Gestational Diabetes - Revisited

A short while ago I was asked my opinion on the GD testing.. I am finally back to blog it out...

OK - the wonderful 'drink this concentrated sugar solution and come to have your finger pricked to see if you have high blood sugars' test.

Well, can you tell my bias simply from that statement.

First off:
How the test is done- This test can be done fasting or non-fasting, with blood drawn from finger sticks or from your veins. You are made to either drink a special sugar enhanced drink called Glucola (the sugar concentrate) or eat jelly beans. Then, a short time later, your blood will be tested for the level of glucose. They usually ask you to not eat for 12 hours before, but not always. And they ALWAYS tell you not to workout much after the Glucola consumption.

When the test is done - It is done to most women around 28 weeks gestation. However, if you have a family history of diabetes or had gestational diabetes in a previous pregnancy they may test you earlier. There are also guidelines that say not everyone needs to be tested for gestational diabetes, though it is routine in many places.

How the results are given- 140 and below are considered not gestational diabetics, anything above this reading will usually be sent for further testing.

Problems with this test... MY GOODNESS, don't get me started.

Most women are told to lay off the physical activity and often are told to take the drink first thing in the morning after a 12 hour fast through the night... OK... (duh) - First off, who actually takes in that amount of sugar after a 12 hour fast? Many MANY women have SOME variation of blood sugar anomalies even when not pregnant - this type of body abuse will most assuredly be skewed in such circumstances.

I tell you, as a borderline hypoglycemic, I SURE would be bouncing sugar out of every pore after doing something as idiotic as that. Not to mention the health risk to someone such as I? Ei, Ei, Ei. In fact, in a study titled "Hypoglycemia during the 100-g oral glucose tolerance test: incidence and perinatal significance", they found that many women (6.3%) who don't have hypoglycemia have reactive hypoglycemia to the oral glucose tolerance test... and they have significantly lower incidences of gestational diabetes. (Weissman A, Solt I, Zloczower M, Jakobi P.Obstet Gynecol. 2005 Jun;105(6):1424-8.)

They 'say' there are no side effects... I took the GD test one time... once! What happened to me? I was sweating, shaking, my heart was racing so fast I thought it was going to fly out of my chest, I got a horrible headache, I felt like I was going to puke, and the room was spinning. I have spoken to many MANY women who reflect similar experiences - some even pass out... don't TELL me there are no side-effects...

Another issue is that if you are sick (a cold, the flu, a tummy bug, not enough sleep, etc...) ALL of those things can inhibit correct (and normal when healthy) glucose metabolism.

A third issue is that, if a woman is NORMALLY small of frame (95-115lbs PREpregnancy) - a normal adult dose of this sugar solution will render inaccurate results.

What do the studies say?
The cochrane review states: There are insufficient data for any reliable conclusions about the effects of treatments for impaired glucose tolerance on perinatal outcome. So... Testing and "treatment" doesn't improve outcomes??

The ACOG recommends only screening those women who are either 30 ears old or older OR who are at an increase risk for GD from personal or familial history.

Why not simply universally advocate healthier diet, exercise, cinnamon as a natural blood sugar assimilator (yes cinnamon), and education? Rather than this UNPROVEN, UNHEALTHY, INEFFECTIVE screening, diagnosis, and treatment?

So - no real help from me, I know. But you asked my thoughts. My thoughts are the misdiagnoses, stress on the maternal body, and the unsubstantiated practice of this routine test is not enough to get me to keep my baby from nourishment for 12 hours, sit on my lazy butt for as long a time, chug sugar solution, and then let someone stick a needle under my skin just to tell me that my sugars are high. Sigh. I am being moody today, I know. :o)


Anonymous said...

Excellent post! Great way to highlight the stupidity of this idiotic test. It is truly "a diagnosis in search of a disease"!


Kim said...

Glad to hear that you have a similar outlook on this as I do =) I do have type-2 diabetes in my family history, but neither my mother nor my sister (who had a baby in the summer) had GD. Am I at increased risk? I was leaning toward refusing the test - I'm borderline hypoglycemic normally - but am wondering if I might be 'hurting myself' by not getting tested.

Crazy question - if they want to test people for GD, why don't they send everyone home with a glucometer and ask them to measure their blood sugars before and after meals for a day? Wouldn't that be more accurate??

Nicole D said...

Kim - GD risk is not determined by hereditary diabetes, only hereditary GD.

Can you 'hurt yourself' for not getting a test that has known risks for borderliners like ourselves when there is no effective treatment anyway? Just something to consider.

I think that your recommendation is a great one. I think that they don't do that, though, because it would be leaving the health care of maternals IN THEIR OWN HANDS... I mean, heaven forbid that we take our own healthcare seriously and into our own hands?!! :o)

Kim said...

Ah - I wasn't sure about the risk factors - good to know! I think I'll be declining the test - as long as my midwife is still allowed to attend the birth without the results of the test! =)

Kimberley said...

There are other ways to test. I think that all pg women should be tested in some capacity for GD. I have *no* family history of GD and I've had it twice. If I had not had my test I surely would have had my dear first born with increased risks of real diabetes and possibly a very serious sugar crash post natal.

If you don't want to take the glucola then opt for jelly beans or ask to 'rent' a monitor and do blood sugars for a week.

But please don't go without some sort of testing.

Ryanne Marmaro said...

Nicole, out of curiosity, what do you mean that GD has "no effective treatment"? I am at high risk of it because of family history and I thought it was relatively easily controlled through diet/exercise and possibly insulin?

Educate me!

Btw, we miss you around CW.

Nicole D said...

Kimberley (and information for ryanne)-

The term 'treatable' means to improve outcome through a series of tests, management, and countermeasures.

Unfortunately, though it can sometimes help to keep sugars at a good level, the treatment of GD through diet or insulin has been shown to NOT reduce mortality or morbidity rates... in other words, the treatment is not working.

If you check out OB Gyn News Vol 24, No 12 - you will see just this finding.

Next, take a look at Am J Obstet Gynecol 1991; 164, 1673:9 - It states:

"In conclusion, the results of this study cast doubt on the current approach to GD. We have been led to believe that challenge testing will help in the management of pregnancies and that therapies based on these tests are beneficial. This study does NOT support this concept." - again, it is not treatable.

Finally, and most disturbing, OB Gyn News printed an article on August 1, of 1996 that said that screening is inefficient, has a high false positive rate, and our current 'treatment' may even be harmful in the long-run.

Your best bet - a healthy, well rounded diet, free of refined sugars, empty carbs, and sedentary lifestyle FROM THE START... don't wait until you get a bad prognosis.

Kari said...

Interesting post. I was recently diagnosed as having gestational diabetes at 29 weeks. So far (only 4 days) not one of my at home blood glucose results have been high. Even after eating sugary cereal in the morning and other big carb meals. It makes me wonder if I was misdiagnosed or if I'm just borderline diabetic. Or maybe the test is just a joke. You have to slam so much sugar into your system that you feel like vomiting. That's not stressful at all - and one of the first things they teach you is that stress increases your insulin resistance!

My biggest fear is being labeled as GD and therefore having a bunch of unnecessary interventions. So far the midwives at my clinic haven't seemed like the type, but I haven't talked to them yet since the diagnosis.

Mari, Carol, and Drew said...

I loved my OB during my first pregnancy. She was great for me at the time. (Now I know next time I want something completely different for me next pregnancy/Birthing experience) But this is the one thing she made me do that I hated. I We will start with the drink itself. I almost threw up half way through drinking it. I asked her what would happen if I did. The answer: I got to drink it again and start over. Sheer will power kept that down. I had no Jelly Bean option. And I have to tell you I cant eat creamsicles any more they make me want to throw up. Then I hated having to sit in their lab all day. I couldnt move around. I could sit and read. Then I was told in the end I was fine and could go home. I thought I was ok so I left. Got to the parking lot felt a little dizzy (first clue) but passed it off. I drove for 30 seconds. And almost passed out. So I pulled into my dads work building so he could drive me home. It was horrible.

Anonymous said...

Thank you for siting actual studies. My wife and I are having a hard time of this whole matter. Great article!

Amy said...

I just (as in this past hour) refused the glucose test. With my first, I had the same horrible experience that you recall. I felt absolutely awful during the test, got a false negative, and then had to do the three-hour version of the test--which left me vomiting in the parking lot trash can by the end of it. It was horrible, but I thought it was necessary. Then I started reading about the false positive on the one-hour test--up to 20% of women fail the one-hour test to go on to the three-hour. Forget it. I will eat wholesomely and exercise regularly. If my doctor really want to know my BSL, she can provide me with a testing kit.

Kimberly L. said...

Thank you for this blog and topic! I just took the gestational diabetes test for my second pregnancy, and felt worse than with my first pregnancy afterwards. It has been almost 10 hours now and I am still nauseous, headachy, achy, and tired. With my daughter (my 1st pregnancy), I did not have gestational diabetes.

My question is whether I can refuse the three hour test if I am asked to take it by the Obgyn? Have patients refused it without consequence from their insurance co.?

Anonymous said...

Kimberly L - I was diagnosed with gestation diabetes during my first pregnancy. I refused all the tests during my second pregnancy, with no consequences from my insurance. Your doctors/midwives might be a different story. I had great midwives though, so they just had me test myself to make sure my sugar wasn't too high.

dahlia'smama said...

GD for low risk people is such a joke. Of course your blood sugar is going to spike drinking that disgusting stuff. I took the 2 hour test: my fasting was 91, the one hour was 207 and the two hour as 95. so only ONE high reading. there are supposed to be two high reading. they diagnosed my anyway. I was given diet counseling & a blood glucose monitor. I have to say, as scary as GD diagnosis was... I LOVED the diet counseling- it helped me a lot. my numbers were ALWAYS low, except when i ate a bagel or pizza or ice-cream or something. but @ 37 weeks my baby was measuring "BIG" so they said INDUCE!!! well, i ended up in a failed induction @ 38.5 weeks and a c-section. my baby was only 8lbs 6oz. that is a terrible outcome! Definitely put mommy and baby in more danger that if they had just left us alone. I am ashamed that i fell for it.

Unknown said...

I just finished taking this test! WHAT AN AWFUL EXPERIENCE! Nobody told me there were side effects. So after half an hour of drinking the sugary drink..I started shaking, my vision blurred, my heart started racing, I started to get extreme hot flashes..I had sweat pouring down my face..and I felt like I was going to vomit and have explosive diareah..my baby was kicking up a storm and going nuts in my belly...and then the panic set in...I started to PANIC...the lab techs were nice n gave me a glass of water and a quiet place to lay down..BUT MY GOD IT WAS AWFUL! and then half an hour later..still didnt feel right. Had my blood taken and now im soooo tired..I could sleep all day...horrible.

LeishaL said...

I am currently awake not being able to sleep due to all this annoying stress over GD . I was never given a 1 hour test only a 3 and my BSL was 2 pts to high on my middle reading. So they shipped me out a meter and supplies and have tested for 3 days with no high readings and some low readings (in the 70's). When I called my NP to let her know I got a call back stating if I don't follow all there directions testing 4x a day they will have me sign a waiver releasing them from liablity because they would not be responsable for any problems my baby might have. I was furious. So now I am being told my only other option is to retest and put my self threw that nauseating stress again! Going to my diabetes counseling appointment in the morning hopefully I can get threw that 3 hour bundle of fun without losing it on anyone : /

Anonymous said...


Serena T said...

I had a really rough time with this one. Iv done all the scans and iv been eating well and getting in regular light exercise - i know my body and i am pro natural birth.
i was told by a midwife at the hospital my last visit that i was boderline over weight. i found this extremely confronting as a women who as always taken great pride in my health and fitness. always been an average weight and had a balanced lifestyle.
i did some research and asked around about the gd test and decided i felt that the results could potentially take my power away in regards to intervention - as a result i let the midwifes know i wont be doing it.
I got absolutely slammed when i got in there - they told me its not a choice its an expectation and they will write me off as high risk if i dont do it.
a second mid wife came in to give her opinion and said that i was overweight before i fell pregnant. i was 70kg and 173cm when i fell pregnant with the flattest toned tummy (that i intend to regain eventually) and i was speechless.
i just said 'so im overwieght' and one of them said 'but you are pretty tall so you look good'
what is this crap?
i burst into tears and the midwife said 'dont worry about what she said'
-im confused.
i said i had to go crying and in an absolute state and the midwife said 'ok sweetheat, il get you booked in for the test and let you know when it is'
im mortified.

Alissa said...

Thank you for writing this. I wish more OBs could be thinking through the ramifications of this test that doesn't mimic real life.

I was thin and petite pre-pregnancy. I "failed" the one hour test at just 140 (new stricter guidelines). Had to take the three hour and failed two of the four blood draws; and I was extremely sick and fatigued when I took the the 3 hour (nurses told me it was fine to be sick and take it).

Now I'm diagnosed GD (nice new scarlett letters for me); I sleep 3 to 4 hours a nice stressing about this and crying all night. I have yet to have a less than ideal blood sugar level.

My first baby was only 5 lbs 3 oz., and yet they tell me that b/c I have GD now I will have a 10 lb baby. Can you imagine the stress and confusion this causes? I was so scared that I would have another LBW baby and now they're trying to convince me I have a disease that can't be replicated without Glucola.

Anyway, thanks for this post. More docs needs to be aware of the harm caused by this.


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