The Gestational Diabetes Test
I took the fasting gestational diabetes test on Tuesday, and I must say that being denied food and water for 11-15 hours (depending on if you fast for 8 or 12 hours before the 3-hour exam) while pregnant is particularly cruel and unusual punishment. Basically you fast for 8-12 hours (I fasted for 9), then you go to your testing place. They draw your blood for the first time; then they have you drink a flat, super-sweet drink (lemon-lime or orange were the two options) in 5 minutes. You sit in their semi-comfortable chairs for an hour. Next, they call you in to draw your blood again. You wait another hour, get your blood drawn a third time. You go back to your seat and fidget while you try to get comfortable. After a third hour of waiting, they draw your blood for the fourth time, and you are allowed to leave.
Important Things To Know About the Gestational Diabetes Exam
- The people drawing your blood need to draw it every hour on the hour. More than 5-10 minutes late, and they’ll make you redo the whole test. So be proactive if an hour is up, and they haven’t called your name. (I wasn’t told this fact until the last time they drew my blood, and they’d almost let me go too long. By that time I was tired, hungry and grumpy, so I was not at all pleased to hear they almost messed up and made me do the exam again.)
- Don’t plan on driving yourself if you get tired, grumpy, stubborn and light-headed when you haven’t been fed for extended periods of time. Puck dropped me off for the exam and picked me up.
- Plan ahead for what you will eat. You could pack a snack to eat immediately following the exam, and eat somewhere where you will get your food quickly and where you don’t have to spend time making it. We went out for Indian since they have a buffet that provided immediate satisfaction.
- Prepare your husband for the fact that you might not be at your best when he picks you up. You’re most likely hungry, tired and somewhat uncomfortable from the fasting and 3 hours in waiting room chairs with no convenient way for elevating feet.
- Know that you might be exhausted after the exam. Even after a full night’s sleep, I crashed as soon I got home and slept for 3 hours.
The Results
I had a regularly scheduled Ob/Gyn appointment yesterday afternoon, and the doctor told me at the appointment that I did not have gestational diabetes (though my results from one of the four tests was a bit high) but I am slightly anemic. He gave me a prescription for an iron supplement in addition to my prenatal vitamin.
Today a nurse from the birthing center called to tell me that I do have gestational diabetes and dismissed the Ob/Gyn’s diagnosis. According to her, even one high score means I have gestational diabetes, and I had a second score that was just barely above the acceptable levels. Frustrating to have different people telling you different things? You bet.
What’s Next
So I’ll be going to a class about eating appropriately (spreading carbs out through the day, not eating carbs on their own, and eating somewhat low carb) plus I’ll be learning to use a glucometer.
June 17th, 2010 at 10:19 pm
Oye yeah. I remember taking that test! They made me take the four hour exam because the first time I took the one-hour exam my blood sugar didn’t move in an hour and they freaked out.
It turned out that I just have really weird sugar digestion (which I sort of already knew.) Apparently it sticks around for an hour, then digests completely normally. They told me my numbers were higher than ‘normal’ but not high enough to count as gestational diabetes. Basically they said ‘no, but the numbers are really close. You should be careful anyway and do the following things to make sure your numbers don’t go higher.’ I don’t remember what the numbers were anymore. But yeah, it totally bugs me too when doctors have different diagnoses based on the same information! (I had a major bone to pick with my doc ‘during’ labor for contradicting what he and three other nurses had told me.)
I’m sorry to hear they did full blood draws.
My doc used a finger prick (though I was expecting full draws until I got there).
Hooray for 28 weeks! (read the other post too).
June 18th, 2010 at 5:26 pm
Ack. That’s frustrating that the two authority figures don’t agree.
Much, much sympathy. I’ve had two really long talks with my doctor about how horrible fasting blood tests are, but have only made a wee bit of head-way.
Well, and you know, lifestyle changes to accommodate blood sugar– it’s one of my things. So you get my opinion on it all because I love you and worry.
The gestational diabetes diet (as I got to observe it from the outside, watching Gwennan do it) just looked like a bit of extra work about planning. It wasn’t terribly restrictive, and essentially just had Aeddan attempting to stuff food down Gwennan six times a day instead of three. (Well, and smearing peanut butter on her apple slices.) Her biggest hardship was not being allowed Dr. Pepper. She didn’t have to alter her eating all that much to get her blood sugar back down. So hopefully if you need to do it, you’ll be able to get good results from small changes as well.
So the fasting, sugar test thing is the best that the doctor can do to see what your blood sugar is doing. But that’s a really really stressed environment, and really, really stressed conditions. IMHO it’s not really the best test that you guys could do. Meters cost $15. I like the One Touch Ultra Mini. The strips are more expensive, so maybe another $50 for a little box of them (if your insurance won’t pay for them). If you eat normal food for a couple of days, and test at 30 minutes, 1 hour, and 2 hours, and your blood sugar isn’t doing funky things. Then– your blood sugar isn’t doing funky things to the babies. And that’s the end of it. That’s really all we care about. –And in that case you don’t need to read my fussy comments below.
If it’s going above 120 (which is what they recommend pregnant diabetics to stay below) then you should stop eating whatever high-carb thing it was, or eat a smaller quantity, or “pad” it with fat, fiber, and protein next time. Well, and though you can “guess” which foods are going to be problematic, you could also just check foods with the meter and see which ones are actually problematic. (I can eat peaches better than apples. Potatoes are better than bread. My blood sugar rises 1/3 higher for breakfast than it does for lunch or dinner– no matter what I eat. All that to say, everybody is an individual. There are rules of thumb that a nutritionist can give you, but if you’re in doubt, just get a meter and make sure. The meter doesn’t lie.
Okay, so if it’s going over 140. That means you should get pretty aggressive about getting it down. Cell damage starts at 140. If any of your tests went over 140– that’s a big deal and you should address it. Heck, I’m not pregnant and I don’t want my blood sugar going above 140.
Eh. Doubtless you’ve looked up information and have heard all this (and probably newer and better information). But I feel obliged to dump what knowledge I have on you. There is just so much bad information to be had about controlling blood sugar.
Hugs and much much love,
Cindy
June 18th, 2010 at 5:58 pm
Hi Cindy,
Yes, it looks like we’ll be going down the low carb route. Though, oddly, while they really wanted me to get in and do the test, they don’t seem in too big of a hurry to tell me how to change my diet. Apparently they have classes every Wednesday, but next Wednesday I have my appointment with my perinatologist. So they have me coming in for gestational diabetes 101 in a week and a half. I’ll be at 30 weeks by then. Still, Puck and I have gone low carb before, and thanks to you we know a good bit about that.
As for my numbers, only my fasting and 3-hour glucose levels were below 140. According to the nurse, these are the acceptable numbers and my numbers:
Acceptable glucose numbers under… / My numbers…
Fasting: 95 / 86
1 hour: 180 / 183
2 hour: 155 / 179
3 hour: 140 / 132
While I usually do a good bit of research, I haven’t dug up a lot of quality information on gestational diabetes yet. I had read about the 6 meals, low carb meals (especially at breakfast), and exercise. I hadn’t known what levels I should be trying to keep my glucose under. Makes you wonder why 180 and 155 are considered acceptable in the gestational diabetes test for two of the tests.
I’ll be making a vegetable meatloaf (without bread) this weekend that will give me an easy snack to eat with meat (good for my anemia) and vegetables – healthier carbohydrates. It’s roast with veggies tonight. Puck’s hard at work making it right now.
Hugs!
Mary
June 19th, 2010 at 6:34 am
180 is the OLD number from several years ago before they had any scientific evidence!!!! At 180 your body starts freaking out and dumping sugar into your urine. –Which for years was the only test they had. They could check your urine and tell whether it was above 180 or not. Hence for years they said that anything below 180 must be okay. (And during this time they also said that diabetes always caused nerve damage, blindness, etc. Because even people who only let their numbers go up to 180 still had progressive symptoms of nerve damage.)
At 180 I become so sleepy that I can hardly stay awake. My vision shifts a bit and I have to have my reading glasses. I have the sensation of being too warm. And I’m very cranky and easily made angry. Well, and of course, I’m thirsty and I have to pee because my body is frantically dumping sugar into my urine.
The one piece of true, hard and fast evidence the medical community has is that cell damage starts at blood sugars above 140. That’s it. The rest of it is all pretty much up in the air. The endocrinologists association changed the suggested post-meal high number from 180 to 140 the year after I was diagnosed. Doctors and nutritionists have been slow to adopt the new numbers because the Diabetes Association did not change their informational materials for several years (which all continued to say that below 180 is safe.) —Blast their Hershey and Cadbury-Chocolate-money-soaked-hides!
The doctors are also probably thinking it is not all that bad because “bad” is relative to them. If your blood sugar goes above 140 for two hours after you eat, that’s not all day. It’s only 6 hours a day. That’s not going to cause a miscarriage or cause birth defects. — But it is suspected that it causes a higher incidence of diabetes in the children. And, well, it just can’t be good for them. Of course, doubtless your doctor sees people who ring in numbers at 300– so he’s just not going to get all that excited with someone who’s in the beginning stages of diabetes. But hey– not his babies! You guys have done everything in your power to have healthy children– this is just the next thing.
The 120 number is the number that a friend of mine who is an insulin dependent diabetic was told to stay below if she wanted to get pregnant. There is no scientific evidence to my knowledge to back this up, it’s just a guess to stay on the safe side of the 140 number. My guess is that it is based on the doctors observations that “Normal” people as they get older or have health troubles will have post-meal numbers that go up to 120, and it doesn’t seem to cause them to tip over into permanently damaging the pancreas or becoming diabetic. So since they are picking a number out of the air, it seems like a good one.
The best information about getting blood sugar under control is here:
http://www.phlaunt.com/diabetes/
You could check with Reis, who reads far more than I do, but I’m pretty sure he’d agree. Jenny, the person who runs the site, is the most honest, most informed source out there. She’s not selling anything. (Well, okay, she put the info in the website in a book, but aside from that.)
I still get a little freaked out that doctors and nutritionists give bad advice about getting blood sugar numbers down– but they often do. If the midwife looked at your numbers and told you that you had gestational diabetes, you need to kiss her when you see her next.
So I put almond flour in my meatloaf instead of bread crumbs. It tastes kind of French Cuisine posh.
Instead of potatoes with my roast, I cut up pieces of butternut squash (the solid part, not the seeds, and you can leave the skin on.) They soak up meat juice and get all fabulous the way potatoes do. My other favorite veggies to stick in with a roast are: onions, whole raw mushrooms, carrots, and then 30 minutes from the time the roast is done, I put fresh green beans on the top of the other veggies.
June 19th, 2010 at 8:52 am
http://diabetes.niddk.nih.gov/.....ational/#5
I hate the continuity of care you’re getting. You have so many doctors, I can’t keep track and your stories feature a number of instances where they contradict. From my reading, the nurse is right. You had two abnormal values. However, you should have one primary physician consolidating all this info and advice.
June 19th, 2010 at 7:51 pm
Hi Cindy,
Thanks for all the information! At my next appointments, I’ll tell them that it is my understanding that cell damage starts above 140mg and ask why numbers above that are considered acceptable in their test. My next Ob/Gyn appointment happens to be with the same guy I had this past time. I think my favorite Ob/Gyn is on vacation at present. I’m keeping my fingers crossed that she’ll just happen to be the one on duty when I deliver.
We like almond flour too, and I may add it to the meatloaf. I was thinking about just leaving bread out all together. As for the roast, we usually use sweet potatoes, but we skipped them this time.
I am finding that my naps seem to be getting longer even after a full night’s rest, though according to my multiples pregnancy book needing more sleep in the third trimester is also pretty common. I am glad that our boys’ initial jump in growth occurred before the gestational diabetes because if they start to get extra large now it can be a sign that the gestational diabetes is affecting them. So far they’ve been holding steady at a week to a week and a half ahead in expected growth.
Hugs,
Mary
June 19th, 2010 at 9:24 pm
Hey Chris,
It can be frustrating to see so many different Ob/Gyns, and in general pregnant women are encouraged to rotate through the midwives. We didn’t find that particularly to our satisfaction. It would be a great deal more reassuring to be able to the one Ob/Gyn who is our favorite.
On the flip side, I suppose we get to hear some of the multiple perspectives of doctors, and it does reinforce that there is still a lot we don’t know and information that changes about medicine. Plus, it’s important to try to learn about your own situation. I good book about pregnancy – or in our case – twin pregnancy is indispensable because there is soooo much the doctors and/or midwives just don’t get around to telling you during your visits.
Hugs,
Mary
June 20th, 2010 at 6:07 am
So, my thought is that you’d want to figure out how many grams of carbs you can eat at a sitting without killing your blood sugar. Then I assume you’d want to eat as high as you can. Guessing and just eating super low-carb might cause weight loss. Better to just suck it up and test your blood sugar after meals and figure out how much is “safe.”
Just as an example– I loose weight if I don’t eat at least 10 net grams of carbs per meal (maybe 15 grams of carbs with 5 grams of fiber?). That’s even if I’m eating my three snacks each day.
Everyone is different, so the rules of thumb that a nutritionist can give you, are only rules of thumb. They’re not going to be tweaked for your metabolism. (Well, and to be realistic, they simply can’t be. You’re the only one who could get that data.)
Figuring it out is pretty simple though,
1) Measure what you eat and tally up the net carbs in a meal.
2). Then check your blood sugar 1 hour later and 2 hours later.
3). Then add or delete carbs in the next meals until you’ve got an idea of what you can eat. (I wouldn’t think you’d need to go all anal about this, but it’s good to know whether a meal was 15 grams of carbs or was it 50.)
4). If your highest number is always at 1 hour, then stop checking at 2, and vice-versa.
5). Once you’ve got a clear idea of how many carbs are “safe,” then I assume you could stop checking your blood sugar after every meal, and just check occasionally to see if your metabolism has shifted due to the pregnancy.
Oh, one last thought. If I had it to do over again, I’d have lowered my carb intake over the course of a week, not dropped it all at once. That would have let my body get used to the idea, rather than making me feel wretched for a couple of weeks.
The guidelines–
Looking at Chris’s link, it appears that the government standard for defining gestational diabetes is the same as the numbers on your chart. That seems goofy to me, however, it may reflect that the American Diabetes Association still holds to the older 180 standard. (As does the Canadian Diabetes Association.)
The American Association of Clinical Endocrinologists and the The International Diabetes Federation both recommend 140.
It’s just a confusing world out there for diabetics!
Perhaps it is thought that women in the third tri-mester routinely loose blood sugar control (at least in a challenge test like that)??? So unless it’s really bad you don’t call it gestational diabetes? Perhaps they are afraid you won’t be able to hold your weight if they don’t let your blood sugar spike? –Which is a concern.
Carbs=gaining weight.
Lowering carbs= losing weight usually.
Those are just my stab in the dark guesses. I’ll be interested to know if they have a rational, or whether it’s just an old standard that has never been updated.
Here’s a link to a summary page on some of the recent research into post-meal numbers:
http://www.phlaunt.com/diabetes/14045678.php
I might print out the articles and highlight the pertinent lines if I were you. Doctors are busy people, and they doubtless hear lots of wacky stuff from patients. Well, and I’d be braced for them to defend the high numbers just because those are the guidelines. And I’d be prepared to be good humored and forgiving if they take that tack. What’s the good of antagonizing them? (Okay, to tell the truth. At this point in my life, I might be willing to just let the whole thing slide and not mention the alternate number– as long as the doctor wrote a prescription for the diabetic test strips and a visit to the nutritionist. But I would talk to the nutritionist about it. She’d be the one who should be interested in nuts and bolts.)
I hadn’t read the more recent articles. Not especially good news. The newer bits of research are challenging the 140 number. It may not be low enough for those of us who are going to have to do this life long. One of the studies showed that 125-139 is still too high. Another showed that prolonged blood sugars over 100 kill off Bob (my pancreas)’s ability to make insulin. –Although a 2006 Japanese study showed that tight control of after-meal numbers halted all deterioration in diabetics. Woo hoo!
Symptoms–
I can see why they just have to haul women in for a glucose challenge test. If they asked you about symptoms, it would get them no where. The symptoms for uncontrolled diabetes and pregnancy (sleepiness after meals, urgent need to pee, etc.) seem to be almost identical.
Food—
There are a bunch of bread recipes in the Almond flour cookbook. I’ll try one out and let you know how it went. So far everything I’ve tried in her cookbook has been excellent. I just have to swap out her sweeteners for something that’s lower carb, and tweak it so that it has less cholesterol. (The cookbook is interested in avoiding gluten, not carbs.)
Indeed, Sweet potatoes are much more nutritious than white potatoes, but they are still a potato.
100 grams of Sweet potatos= 20 gms carbs, 3 gms fiber; (17gms net)
100 grams of White Potatoes= 17 gms carbs, 2 gms fiber. (15gms net)
God made them both to be a starch.
For comparison, 100 gms of Butternut squash is 12 carbs, 2 fiber (10gms net). So still kinda carby, but low enough that one can have a decent portion size of them.
Ah, you are thinking that I’m just a nutrition information goddess? No, I just have a quick way to check.
My favorite place to get nutrition data is:
http://www.nutritiondata.com/
You plug in the food name at the top of the page, and select the food group. It includes pretty much everything. It’s hooked to the big USDA database. It even includes fast foods.
Hope some of this is useful. As always, I understand you have to sift through all the information and make the best decisions that you can at this moment.
I’ll try to be a little less overwhelming in your comments.