Any tips on how to optimize glucose tolerance for the screening test?

[Anonymous]

Good for you, OP for coming up with an alternative way to approach this. I actually borderline failed the 1-hour and borderline failed the 3-hr. But, my practice allowed me to start monitoring my sugar (but not go on a GD diet) just to test the results. (I had fasted longer than you're supposed to for the 3-hr test). After 2 weeks of monitoring and very normal blood sugar, for the next month they decided to keep an eye on baby size (one of the two biggest concerns of GD is an oversized baby). I measured normally for my following 2-3 visits and then they had me test sugar again on a regular basis for a week or two. Again, all normal results for both fasting and after-meal tests. Alas, I also managed to dodge the bullet, despite the glucola test results....

[Anonymous]

Anonymous wrote:Good for you, OP for coming up with an alternative way to approach this. I actually borderline failed the 1-hour and borderline failed the 3-hr. But, my practice allowed me to start monitoring my sugar (but not go on a GD diet) just to test the results. (I had fasted longer than you're supposed to for the 3-hr test). After 2 weeks of monitoring and very normal blood sugar, for the next month they decided to keep an eye on baby size (one of the two biggest concerns of GD is an oversized baby). I measured normally for my following 2-3 visits and then they had me test sugar again on a regular basis for a week or two. Again, all normal results for both fasting and after-meal tests. Alas, I also managed to dodge the bullet, despite the glucola test results....

Just to present an alternate point of view, it could be that since you knew you would be checking your sugars, you were motivated to eat more carefully-ie portion size and to exercise. Spot testing like you did is probably more of an accurate picture of overall glucose control than the 3 hour test. Good for you for being proactive.

[Anonymous]

Just curious here but I don't understand how pricking your finger, monitoring your own blood sugar and following the GD diet just to avoid drinking the glucola and possibly getting a positive (which would lead to a recommendation to do exactly what you are already doing??) is less invasive?

[Anonymous]

Anonymous wrote:Just curious here but I don't understand how pricking your finger, monitoring your own blood sugar and following the GD diet just to avoid drinking the glucola and possibly getting a positive (which would lead to a recommendation to do exactly what you are already doing??) is less invasive?

I think the point is that by monitoring your own blood sugar, you can make adjustments in your eating and exercise regime to keep your sugars within normal limits. Therefore, you hopefully prevent the complications associated with having your baby constantly exposed to high blood sugars.

[Anonymous]

"I think the point is that by monitoring your own blood sugar, you can make adjustments in your eating and exercise regime to keep your sugars within normal limits. Therefore, you hopefully prevent the complications associated with having your baby constantly exposed to high blood sugars."

Isn't this unnecessary if the OP does not have GD?

[Anonymous]

I don't get it, for the safety of your baby why would you try and mask a medical issue?

[Anonymous]

Anonymous wrote:I don't get it, for the safety of your baby why would you try and mask a medical issue?

Did you read any of the previous posts? it doesn't seem like it.

[Anonymous]

Oh, good grief. It's not trying to "mask" a medical condition -- it's eliciting the same information using a different way of testing, plus taking proactive steps to prevent the development of a condition. Neither of which has even a remote chance of compromising my baby's safety -- quite the opposite, in fact. Thanks for proving me right, though -- you cannot have a discussion on this board without someone saying something idiotic. It just wouldn't have been the same DCUM without that comment.

And as for invasiveness, I'll take pricking my finger over a c-section any day. But that's just me.

[Anonymous]

If a c-section is your fear then you really should make sure that your ob/gyn is more liberal and very supportive of natural birth. An ob/gyn who is going to schedule a c-section simply for a big baby is probably more likely to jump c-section for a host of other reasons. Avoiding a GD diagnosis isn't going to necessarily yield the result you are looking for here.

[Anonymous]

Anonymous wrote:If a c-section is your fear then you really should make sure that your ob/gyn is more liberal and very supportive of natural birth. An ob/gyn who is going to schedule a c-section simply for a big baby is probably more likely to jump c-section for a host of other reasons. Avoiding a GD diagnosis isn't going to necessarily yield the result you are looking for here.

It's pretty obvious that OP is being proactive on this issue on many levels and has already addressed her concerns about her caregiver's approach. Kudos to OP for standing up against a bogus test. I'm the other poster who was worried about a false positive (got my results back last week, all clear). I took the test after thoroughly discussing it with my OB. I laid out my concerns (I think it is overdiagnosed, I have a problem with the accuracy of the screening test, I feel it often leads to unnecessary interventions). Only after he reassured me on the final concern (and after i did my own research on how to make sure I didn't come up as a false positive) did I agree to the test. My levels were in the low hundreds, so I am all clear. My position, however, remains unchanged -- this "disorder" is grossly overdiagnosed. And the poster above, who incorrectly boils the concerns down to aggressive c-section or not, misses the mark, however well-intentioned her post was. Because there are a number of interventions that can happen with a GD diagnosis. C section, early induction, and significant dietary restrictions, to name a few.

The latter may seem benign enough, but a friend shared a story with me about what happened to her after a GD diagnosis last year. She was diagnosed GD after barely "failing" the one hour and then barely (within 5-10 points of the cut off) "failing" the 3 hour test. She was put on a diet where her carb / starch / sugar intake was severely restricted and had to prick her finger daily. On several occasions her blood sugar was low -- as in, not "normal" but low. Her doctors said this was a good thing, and meant she was doing well on the diet. Yet, she continued to lose weight. Her doctors actually took her to task for this, and said that she needed to increase her proteins and suggested she was putting her baby in harm's way, when all she did was cut out carbs (she said she was, in fact, giving it her all to eat MORE than she had been eating previously). She lost weight for 5 consecutive weeks, a pound or so at a time, and the doctors didn't say much until she actually lost 4 lbs between visits. This raised some concerns, but they said it still didn't mean she should allow carbs back in her life -- she should just eat ever more meat and other proteins. So she has an ultrasound at, like, 36 weeks, and they completely panic because her baby is only measuring 5 lbs or something like that, so then she has to go for weekly non-stress tests. She goes into premature labor (does the stress have anything to do with it? not sure) and, while at the hospital, the attending doc says she has no signs of GD, and should resume a normal diet. They fill her with magnesium and labor is averted, but not without days of bed rest in the hospital and tons of stress and fear on her. She finally gets out and resumes normal prenatal visits, at which point they don't take her word for it on the GD but insist on giving her the test again. She flatly refused to take it, and just started eating normally again. Whaddya know, she gains a few pounds, feels a ton better, and goes on to deliver a slightly small but still completely healthy baby boy at 40 weeks 3 days.

Is this a scientific study? No, absolutely not. But it's a true story and I think is a very good alegory of what can happen when the weird diagnosis and treatments start stacking up -- especially when the doctors don't stop and think " hm -- the concern with GD is a large baby and unhealthy blood sugar levels. Due to the treatment, we have a smaller than average baby and a mom with borderline unhealthy on the low side sugar levels -- maybe we should rethink the treatment / diet / diagnosis." Instead, they kept piling more interventions on her to deal with the side effects of the first set of interventions.

Moral of the story -- even the benign and non-invasive tests really do come with some drawbacks, and we're all smart to think carefully about each test they ask us to take.

I felt pushed into a test for a disease i knew I didn't have. I resent the fact that the hunt for a GD diagnosis is one of many instances where pregnancy is treated like the disease / side effects are almost presumed instead of tested for upon signs of trouble. While I didn't have a huge amount of trouble with the test, it was extremely unpleasant and I felt like crud for the rest of the day, and I don't really enjoy having my arm used as a pin cushion for no good reason.

[Anonymous]

You know there is a difference between a screening test and a diagnostic test. There are many screening tests in medical science with the relevant threshold being a low false negative rate and higher acceptance of a false positive rate. This is why screening tests are followed by more extensive diagnostic tests if they exist. If they do not exist the information from a screening test is then evaluated against a range of conservative to less conservative approaches.

The GD screening test is no more bogus than the AFP, BP tests, protein dip, or many of the tests that you undergo in a regular physical etc. ( In fact the protein dip is probably the least effective as it has a false negative rate. ) If you understand what it is, it a less scary test.

[Anonymous]

Anonymous wrote:You know there is a difference between a screening test and a diagnostic test. There are many screening tests in medical science with the relevant threshold being a low false negative rate and higher acceptance of a false positive rate. This is why screening tests are followed by more extensive diagnostic tests if they exist. If they do not exist the information from a screening test is then evaluated against a range of conservative to less conservative approaches.

The GD screening test is no more bogus than the AFP, BP tests, protein dip, or many of the tests that you undergo in a regular physical etc. ( In fact the protein dip is probably the least effective as it has a false negative rate. ) If you understand what it is, it a less scary test.

I'm not sure which poster you're talking to, but I'm the one right above you who called the GD screening "bogus." To answer your question, I'm well aware that it is a screening test and that the 3 hour test is more diagnostic in nature. I still don't really follow your logic about the comparison to other tests, and I don't think I've even had all of them so I can't really speak to that. Whether it is more or less "bogus" than other tests, though, isn't really my point. My point is that it is not a good way to screen for a problem -- I've already made the case for it earlier, so I won't repeat myself -- if you're interested in knowing why I have a problem with the test, you can look back through the posts. In any event, my objection to the screening test has absolutely nothing to do with not understanding it. I understand it very well -- have researched it extensively -- and feel that the screening test is problematic and quite flawed. The one hour test is not "scary," but a diagnosis of GD for marginally high numbers after the 3 hour test (which happens often) and the resulting treatment can be. What's more, the one hour test is uncomfortable (some women faint) and the three hour test is even more so (stories of women having collapsed veins from 4-5 blood draws, even more fainting, and how does it make sense to ask a pregnant woman to fast for 12 hours when she should be eating properly and then load herself up with 100g of sugar all at once?). Anyway, this is only part of my reasoning and, as i said before, I don't aim to repeat myself. I have many concrete reasons for doubting the utility of the test. And want to know something else? ACOG now recommends AGAINST routine screening for every mom without evidence of trouble or reasons to suspect she is high risk. So don't take my word for it...!

[Anonymous]

"ACOG now recommends AGAINST routine screening for every mom without evidence of trouble or reasons to suspect she is high risk. "

Not true in fact ACOG lowered the thresholds on the screening tests.

[Anonymous]

OP here -- thanks, kindred spirit PP, for all your supportive words and trying to educate others. As it happens, my OB practice agreed to let me bring in the results of my home monitoring as a substitute for the glucola test, so avoiding it can be done depending on your provider's willingness. I see why your friend had the experience she did -- I lost 4 lbs. between my 24 and 29 week visits, though the doctor did not seem concerned about it, I just told her I had been making an effort to eat better and exercise. But I have been spilling ketones in my urine, which my midwife (the new care provider I alluded to earlier) is a little concerned about -- that means I have been losing fat, which is not considered the best thing to do. It is damn hard to get enough calories if you cut out carbs, though it certainly is successful in keeping blood sugar at the recommended levels. We decided that I'm going to reintroduce some carbs (whole grains, etc.) so that the baby's weight gain is not compromised.

Oh, and the other PP is right that ACOG recommended lowering the level on the screening test from 140 to 130. Which is ridiculous, IMO. It was based on a study from the NEJM that came out last summer alleging that "adverse outcomes" are increased with even marginally high blood sugar during pregnancy. Except one of the "adverse outcomes" they used as a measure was c-sections, which makes no sense because so many are performed unnecessarily and for reasons that could not conceivably have anything to do with GD. However, the editorial accompanying the study strongly disagreed with the conclusion that the authors of the study drew and recommended that the protocols not be changed until studies were done that actually showed evidence of harm. There are just a few researchers out there who are determined to increase "diagnosis" of GD, for whatever reason.

Not to worry on the care provider thing. My midwife and I are on the same page, and barring a REAL complication, I will absolutely be able to have a natural birth.

[Anonymous]

OP, this is kindred spirit. I double checked and you and the other PP are correct about ACOG. I swear I remembered reading in one of the books -- maybe dr. sears, i thought? -- that ACOG does not recommend screening women that do not have other risk factors. However, either this was old info that has changed or I've gotten the organization wrong, or something else.

My FIL is a surgeon, and I sort of tentatively approached this issue and some others with him, and it's been very revealing to talk to him about how the organizations like ACOG reach their positions on things (he is the president of his organization's version of ACOG). I work in the association world, and I was shocked when his description on how his organization reaches conclusions and positions. They can and do cherrypick research based on what the individual providers want to do. Generally speaking, the members don't try to do this, nor do they do it out of malice or negligence, but they're simply human beings and are therefore capable of bias. They always like to err on the side of caution. Of course, to me, erring on the side of caution means being careful not to overdiagnose something. But I can see why a doctor's bias would be in the other direction. and of course, that bias can be reflected in their recommendations. It's not that they don't look at the science, or dismiss science that doesn't fit their position, but it does impact how they interpret the science (case in point -- is the c-section risk a byproduct of the disease or a byproduct of the the "cure?" Remember that some doctors still ask moms to give birth in the lithotomy position when it comes time to push, even though the science is in that this is not the best position.