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

[Anonymous]

With my first child, I barely failed the screening test (by three points) and barely passed the three-hour GTT (one of the four numbers was over the cutoff, two over means you are diagnosed with GD). I'd like to avoid the three-hour test this time. Does anyone have any tips for how to prepare in the next four weeks so that I'll pass the initial screening test? I.e., did you change your diet and exercise routine and find that it affected the outcome? What did you eat or how long did you fast the day of the test, and do you feel this made a difference in the outcome? (Doctors tell people different things on this).

To avoid flames, I should probably explain by way of background that a lot of medical professionals question the value of GD screening and treatment for women who are borderline cases (as I would be were I to fail the three-hour test). A GD diagnosis opens one up to unnecessary early induction and c-section, not to mention being put on a diabetic diet and being forced to monitor blood sugar like a diabetic. In my opinion, this is way over the top for someone who is only off by a couple of points. Obviously, if I was truly GD or Type II, it wouldn't be possible to make such changes for four weeks and alter the outcome significantly enough to avoid a diagnosis. But since I'm on the borderline, I'd like to try to optimize the test result as much as I can.

[Anonymous]

I failed with first baby by one point! So frustrating. Passed the three-hour. Second baby - I ate and drank nothing the day of the screening and passed. Not sure there is much more you can do.

[Anonymous]

Hi OP, search the archives for several (cranky!) posts authored by me on the same subject -- though I do hope people will answer you here because I'm dealing with a similar issue. My dad has type II diabetes so this has flagged me for additional GD screening, despite the fact that my dad is easily 50 lbs overweight, lives a very sedentary lifestyle, and has never met a donut he didn't eat. I also think that it is a bit of a bogus test. A really good test would be to see how my body reacts to the NORMAL sugar and carbs I eat every day, not a superman sized shock to the system of sugar that I would never, ever ingest under ordinary conditions. And I'm pretty sure ACOG agrees with me on this, they've said routine screening of women for GD is not useful.

I especially think it is bogus that I get screwed b/c of my dad's issue (it is not in our family otherwise) and don't even think I want to even endure the first round of testing b/c I understand the test results are highly variable. I'm also with you on the fear of early induction, getting flagged for c-section if the baby seems big according to u/s (and we know that's not terribly reliable) etc. (we've probably read the same stuff in the Dr. Sears Pregnancy book, right?) Anyway, the consensus seemed to me to be that one should actually eat a very high carb diet for several days before the test, which seems counter to logic, but I guess the idea is that it prepares the body for the sugar shock to come. Then the morning of, you have to be careful not to eat ANY sugar at all, because they don't tell you but this adds to the sugar in your system and can put you over the limit.

I hope this helps. You sound like you've educated yourself about it, so the only thing I would add, out of abundance of caution (and the same applies to me), is that if we're going to try to game the GD system, we should be especially careful to make good diet choices that recognize the fact that we might have additional risks.

Good luck! I hope others post with better and more detailed info -- I'll be watching this thread too.

[Anonymous]

Many people fail the 1 hour test and then go on to to pass the 3 hour test because ob/gyns do not tell you what not to eat before the 1 hour. They figure if you fail no problem you'll pass the 3 hr if you don't have it.

*Schedule the test early in the morning
*Do not eat carbs or processed sugar the night before and stick to proteins and water.
*Avoid strenuous physical activity before the test. Running/waddling a few blocks or across the parking lot and up the stairs because you are running late can actually raise your blood sugar.

If you are worried in general about GD, a diet with less processed carbs and sugar is always good. Eat whole grains and vegetables for carbs rather than white rice, white bread and processed cereals etc. Don't go to far with a diet weighted too heavily in protein but eat lots of healthy fats and proteins. For fruit avoid orange juice, eat an orange instead. Sugar is just empty calories anyway so cutting out the sweets is never bad. Avoid all fast food it is loaded with sugar and bad carbs.

GD, if you have it is serious. The big baby risk is not induction and a c-section. A big baby requires more from the placenta and the extra load matures/deteriorates the placenta faster than a normally developing baby. This can lead to stillbirth and delayed lung development. It can also raise the risk of developing pre-eclampsia.

[Anonymous]

GD is dangerous...yes, I suppose in its more severe form. But not only are the numbers for GD lower than the normal numbers, pregnant women normally have higher numbers than non-pregnant women. It is normal for a pregnant woman's blood sugar to go up. Additionally, the way the test is administered causes blood pressure to spike higher than it ever would in real life. If your reading is signficantly high, (not just a point or two, maybe not even 20 points) then they need to be aware of it. So I'm not saying that testing, itself, is necessarily useless, but the way the test is conducted causes too many positives and doctors use an overly stringent set of numbers.

PP says the "true danger" of a big baby is not induction and c-section but rather placenta issues. That doesn't make a lot of sense to me. All of these things carry a risk. Yes, a truly big baby requires more of the placenta and can cause complications, but inductions and c-sections also carry their own set of risks. I have read a number of studies that show its a struggle to try and correlate mild GD with the size of the baby. Likewise, there IS an increase between diagnosis of GD and the c-section rate.

Bottom line: if one is diagnosed with GD, even with relatively low numbers, one is labeled "high risk." Monitoring during birth is more likely. Induction is MUCH more likely, as doctor worries about the size of the baby. And I have heard far too many stories of women with supposed huge babies being induced 2 weeks early, having to have amniocentesis to see whether or not the lungs are developed enough, etc, and then ending up with 6 lb babies. Another issue is that some doctors now consider 9 lb babies "large." On top of that, some women who simply have slightly elevated blood sugar levels are being diagnosed with GD. And then they're high risk, and they can run into insurance problems both during the pregnancy and afterwards.

To me, the insurance issue is a bit extraneous. The bigger issue is that mom can be pushed into induction and interventions that could lead to a C-section that simply are not necessary due to slightly elevated blood sugar levels, especially since every woman is different and all women have sligthly elevated blood sugars during pregnancy anyway.

In the meantime, if OP takes the test, she is smart to do what she can to minimize her risk of being over-diagnosed. If she has a serious problem, no amount of "gaming" the system is going to hide it from the test, but she can at least avoid a misdiagnosis for a borderline case.

[Anonymous]

*Schedule the test early in the morning
*Do not eat carbs or processed sugar the night before and stick to proteins and water.
*Avoid strenuous physical activity before the test. Running/waddling a few blocks or across the parking lot and up the stairs because you are running late can actually raise your blood sugar.

See, I did almost exactly the opposite of the above and passed with flying colors (score was 114; the cutoff is 130). My appointment wasn't until 10:30am and I ate two slices of whole wheat toast with peanut butter at 7:30am and finished a bagel with cream cheese at about 9:25, right before taking the glucose drink. That was a pretty normal breakfast for me at that time. I can't remember what was for dinner the night before, but I guarantee it included carbs and I most likely had a small sugary something for dessert. And finally, I walked the 10 blocks from my office to the doctor's office immediately before the test in the aftermath of that January ice and snow storm we had (i.e., it was not an easy stroll).

All of which makes me think there isn't really any one way to beat the test.

[Anonymous]

Google the carb-loading diet for GD screens. It was required by my doc for the three days leading up to the 3 hr. You can search the archives for my previous explanations and directions for carb-loading.

[Anonymous]

I failed the first time I did the one hour (just barely- 140-something). The test was in the early afternoon, and I had just eaten a big lunch. So I did the 3-hour, and my 3-hour measures were WAY below the "failing" limits (the 3rd hour measure was a dangerously low 32 mg/dl- yes, I was disoriented and had to have someone come get me).

This pregnancy, I scheduled my test at 10am and did not eat after midnight the night before. I did, however, go to the gym in the morning. This time my 1-hour result was 89 mg/dl, not even close to failing.

Noone told me to fast the first time, but I changed doctors, and this one DID tell me to fast. Made quite a difference.

[Anonymous]

OP here -- I think I'm more confused now than before with all this conflicting advice (not that I don't appreciate all the replies!). I'm consulting with a friend of mine who's finishing up medical school, but endocrine issues aren't his specialty either . . . Based on what I've learned online, it seems that for the long term and possibly short term, daily exercise and a diet low in refined carbs are the best ways short of meds to lower blood glucose levels. So that's what I'm doing for the next few weeks. I guess my main concern is now about how I should approach the day of and day before the test. My appointment is at 9 a.m. All the doctor told me was not to eat in the two hours before my appointment, but I am wondering if coming in without having eaten any breakfast is better, with maybe a late-night snack the evening before. I'm going to continue to do more research on how blood sugar works to see if I can understand the basics.

[Anonymous]

DO NOT drink orange juice before the exam. With number 1, I did and borderline failed it. I pass the 3 hour one (which is horrible) with flying colors. The doctor told me the discrepancy between the two tests was probably in what I had eaten in the morning and that juice was a major culprit. With number 2, I had some eggs and whole wheat toast, no juice and got great numbers.
Good luck!

[Anonymous]

I was deathly terrified of testing positive (family history of diabetes and have been extremely thirsty throughout pregnancy). I knew that if I did have GD, I wouldn't be able to mask it so I wasn't worried about "gaming" the test, I just wanted to avoid a false positive.

I scheduled my appointment for first thing in the morning. No carbs following the prior day's lunch. The morning of, I had a hard boiled egg and a large glass of milk. The initial rush from the drink wasn't so bad, but by the time my hour was up, I definitely needed a snack, so pack something to eat once they draw your blood.

I got my results back: 97 (cutoff for my doctor was 130).

[Anonymous]

Try a diet higher in cinnamon. Believe it or not, it has recently been proven to contribute to balanced glucose processing in the diet.

Also, diet, and exercise have been proven to change the diabetes symptoms.

[Anonymous]

Anonymous wrote:

*Schedule the test early in the morning
*Do not eat carbs or processed sugar the night before and stick to proteins and water.
*Avoid strenuous physical activity before the test. Running/waddling a few blocks or across the parking lot and up the stairs because you are running late can actually raise your blood sugar.

See, I did almost exactly the opposite of the above and passed with flying colors (score was 114; the cutoff is 130). My appointment wasn't until 10:30am and I ate two slices of whole wheat toast with peanut butter at 7:30am and finished a bagel with cream cheese at about 9:25, right before taking the glucose drink. That was a pretty normal breakfast for me at that time. I can't remember what was for dinner the night before, but I guarantee it included carbs and I most likely had a small sugary something for dessert. And finally, I walked the 10 blocks from my office to the doctor's office immediately before the test in the aftermath of that January ice and snow storm we had (i.e., it was not an easy stroll).

All of which makes me think there isn't really any one way to beat the test.

Same here. I did ALL the exact opposite of the above - 1 1/2 bagels for breakfast (they were soo good fresh), went for my usual noontime run (life long runner though), had a piece of cake during a meeting, drank the glucola while commuting to the doc office, and took the test at 5pm and passed with no problem!

To me, it's not really anything you can truly alter or change. The GD test is sorta a general gauge of your OVERALL kidney health (to include the extra "work" your body does to ensure a healthy pregnancy) - not something you can manipulate the morning of your glucola test.

[Anonymous]

I was borderline for GD. One doc said I should treat it, one doc said don't bother. I got it treated. My baby was still affected.

[Anonymous]

I also disagree with the PP's suggestion of not exercising before the test. My husband is diabetic and the one surefire way for him to keep his blood sugar low is to exercise regularly. It is much more effective than diet or anything else he does.

To prepare to pass the 1 hour, I'd strongly recommend regular exercise. This can be as simple as walking 20 minutes a day with a moderate increase in heart rate -- no need for anything too strenuous here. I'd even start the day of the test off with moderate exercise to get your metabolism working for the day.......