No glucose test?

brookey79 · August 2014

At my last appointment the doctor (who was filling in while mine was on vacation) mentioned that we would be discussing at my next appointment whether I needed a glucose test or not. Supposedly, the doctors in the group I go to believe that it is an overprescribed test that not everyone needs. I was under the impression that it was a standard test that everyone got. Did anyone not/ or is not planning to take a glucose test? I'd just like a little more information before I have the discussion with my doctor at the next appointment.

NELSMD · August 2014

I just asked this at my most recent appointment. My doc said, for expectant mothers in their practice, it's mandatory. Maybe it's different in different practices...

[Deleted User] · August 2014

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marriedinaugust · August 2014

It was mandatory at my last OB but we haven't talked about it with our midwives yet.

ColeyCannoli · August 2014

Strange.. I guess each practice is different but it was definitely mandatory for both the OB and the midwife I went to. Interesting.

soulcupcake · August 2014

OP, your doctor's practice is right, and the evidence does not support routine testing.

I did a typical postprandial (1-2 hour) test via glucometer with #3, and did the same over a course of a few days with #4. I ate what constitutes a normal meal for me as it provides a more accurate representation of how my body metabolizes glucose.

My midwife allows her clients to choose whether they want to test for impaired glucose tolerance (not the same as diabetes, nor is "GD"), and what method they wish to use, A1C or test at home.

ETA: I'll return with the current research and data after finishing this episode of House.

path75 · August 2014

I actually had an early glucose test but I have a history of diabetes in my family and I am overweight so I don't know if that matters. I never knew anyone to not have it but I guess as long as there is no history you should be fine. I have to take another test I think at 26 weeks.

allfalldown14 · August 2014

I really hope I don't have to take this test because I have hypoglycemia and I'm terrified of what will happen when I drink that sugary drink. I'll be talking to my ob about it on Monday.

Kmm1023 · August 2014

How many weeks along do they want them done?

taylojade57 · August 2014

allfalldown14 said:
I really hope I don't have to take this test because I have hypoglycemia and I'm terrified of what will happen when I drink that sugary drink. I'll be talking to my ob about it on Monday.

I would definitely talk to your doc. I'm not having the standard drink, simply because I don't want to drink something with BVO in it. The med student tried to talk me into it (because it's easier for him), but I didn't back down. When I talked to the midwife she completely supported my decision. Instead, I will go in first thing and have my blood drawn, then go eat breakfast, then go back two hours later and have my blood drawn again. There ARE other options than the drink, you just have to stand your ground.

PDXLaurenS · August 2014

Kmm1023 said:
How many weeks along do they want them done?

My doc yesterday said they want it between 24 and 26 weeks but I know some practices it is more like 28 weeks.

allfalldown14 · August 2014

taylojade57 said:

I really hope I don't have to take this test because I have hypoglycemia and I'm terrified of what will happen when I drink that sugary drink. I'll be talking to my ob about it on Monday.
I would definitely talk to your doc. I'm not having the standard drink, simply because I don't want to drink something with BVO in it. The med student tried to talk me into it (because it's easier for him), but I didn't back down. When I talked to the midwife she completely supported my decision. Instead, I will go in first thing and have my blood drawn, then go eat breakfast, then go back two hours later and have my blood drawn again. There ARE other options than the drink, you just have to stand your ground.

Thanks for the encouragement. I'm planning on pushing hard for a different test than the standard because I don't ever eat/drink more than 6-8 grams of sugar WITH a meal so I know I would for sure pass out with the glucose drink.

SerenityAE · August 2014

My OB mentioned it last appointment but hasn't scheduled the test. My next appointment is on Tuesday I suspect he will try to bring it up again then. (I'll be right at 23 weeks)

I am going to refuse it if at all possible or talk alternative methods with him because I'm borderline hypoglycemic and I cant do the fasting/drinking sugar water.

soulcupcake · August 2014

@brookey79 - Here's some info on routine testing for "GD." This is likely the basis for their protocol:

Marsden Wagner was a world renown perinatologist and perinatal epidemiologist. He was the WHO director for Women's and Children's Health.

Creating Your Birth Plan

And in his Born in the USA

Obstetric practices that should not be done:

"Screening for 'Gestational Diabetes,'" the authors put gestational diabetes in quotation marks because there's no such thing as gestational diabetes. It is an invention of obstetricians that describes an elevated glucose level in the blood, a level that is normal in pregnancy and without complications.

Henci Goer's articles can be found here.

And here.

Current research and data can be found in this book (this is a medical publication and the "bible" for evidence-based maternity care, well, it's supposed to be)

Chapter 11:

"BACKGROUND: Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects between 3 and 6% of all pregnancies and both have been associated with pregnancy complications. A lack of conclusive evidence has led clinicians to equate the risk of adverse perinatal outcome with pre-existing diabetes. Consequently, women are often intensively managed with increased obstetric monitoring, dietary regulation, and in some cases insulin therapy. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of gestational diabetes and IGT will improve perinatal outcome.

REVIEWER'S CONCLUSIONS: There are insufficient data for any reliable conclusions about the effects of treatments for impaired glucose tolerance on perinatal outcome."

Obstetric Myths vs. Research Realities

Source

Review of Current Literature and Guidelines

PubMed

Annals

Kmm1023 · August 2014

PDXLaurenS said:

Kmm1023 said:
How many weeks along do they want them done?
My doc yesterday said they want it between 24 and 26 weeks but I know some practices it is more like 28 weeks.

Thanks! I could have googled but I was lazy!

aeseager · August 2014

I had an appointment today at 24 weeks, that had me schedule the 1 hour test for my next appointment at 28 weeks. They made it seem as though everyone had to do it.

JesseCingel · August 2014

No test is mandatory. If all of your ruined have been free of protein and your glucose has been within normal limits, discuss with your provider the risks and benefits of having the test. I had midwifery care with my first and current pregnancy and I opted out.

JesseCingel · August 2014

That is supposed to say urines, as in urine tests, not ruined

brookey79 · August 2014

@aeonlux - Thank you for this information! I had googled it myself and couldn't seem to find much. I will feel much more informed at my next appointment. It sounds like this is the research my doctor's practice is following, so it is nice to have it ahead of time. I guess it will still depend on my risk factors which I'm sure is what we will be discussing at the appointment.

ecopen · August 2014

There are no symptoms for gestational diabetes, and it's important to know if you have it or not. Even if you're a totally healthy person you could have it. I'd get tested just in case unless there is some type of insurance/financial issue blocking your path.

nextworldwonder · August 2014

My midwife sent the drink home with me. When I go back in at 28 weeks I'm supposed to drink it an hour before coming in. That will keep my appointment time down to regular size. I was super stoked about not having to spend all morning there!

JCM285 · August 2014

It might just be me, but I would feel better taking the test. I got the glucose solution at my last appointment and I'm taking it on Sept. 3 (Ill be about 26 w) and getting my blood drawn within the hour.I totaly understand why some doctots may say it is unnecessary but it makes me feel better to get everything checked. That's just my 2 cents :-)

j42552 · August 2014

I actually requested the glucometer. My brother has DM1 so I know I'm at an increased risk, but it makes no sense to me to chug 50g of glucose in five minutes when I never do that in real life. Why does my body need to perform at that level? That's like, "We're gonna test your fitness...by having you outrun a pack of pitbulls." Uhhh what if I just lead a pitbull-free life?

I like tracking my sugars better anyway because I feel like it gives a more complete picture, even if it does take more work. (For the record...if you forget that your two-hour mark is coming up and thus eat a laffy taffy...yes, your sugars will be elevating at that next reading. Oops.)

ebilbao · August 2014

This is very encouraging to hear that docs are realizing this test is over-prescribed. I have reactive hypoglycemia (meaning, if I eat a lot of sugar, my blood sugar drops like a rock, cold sweat, feel faint, etc.) I would much rather monitor my blood sugar over the course of a few days than chug that nasty, syrupy drink on an empty stomach and pass out.

It just can't be healthy for me or the baby. Vom.

LSauer21 · August 2014

My doc set me up for next tues, 24 weeks

soulcupcake · August 2014

ecopen said:

There are no symptoms for gestational diabetes, and it's important to know if you have it or not. Even if you're a totally healthy person you could have it. I'd get tested just in case unless there is some type of insurance/financial issue blocking your path.

It doesn't present with symptoms because it is not an actual condition or disease. "GD" should not be confused with long-standing diabetes. They are not the same, and do not carry the same symptoms and risks.

Pregnant women go through metabolic changes during pregnancy, whereby insulin doesn't breakdown glucose the way it does in non-pregnant women. This allows the placenta easy access to energy the baby needs, especially in the second and third trimester. So when glucose is tested it may be elevated, which is normal. This is based on current research and data, not outdated "data" that is decades old.

When glucose is elevated, which is called impaired glucose tolerance or glucose intolerance of pregnancy, the only real risk is a larger than average baby, which is not a huge cause for concern. However, there are women whose glucose levels are very high and tip into diabetic range, and in these cases the women may have pre-diabetes or undiagnosed diabetes, which can go unnoticed for years. There are also few women whose bodies are under more metabolic changes/stress during pregnancy and they tip into diabetic range (that aren't pre or undiagnosed diabetics), but this is seen much less.

Yes, being pre-diabetic or an undiganosed diabetic during pregnancy can come with a host of risks, but neither should be labeled as "GD" because it is not pregnancy related. It's preexisting, and doctors would know this if they did an A1C at the very beginning of pregnancy to check glucose levels over the last few months. This would help screen for patients who had glucose issues prior to pregnancy.

Michel Odent discusses in a journal.

Looking for a disease

"Almost everywhere in the world, “gestational diabetes” is a frequent diagnosis. We should therefore not be surprised by the tendency to assign it the status of a disease. This might appear as a feat, since this diagnosis is not based on any specific symptom, but just on the effects of an intervention (giving glucose) on blood biochemistry.

One of the ways to transform a diagnosis into a disease is to list its complications. The well-documented fact that women carrying this label are more at risk than others to develop later on in life a non-insulin dependent diabetes has often been presented as a complication.(14) But this “type 2 diabetes” is not a consequence of reduced glucose tolerance in pregnancy. It is simply the expression, in another context, of a particular metabolic type. One might even claim that the only interest of glucose tolerance test in pregnancy is to identify a population at risk of developing a type 2 diabetes. But when a woman is looking forward to having a baby, is it the right time to bother her with glucose intake and blood samples, and to tell her that she is more at risk than others to have a future chronic disease? It is probably more important to talk routinely about nutrition and exercise.

Gestational hypertension has also been presented as a complication of gestational diabetes. In fact an isolated increased blood pressure in pregnancy is a transitory physiological reaction associated with good perinatal outcomes.(15, 16, 17, 18) Once more the concomitant expression of a particular metabolic type should not be confused with the evolution of a disease towards complications.

Professor Jarrett, a London epidemiologist, made a synthesis of the questions inspired by such associations. He stressed that women who carry this label are, on average, older and heavier than the overall population of pregnant women, and their average blood pressure is higher. This is enough to explain differences in perinatal outcomes. The results of glucose tolerance tests are superfluous. According to Professor Jarrett, gestational diabetes is a “non-entity”.(19)

The concept of fetal complications is also widespread. Fetal death has long been thought to be associated with gestational diabetes. However all well-designed studies looking at comparable groups of women dismissed this belief, in populations as divers as Western European (20) or Chinese (21), and also in Singapore (22) and Mauritius.(23) High birth weight has also been presented as a complication. In fact it should be considered an association whose expression is influenced by maternal age, parity and the degree of nutritional unbalance. If there is a cause and effect relation, it might be the other way round: a big baby requires more glucose than a small one. It is significant that in the case of twins “when the demand is double” the glucose tolerance test is more often positive than for singleton pregnancies. Only hypoglycemia of the newborn baby might be considered a complication, although there are multiple risk factors.

Another way to transform a diagnosis into a disease is to establish therapeutic guidelines. Until now, no study has ever demonstrated any positive effect of a pharmacological treatment on the maternal and neonatal morbidity rates, in a population with impaired glucose tolerance. On the contrary no pharmacological particular treatment is able to reduce the risks of neonatal hypoglycaemia.(24,25) However gestational diabetes is often treated with drugs. The frequency of pharmacological treatment has even been evaluated among the fellows of the American College of Obstetricians and Gynecologists (ACOG).(26) It appears that 96% of these practitioners routinely screen for gestational diabetes. When glycaemic control is not considered acceptable, 82% prescribe insulin right away, while 13% try first glyburide, an hypoglycaemic oral drug of the sulfonylureas family.

While practitioners are keen on drugs, there are more and more studies comparing the advantages of human insulin and synthetic insulins lispro and aspart,(27, 28) or comparing the effects of twice-daily regimen with four-times-daily regimen of short-acting and intermediate-actinginsulins.(29) Meanwhile the comparative advantages of several oral hypoglycaemic drugs are also evaluated. The criteria are always short- term and “glycaemic control” is the main objective.(30) The fact, for example, that sulfonylureas cross the placenta should lead to caution and to raise questions about the long-term future of children exposed to such drugs during crucial phases of their development."

"GD" and big babies - Evidence-Based Birth

However, I will say much of the routine practice here is in response to the Standard American Diet, in which case a lot of Americans deal with issues caused by metabolic stress and eat a diet high in refined carbs and sugars, thus leading to diseases of Western culture.

Origins and evolution of the Western diet: health implications for the 21st century (American Journal of Clinical Nutrition)

GD: What Constitutes Low Blood Sugar?

"On the one hand our medical professionals deal with a huge population of women who eat very poorly, never exercise and somehow still manage to get pregnant. Miracle that this situation is, biology makes things worse. During pregnancy the mom becomes even more insulin resistant due to an evolutionary adaption in mammalian-mom’s in which they become slightly insulin resistant to allow a positive flow of nutrients to the developing fetus via the placenta. If the mom was more insulin sensitive than the fetus we could end up in a nutrient scarcity situation due to nutrition flowing to the more ubiquitous tissues of the mom. Biology fixes this problem by making mom a little insulin resistant, effectively “pushing” nutrients to the fetus. Score one for biology! Problems arise however when our modern diet and lifestyle make this otherwise favorable adaptation dangerous. Too many carbs (particularly chronic fructose intake), autoimmune complications with lectins, loss of insulin sensitivity due to sleep deprivation and stress can drive expecting moms into gestational diabetes. From the paper linked above we have an interesting observation that severity of GD is likely determined in part by estrogen and progesterone levels. One of the key features of hyperinsulinism is a decrease in sex hormone binding protein (SHBP) which then makes estrogen more available to the tissues. Interestingly, this problem with estrogen is actually at the heart of most female infertility, but that is a topic for another day (or a book…)"

[...]

(there are awesome links in the article)

soulcupcake · August 2014

ebilbao said:

This is very encouraging to hear that docs are realizing this test is over-prescribed. I have reactive hypoglycemia (meaning, if I eat a lot of sugar, my blood sugar drops like a rock, cold sweat, feel faint, etc.) I would much rather monitor my blood sugar over the course of a few days than chug that nasty, syrupy drink on an empty stomach and pass out.

It just can't be healthy for me or the baby. Vom.

True indeed. I will test my glucose levels with a glucometer at around 28-30 weeks, just as I did during my last two pregnancies. My midwife allows her clients to choose how they wish to proceed. Most are pretty informed and educated on the issue of impaired glucose tolerance, and choose either the A1C or home testing. (my fasting glucose during my last pregnancy was in the high 60s)

I eat Primal. When not pregnant my carb level ranges from 50-100g depending if I am trying to lose or maintain. But during pregnancy it averages from 75-150g.

This article goes into carbs and glucose during pregnancy.

Shortstack06 · August 2014

I believe where I go it depends on the mom also. I do a urine sample where they check sugar, protein, and for drugs (this is standard for every pregnant woman, at every appointment ). If they notice a drastic change, or different test results over the course of appointments then they require the test. If the mom requests the test, they also will perform it.

aksue22 · August 2014

I have PCOS so they tested me early on. My sugars were elevated, which was not surprising because they took me off my Metformin at 10 weeks. I take Glyburide in small doses now, and test my sugars four times a day. I'm not considered high risk, though there is additional testing (fetal echo, weekly ultrasounds after week 32). I'm not thrilled about the extra ultrasounds, but better safe than sorry.

lionyloo32 · August 2014

According to the NIH the following must ALL be true for you NOT to get the test done. Otherwise it's standard practice for most OB's to perform the screening and subsequent testing between 24 and 28 weeks.

Women who have a low risk for diabetes may not have the screening test. To be low-risk, all of these statements must be true:

You have never had a test that showed your blood glucose was higher than normal.
Your ethnic group has a low risk for diabetes.
You do not have any first-degree relatives (parent, sibling, or child) with diabetes.
You are younger than 25 years old and have a normal weight.
You have not had any bad outcomes during an earlier pregnancy.

https://www.nlm.nih.gov/medlineplus/ency/article/007562.htm

JRod13 · August 2014

I had to take an early one and I have another at 26 weeks. I suppose it varies doctor to doctor.

taylojade57 · August 2014

@gradschoolmom1234‌ there are alternatives! Don't be afraid to let them know you don't want the drink. I think I posted what my midwife is doing for my test on the previous page. Just because you don't drink the nasty stuff, doesn't mean you don't have a glucose test.

Eliz77 · August 2014

I got my prescription for the glucose check at my last o/b appointment and was told to have it done between 24-28 weeks. I can go to the lab one morning, 1st thing at 7am, so fasting really shouldn't be an issue considering I don't normally eat until I've been awake a couple hours anyway. But the NP did tell me I can eat as long as it is something protein based.

brookey79 · August 2014

Thanks for all of your thoughts. Saw the doctor today and she said that most of my risk factors were low, but since I'm over 35, I could choose whether or not to get it. I decided that I feel more comfortable having it, so I'll go first thing tomorrow morning. She told me I could eat breakfast though

.

brittandjp · August 2014

Interesting. I was under the impression it was mandatory. My OB gave me the drink today and I have to drink it about 45 minutes before my next appointment.

BayCamp · August 2014

Just got the info for my next appointment at the mw today. Only complex carbs, no refined sugar or simple carbs, for one week prior to test. Morning of the give you a suggested breakfast plan and then I go in an hour and a half later for the blood test. I think I would rather have the glucose drink. No sugar for a week??? That just sucks the fun out of life.

JunkieBrewster · August 2014

ebilbao said:
This is very encouraging to hear that docs are realizing this test is over-prescribed. I have reactive hypoglycemia (meaning, if I eat a lot of sugar, my blood sugar drops like a rock, cold sweat, feel faint, etc.) I would much rather monitor my blood sugar over the course of a few days than chug that nasty, syrupy drink on an empty stomach and pass out.

It just can't be healthy for me or the baby. Vom.

oh hey, me too. I cannot tolerate cards in the morning. Or any form of sugar, really for hours after I wake. they gave me the option to skip it, but I opted to take it. I am doing jelly beans instead.

courtelizabeth81708 · August 2014

My midwife does it different than my OB I went to with my first pregnancy. I just have to drink 16 oz of orange juice!! Then show up at their office and they take my blood. I was shocked to hear it done differently but I'm not complaining!!

brookey79 · August 2014

I had my test today. Just got my results back online and it says that they are outside the normal range....but they are too low! Did anyone else get back a result that was deemed "too low"? I'm sure my doctor will call me with the results, but it probably won't be for a few days because I'm waiting for other tests too.

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