. I have been testing at least 4 times daily, and have not seen a single number outside of normal.

So I thought this diet must be working great for me to control my blood sugar, but at the same time I have this feeling that the glucose test was some kind of weird fluke (processed nasty 50g of straight sugar, which is unlike nothing I eat/drink in real life). Yesterday I started pushing the limits a bit. I had a pasta dish for lunch that was probably 1.5-2 times my carb limit. Perfect blood sugar readings afterwards. My snack before bed last time was a little pumpkin pie ice cream mochi. Again, perfect blood sugar an hour later. Tonight I decided to really push it. It's my husband's birthday and he wanted his favorite pizza. While pizza is allowed on the GD diet, just in limited portions, I did not limit how much I had tonight - salad, pizza and wings. I tested 1 and 2 hours later - both perfectly normal. Since that was all good, I went ahead and ate a piece of the birthday ice cream cake and will test to see how that affects me. (This is not how I normally eat! But in the interest of it being a special occasion and performing scientific experiments, I am indulging.)

We also had a growth scan this morning. Baby is measuring about one week ahead, which I don't think is bad at all. Estimated weight was 3.5 lbs, +/- 0.5 lbs. One site online said that's 97th percentile or so, but multiple other charts said that's 61st percentile for 29 weeks. Even if baby grows half a pound per week for the next 11 weeks, that's only 9 lbs. The midwife told me 10 lbs is when they start considering c-sections, so my biggest fear is getting to that point or being talked into an early induction because the baby is too big. I feel pretty confident I can control my blood sugar through monitoring, diet and exercise (although I'm not convinced I truly have an issue in the first place), and therefore keep baby's weight in check. I'm also hoping they didn't give me the official GD diagnosis since technically I didn't fail the diagnostic test. What I'm doing now is way more educational and beneficial to me anyway, to understand how I handle real food on a nearly real-time basis.

How did everyone else do with the glucose testing? Or did you skip it / do an alternate test?
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#2 of 16 Old 12-05-2014, 09:00 PM
 
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That's strange and would make me a little skeptical too. If your blood sugar is fine then I wouldnt really worry about it too much but I don't know much about GD. I took my glucose test on Tuesday and haven't heard anything from my midwife so I guess that's a good sign that things are normal?
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#3 of 16 Old 12-05-2014, 09:30 PM - Thread Starter
 
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I would guess you're fine too, Bren. I go crazy not seeing my test results for myself though.

My blood sugar after the cake was within normal at both 1 hour and 2 hours after. So, wtf glucose test? I found posts from a couple years ago here on MDC where one person said she did fine with every day real food, but if she ate processed sugar crap or candy, her blood sugar went crazy. I must have had something similar going on with the glucose drink. Some day I may decide to try a big glass of orange juice or a coke and see what happens, but for now I'm much less worried about being super strict with the GD diet guidelines. It's actually pretty manageable and I'm sure I will continue to follow it for the most part, but won't stress too much about it as long as my blood sugar numbers stay good.
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#4 of 16 Old 12-06-2014, 03:30 AM
 
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I always skip the GTT and just use a glucometer at home (my dad had an extra, since he's type 2 diabetic). My doctor told me to start checking after 26 weeks. Well, at 24 weeks, I spilled 4+ glucose in my urine after eating Wendy's cheeseburger and fries before my appointment. The thing is... I have spilled glucose EVERY pregnancy, and blood sugar has always been fine. So doctor told me to go ahead and test. I brought in numbers at my 26 week appointment, and they were great. One of my fasting numbers was almost hypoglycemic. Two hours after Papa Murphy's pizza and cheesy bread (two slices of each), it was 77! I had that Wendy's meal again, this time eating a little more fries, and it was 114. So with all that, doctor said, "You passed."

Note that all of my babies have measured two weeks ahead, but I just deliver early. I had one come at 29w4d, weighing 3lb 13oz. My two "term" babies both came 36w6d (separate pregnancies), weighing 7lb 4oz and 7lb 8oz, respectively. The first "term" baby measured 22 weeks on the 20 week u/s (and a dating u/s around 7-8 weeks had confirmed my charting based date, so my dates were accurate). I just grow my babies quickly and deliver them a few weeks early. They act like normal newborns in every way. Nothing premature about them (the "term" ones, not that first one - he acted more like a 31-32 weeker size that he was). So don't let big baby thoughts scare you. And why would a c/s be required for over 10 lbs? A local woman had a 12 lb baby at home several years back. Her midwife was present but on the other side of the room. She had no problem delivering him, and he really did look like a 3 month old! It was funny sticking my preemie next to her giant, as they were born the same month.

Anyway, if your fasting numbers are also good, I'd take a couple weeks worth of numbers in to your doctor and say you don't have GD, but you'll be happy to avoid drinking drinks containing high amounts of glucose with no protein or fat in sight.
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#5 of 16 Old 12-06-2014, 05:07 AM
 
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You all might find this interesting, written by Henci Goer -

http://www.drmomma.org/2010/06/gesta...as-no.html?m=1


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#6 of 16 Old 12-06-2014, 06:25 AM
 
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The facts in the article @luckiest posted are the exact reason why I skip the GTT.

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#7 of 16 Old 12-06-2014, 06:47 AM
 
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From a general wellness standpoint, I think everyone should be following a diet that limits blood sugar surges, pregnant or not. It's a major stress on the body, too many consequences to name. Most of us don't eat a diet rich enough in micronutrients to support refined sugar consumption, period. I think the GTT is silly, but regulating your blood sugar isn't. But yeah, managing "gestational diabetes" based on a single GTT reading is not evidence based medicine.

Anywho, I don't mind the approach of my midwives, which is to test two hours after eating a "carby" breakfast. That way they have something in your chart about it, but without the glucola. I also like when practitioners just have you use a glucometer for a week or so. GD or not, erratic blood sugar warrants dietary intervention.




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#8 of 16 Old 12-06-2014, 08:43 AM
 
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I've heard a lot of people "fail" the Glucola version of the test but don't actually have any real health issues. My midwife offered me the option of coming in to have a fasting blood draw first thing in the morning, then go out and eat a high sugar breakfast (I ate a veggie omelet for actual nutrition, plus a cinnamon roll and orange juice for the sugar) and then come back two hours later for another blood draw. It's supposed to be a much more accurate way of seeing how your body reacts to actual food, instead of whatever kind of junk is in the Glucola drink. My results after breakfast was 137, which is just three points away from potentially retesting, but my midwife was not concerned, since my usual diet is pretty healthy and everything else with the pregnancy seems to be going well. My only complaint was that, as yummy as that cinnamon roll was, that was waaaay more sugar than I normally have (especially first thing in the morning on an empty stomach) and I spent the rest of the day in a sugar crash.
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#9 of 16 Old 12-08-2014, 02:52 PM - Thread Starter
 
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Quote:
Originally Posted by boscopup View Post
So don't let big baby thoughts scare you. And why would a c/s be required for over 10 lbs?
I am not personally scared of a big baby, but I am giving birth in a hospital and therefore subject to hospital policies. At my last midwife appointment when we were talking about baby being bigger and the possibility of GD, she mentioned more risk of c-sections with gestational diabetes. So I asked what are the factors that would lead to a c-section. 10+ lb baby was one of the reasons. Now, I don't know if it's automatic, or difficulty in labor due to the large baby, but I am certainly going to argue against it if the baby measures that big towards the end and they try to push c/s. She also talked about shoulder dystocia with a larger baby (and in particular babies with a larger abdomen than head, which is my baby's measurements).

I didn't really know anything about that at the time, but coincidentally, my reading material during the glucose test was Ina May's Guide to Childbirth, and specifically the section of birth stories about large babies and shoulder dystocia. I went home and told my husband about what I read, and told him to internalize that if I have any difficulty in getting the baby's body out that I need to go to all fours. I'm sure the midwife knows all of these things, but I think she is just bound by hospital rules. On more than on occasion, she has told me something and said, "Because I have chosen to work for this hospital, I am supposed to tell you this...." My next appointment is next Friday with a different midwife, so I'll talk to her about all this stuff again, now that I know more and understand what my body is doing blood sugar-wise.
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#10 of 16 Old 12-08-2014, 05:55 PM
 
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Interestingly, most cases of shoulder dyscotia happen in babies smaller than 10 lbs. That article posted by luckiest had some interesting insight on that. I am also wondering how all of these "10lb+" babies are being "diagnosed." Ultrasound, at full term can be off a full couple of pounds (margin of error is +/- 2 lbs)! So, a c/s because of u/s estimates is not a good reason in my mind. I have had quite a few clients diagnosed with babies that would be "so big" end up with itty bitties! :/

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#11 of 16 Old 12-08-2014, 06:13 PM
 
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Yeah. My friend's u/s put her baby over 9lbs and she measured 2 wks ahead and her ended up having a 7 lb baby

Sarah- sahm to a little boy and girl with a third blessing due in Feb.
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#12 of 16 Old 12-08-2014, 07:53 PM - Thread Starter
 
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I've read a bunch of those stories too (ultrasound says baby is huge and comes out normal size), which is I why I'm hoping to avoid the situation completely of anyone thinking the baby is "too big for a natural birth" and I end up with unnecessary interventions. I looked at my ultrasound printouts again, and think I found where they note the percentile of estimated weight. If that's what the number is, baby is at 89 now and was at 95 at the 21 week ultrasound.
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#13 of 16 Old 12-09-2014, 07:10 AM
 
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Quote:
Originally Posted by jodieanneanton View Post
Interestingly, most cases of shoulder dyscotia happen in babies smaller than 10 lbs. That article posted by luckiest had some interesting insight on that. I am also wondering how all of these "10lb+" babies are being "diagnosed." Ultrasound, at full term can be off a full couple of pounds (margin of error is +/- 2 lbs)! So, a c/s because of u/s estimates is not a good reason in my mind. I have had quite a few clients diagnosed with babies that would be "so big" end up with itty bitties! :/
I see and hear stories of this all the time. It is very sad.
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#14 of 16 Old 12-09-2014, 07:31 AM
 
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Yeah, I had a friend with a supposed 9+ lb baby on u/s, so they did a c/s. Baby was 6 lb 8 oz!
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#15 of 16 Old 12-09-2014, 08:02 AM
 
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DDC-crashing from the March thread.

I'm scheduled to take my glucose test next week. I've refused it the last 2 pregnancies (failed the screen my first pregnancy, and then did fine on the 3 hr. fasting one afterwards), and was ready to refuse it again, mostly because I wasn't about to be convinced of an early delivery for macrosomia, no matter what dx they give me. Also because I'm fairly low risk. But, my OB nurse (who's a Doctor of nursing & is really great) talked me into it this time by talking about the reasons it will change the care the baby receives after the birth, if there is a diabetes dx.

As for macrosomia & "automatic" c-sections, there has been recent evidence that that link is much weaker than previously thought. Plus, they can't force you to have a c-section. Coerce, yes, but force, no. I copied a couple of pubmed-linked articles (just the conclusions for brevity, but you can look them up) about glucose/insulin and birthweight below. Hope that helps.

J Reprod Med. 2014 May-Jun;59(5-6):293-8.
Third trimester insulin levels are not correlated with fetal macrosomia or delivery complications.

Ali MM, Brown M, Karnitis VJ.
CONCLUSION:

Our data indicates that neither insulin nor glucose levels are predictive of fetal macrosomia, low Apgar scores, or birth injuries.

Another one:
BMC Pregnancy Childbirth. 2014 May 1;14:156. doi: 10.1186/1471-2393-14-156.
Does induction of labor for constitutionally large-for-gestational-age fetuses identified in utero reduce maternal morbidity?

Vendittelli F1, Rivière O, Neveu B, Lémery D; Audipog Sentinel Network.

CONCLUSIONS:

A policy of induction of labor for women with a constitutionally large-for-gestational-age fetus among women without diabetes does not reduce maternal morbidity.

And finally,
Am J Obstet Gynecol. 2000 Nov;183(5):1296-300.
Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery.

Gonen R1, Bader D, Ajami M.

RESULTS:

During the 4 years of the study 16,416 deliveries resulted in 133 infants with macrosomia (0.8%). Macrosomia was suspected in 47 cases and confirmed by birth weight in 21 (45%). Antenatal estimation of fetal weight was carried out for 115 of the fetuses with macrosomia (86%). Macrosomia was correctly predicted in 21 of 115 cases (18.3%). Thirteen infants with undiagnosed macrosomia were delivered by emergency cesarean procedures, and 99 were delivered vaginally. Three infants with macrosomia (3%) and 14 infants without macrosomia (0.1%) sustained brachial plexus injury. Our policy prevented at most a single case of brachial palsy, and it contributed 0.16% to our cesarean delivery rate.
CONCLUSIONS:

A policy of elective cesarean delivery in cases of suspected fetal macrosomia had an insignificant effect on the incidence of brachial plexus injury. Its contribution to the rate of cesarean delivery was also small.

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#16 of 16 Old 12-09-2014, 09:39 AM
 
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I also think c/s because of suspected big baby is ridiculous and infuriating.

But... I understand the pressure of hospital protocol. I'm a hospital birther too and I know how hard they can make things for moms. You can always look for a new OB, but that's much easier said than done that late in the game. You can present facts and stats and all that, but... in the end... you will be left with 2 options: do the c-section, or leave the practice and go it alone. The hospital CAN call CPS or some other similar agency and report you. It's happened. They CAN get a court order. How often does that actually happen? I don't know. It's not something I would be willing be to go through. I hate to say it, but if I couldn't find another OB to take me, and I couldn't change my OB's mind, I would cave and have the c/s. Is it right and fair? No. But that would be the better option, in my mind. I'd make the best of it. I wouldn't return to that practice or hospital for future pregnancies.

The birthing industry in this country is awful

Hoping for the best for you, Sarah!

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