If you have no risk factors and you can "spot check" your blood glucose levels some to make sure you are staying within normal limits (and if you test yourself after typical meals, not that day when you ate just a salad for dinner, yk?), there is probably no risk in skipping it. But I have a pretty different feeling about GD than most people on MDC, maybe because I come from a family with a strong history of Type II diabetes, so the disease seems pretty "real" to me and I reject this idea that diabetics are somehow to blame for having it.
I tested. I have 2 big risk factors (strong family history, suspected GD of my mom with me). I was totally normal with my first pregnancy. I was totally normal at 20 weeks with this pregnancy. I was borderline GD at 28 weeks- some practices wouldn't have classified me, but the one I am going to for "shadow care" for my HB did. I *DO NOT* eat lots of sweets or refined foods, and anyway, truly, GD is not caused by diet. Plenty of people drink soda-pop and eat crap food and don't have any sort of diabetes. I mean, I am sure the diet isn't good for them, but their body quickly eliminates the excess sugar from their bloodstream. GD is a form of temporary insulin resistance that is caused by the effect of the placenta's hormones on the mother's system, and probably affects some of us b/c of our genetic predisposition to poor insulin function. Yes, a lot of "GD" cases are actually undiagnosed, pre-existing type II diabetes, but I know for sure mine isn't. Also, if you look over at the GD support thread you can see that many of the moms posting there did not have GD with prior pregnancies.
It CAN be asymptomatic, and people with no risk factors can have it. The benefit of knowing, even if you are borderline, is that for most of us, we can monitor and modify our diets to keep your blood sugar levels even and normal (if you can't, and your blood sugars are that high, there IS pretty good evidence that its harmful for the fetus, though I agree that the issue of at what levels to start medicating seems really nonstandardized and based on a particular practice's comfort levels).
For me, just so you get an idea, that has meant entirely cutting out not just sweets (and I mean ALL sweets, absolutely ALL of them) but almost all grains (not just refined grains), starchy vegetables, juices, and eating fruits in very careful portions. After testing my own blood sugar levels, I found out that I can't eat things I think of as very healthy: unsweetened steel cut oats, or brown rice (even 1/4c cooked is too much), or home-made whole-grain buttermilk pancakes, or oven-roasted potatoes, etc, and stay within normal limits. I've also been exercising twice a day (well, now that I am almost 38 weeks I am slowing down a lot, its just getting too hard). With all this, my blood sugar has been totally normal, and so, yes, its very annoying to have a "high risk" label despite the effective self-care I've done. I am *very* glad I am planning a HB, because I wouldn't want to be in the hospital as a "high risk" patient. However at the hospital I would have gone to, refusing the test would have automatically put me in that category.
I am very glad I've had the opportunity to know that my body wasn't processing glucose well (glucose in whatever form my body was getting it from my whole-foods based, healthy vegetarian diet), and to take charge and modify my diet to keep things normal. As I understand it, all other debated risks aside (which I am sure correlate pretty much to the actual blood sugar levels that we're talking about, which, yes, vary a lot from case to case and aren't differentiated when they run down the "risks"), there is actually pretty good evidence that exposure to hyper- OR hypoglycemia as a fetus DOES put the baby at a significantly elevated risk for developing type II diabetes later in life, and for that reason alone I am happy to test myself 4x per day and eat carefully. (As well as avoiding the potential damage to my own endocrine system of even two months of trying to handle high blood sugar or big swings in blood sugar, which is something I've not read but which makes sense to me from what I know about how type II diabetes develops).
There are other ways to test than the glucola, like jelly beans, or eating a special carb-loaded meal, etc. If your health care practitioner will agree to that, I'd go for it. The glucola is gross. I literally never drink soda, and this seems grosser than regular soda to me. On the other hand- the nutritionist at the medical practice I've been seeing assures me that people FREQUENTLY have 50g or even 100g of carbs at a meal. So, while the delivery method is hopefully not the least bit typical (though its not any different nutritionally than drinking a can of soda, which sure, personally I don't but plenty of people do), the AMOUNT of carbohydrates is not actually that large.
Anyway, just my $.02. Sorry to write a novel about GD, but personally I think its too easy to write it off entirely- just like its too easy to just "go with the flow" and not question the docs about their protocols and reasoning. I wish having tested didn't mean I was stuck with a "label" but in the end I am glad to know rather than not to.