Re: 30 week visit--failed 1-hour GTT :o(

[Dagny]

I am going to do the 1-hour test this week or next, I just asked to take the
lab sheet home. The first time (abt 13w, had a little sugar in urine) I was
told to do it about 3 hours after a nice breakfast. I passed. This time,
the routine time, with a different doctor I wasn't given any instructions.
I would think someone coming in to the lab after eating eggs and meat for
breakfast would fare better on the test than someone who ran in after eating
a Nutragrain bar. Not sure. What were your instructions?

Don't know what I'll do in your position. I'd be tempted to go straight to
the diet, because I suspect that's how I should be eating anyway and don't
;).

-- Dagny
EDD 10/6/03


I think if I barely fail, I will just
"zeldabee" > wrote in message
...
> I went to my 30 week checkup, and it was definitely a good news/bad news
> visit. First, the good news--I'd mentioned to my OB a couple of visits ago
> that I had been thinking of switching to a midwife, and she'd told me that
> a midwife would soon be starting at her practice, and I might want to see
> her. This was before I'd called the midwifery services at the birthing
> center where I plan to go, and was told that I was too far along and they
> wouldn't be able to help me. So I was pleased when at this visit my OB
> introduced me to the midwife, and she'll take care of me from here on
> unless something goes awry.
>
> The bad news was that I failed the 1-hour GTT I had two weeks ago (though
> I'd expected for them to call me if I had). So now I'm supposed to take
the
> 3 hour test next week. The midwife said it was pretty awful...
>
> What happens if I fail the 3-hour? Would that mean I definitely have GD?
> I've always been sensitive to sugar, and I'd never consume as much as the
> sweet drink they give you for the 1 hour test all at one time...I wasn't
> diabetic before, at least I assume regular checkups would have uncovered
it
> if I was, but I've always reacted to sugar.
>
> Should I watch what I eat more carefully? I've been avoiding eating too
> many sweets, but I don't avoid them entirely--I'll usually have some kind
> of treat every day (e.g., a dish of ice cream). I've tried to focus more
on
> making sure I get enough vegetables and protein, but maybe that's not
> enough. Will I have to follow a diet?
>
> --
> z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/
>

[Em]

"zeldabee" > wrote in message news
> I went to my 30 week checkup, and it was definitely a good news/bad news
> visit. First, the good news--I'd mentioned to my OB a couple of visits ago
> that I had been thinking of switching to a midwife, and she'd told me that
> a midwife would soon be starting at her practice, and I might want to see
> her. This was before I'd called the midwifery services at the birthing
> center where I plan to go, and was told that I was too far along and they
> wouldn't be able to help me. So I was pleased when at this visit my OB
> introduced me to the midwife, and she'll take care of me from here on
> unless something goes awry.

That's great about the midwife!

> The bad news was that I failed the 1-hour GTT I had two weeks ago (though
> I'd expected for them to call me if I had). So now I'm supposed to take
the
> 3 hour test next week. The midwife said it was pretty awful...
>
> What happens if I fail the 3-hour? Would that mean I definitely have GD?

Bummer about the 1 hr GTT. I don't know much about it, but from what I
understand *many* women who fail the 1 hour go on to pass the 3-hour.
Hopefully you'll be one of those! Best wishes!

--
Em
edd 9/23/03

[zeldabee]

"Dagny" > wrote:
> I am going to do the 1-hour test this week or next, I just asked to take
> the lab sheet home. The first time (abt 13w, had a little sugar in
> urine) I was told to do it about 3 hours after a nice breakfast. I
> passed. This time, the routine time, with a different doctor I wasn't
> given any instructions. I would think someone coming in to the lab after
> eating eggs and meat for breakfast would fare better on the test than
> someone who ran in after eating a Nutragrain bar. Not sure. What were
> your instructions?

I wasn't given any at all for the 1-hour. For the 3-hour, I'm supposed to
fast from midnight until my appointment in the morning. Then they're going
to dose me up with enough sugar to choke a horse. :o/

> Don't know what I'll do in your position. I'd be tempted to go straight
> to the diet, because I suspect that's how I should be eating anyway and
> don't ;).

Well, I passed on my usual ice cream dessert last night... :o)

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[zeldabee]

"Alicia Elliott" > wrote:
> But my natural inclination is to
> take with a grain of salt a great deal of what the medical community
> tends to speak of as 'risk' and 'treatment'. (Eg, the cesarean rate has
> gone up by almost half over the last 30 years due to medical
> interventions when they aren't necessary).

This worries me, as I read that c-section rate is higher in women with GD,
since they tend to have "big babies"...I really want to avoid a
high-intervention birth. I'm worried that I might risk out of the birthing
center I want to go to.

> The truth is, the medical
> community likes to cover themselves, and it doesn't always benefit the
> people involved.
>
> Try looking it up online as well if you are still unsure. I imagine that
> a number of other people will post their findings to you too. Good luck
> either way.

This I've done, and AFAICS I'd probably have to monitor blood sugar, and
possibly even take insulin, in addition to modifying my diet, if I do have
GD.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[Cheryl S.]

zeldabee > wrote in message
...
> So I was pleased when at this visit my OB introduced me
> to the midwife, and she'll take care of me from here on
> unless something goes awry.

Great! I hope you and she get along well and that you're able to
continue care with her throughout the rest of your pregnancy, and birth.

> The bad news was that I failed the 1-hour GTT I had two
> weeks ago (though I'd expected for them to call me if I had).
> So now I'm supposed to take the 3 hour test next week. The
> midwife said it was pretty awful...

I've had the three-hour GTT before (while not pregnant) and didn't think
it was that awful. It's just like the one-hour, just two hours more of
sitting and waiting (and two extra blood draws of course, but those
don't bother me). Just be sure to take something interesting to do!

> What happens if I fail the 3-hour? Would that mean I definitely
> have GD? I've always been sensitive to sugar, and I'd never
> consume as much as the sweet drink they give you for the 1 hour
> test all at one time...I wasn't diabetic before, at least I assume
> regular checkups would have uncovered it if I was, but I've always
> reacted to sugar.

If you fail the three-hour, then they probably would diagnose you with
GD. I think that regular checkups would not necessarily detect diabetes
unless they specifically tested your blood sugar level or did a GTT.

> Should I watch what I eat more carefully? I've been avoiding eating
> too many sweets, but I don't avoid them entirely--I'll usually have
> some kind of treat every day (e.g., a dish of ice cream). I've tried
to
> focus more on making sure I get enough vegetables and protein, but
> maybe that's not enough. Will I have to follow a diet?

Once you have the results of the three-hour GTT they will be better able
to advise you on exactly what you need to do to control your blood
sugar. I think the usual thing to do is see if you can control it
through diet first, and if not, then move on to more drastic measure.
The people I know IRL who have been diagnosed with GD have had to check
their own blood sugar level X number of times per day, and were able to
keep their numbers within range just by eating carefully. For example,
one woman told me she could not eat just an apple and nothing else with
it. She had to eat some kind of protein (IIRC) at the same time. So it
wasn't even necessarily different foods than she would normally eat, she
just had to watch the timing and food combinations. Since you eat
little sugar normally, your body probably just isn't used to having to
produce a large amount of insulin all at once and didn't respond quickly
to the one-hour test. Hopefully the longer test will give your body
time to respond and bring the sugar level down so that GD is not
diagnosed. You actually don't want to avoid sweets in the days leading
up to the test. Eat normally, or even add just a little extra, like
some chocolate syrup in that bowl of ice-cream or something. I saw in a
later post that you're not supposed to eat the morning of the test but
in general, if you can eat that morning, that is the time to avoid carbs
and sugar and go for protein. Like Em said, a lot of people "fail" the
one-hour screening test but do fine on the three-hour diagnostic test.
I hope that happens for you! Good luck.
--
Cheryl S.
Mom to Julie, 2 yr., 3 mo.
And a boy, EDD 4.Sept

Cleaning the house while your children are small is like
shoveling the sidewalk while it's still snowing.

[Em]

"zeldabee" > wrote in message
> This worries me, as I read that c-section rate is higher in women with GD,
> since they tend to have "big babies"...I really want to avoid a
> high-intervention birth. I'm worried that I might risk out of the birthing
> center I want to go to.
<snip>

I hear you about fear about a high-intervention birth (I've had various
moments of anxiety re: most possible complications that might risk me out of
the birth center). Anyway, I don't know anything about your birthing center,
but I looked up gestational diabetes in my copy of the "transfer of care"
section of my birth center's Administrative Policies (I asked for this info
several appts ago & the doctor copied it out of their operations book for
me). Apparently, they won't take a client who has pre-pregnancy insulin
controlled diabetes. With regard to gestational diabetes, you will still be
able to have your baby at the birth center as long as the diabetes is diet
controlled. Even if it is diet controlled though, you are still required to
have a "consulting physician" involved with your care & not just the birth
center doctor. This particular birth center doesn't do the traditional
glucola GTT though, just a post-prandial, & I suspect that they are not so
quick to "diagnose" as a more mainstream doctor may be.

Good luck! You will probably pass the 3-hour & can move on to worrying about
what if you have pre-eclampsia and have to risk out, etc!

--
Em
edd 9/23/03
P.S. I forgot to say before that I find it kind of odd that they just waited
until your next appt. to tell you that you "failed" instead of calling
you...

[zeldabee]

"Em" > wrote:
> "zeldabee" > wrote in message news
[...]
> > So I was
> > pleased when at this visit my OB introduced me to the midwife, and
> > she'll take care of me from here on unless something goes awry.
>
> That's great about the midwife!

Yes, I'm glad. I really think I'll do better with a midwife.

> > The bad news was that I failed the 1-hour GTT I had two weeks ago
[...]

> Bummer about the 1 hr GTT. I don't know much about it, but from what I
> understand *many* women who fail the 1 hour go on to pass the 3-hour.
> Hopefully you'll be one of those! Best wishes!

Thanks...

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[zeldabee]

"Cheryl S." > wrote:
> zeldabee > wrote...
> > So I was pleased when at this visit my OB introduced me
> > to the midwife, and she'll take care of me from here on
> > unless something goes awry.
>
> Great! I hope you and she get along well and that you're able to
> continue care with her throughout the rest of your pregnancy, and birth.

I hope so too. I liked her. Right away she had some suggestions about
dealing with the swelling in my feet (vitamin B6, and a glass of grapefruit
juice each day, heartburn permitting).

> > The bad news was that I failed the 1-hour GTT I had two
> > weeks ago (though I'd expected for them to call me if I had).
> > So now I'm supposed to take the 3 hour test next week. The
> > midwife said it was pretty awful...
>
> I've had the three-hour GTT before (while not pregnant) and didn't think
> it was that awful. It's just like the one-hour, just two hours more of
> sitting and waiting (and two extra blood draws of course, but those
> don't bother me). Just be sure to take something interesting to do!

Awfully boring...during the wait for the 1-hour, I was too jittery to sit
still and read. So was the baby. Well, not that he can read, that's a
little optimistic...but he really jumped around.

[...]
>
> > [...]Will I have to follow a diet?
>
> Once you have the results of the three-hour GTT they will be better able
> to advise you on exactly what you need to do to control your blood
> sugar. I think the usual thing to do is see if you can control it
> through diet first, and if not, then move on to more drastic measure.
> The people I know IRL who have been diagnosed with GD have had to check
> their own blood sugar level X number of times per day, and were able to
> keep their numbers within range just by eating carefully. For example,
> one woman told me she could not eat just an apple and nothing else with
> it. She had to eat some kind of protein (IIRC) at the same time. So it
> wasn't even necessarily different foods than she would normally eat, she
> just had to watch the timing and food combinations.

I suppose I can deal with whatever is required, though it might be
difficult because my life is in such an uproar now, and it's hard to make
time to prepare food.

> Since you eat
> little sugar normally, your body probably just isn't used to having to
> produce a large amount of insulin all at once and didn't respond quickly
> to the one-hour test. Hopefully the longer test will give your body
> time to respond and bring the sugar level down so that GD is not
> diagnosed. You actually don't want to avoid sweets in the days leading
> up to the test. Eat normally, or even add just a little extra, like
> some chocolate syrup in that bowl of ice-cream or something.

This is useful information. :o) Not that I want to "beat" the test--if
there might be a problem with my blood sugar, I want to know about it--but
I don't want my regular habits to stack the deck against me, or lead to a
false positive (is that possible?).

> I saw in a
> later post that you're not supposed to eat the morning of the test but
> in general, if you can eat that morning, that is the time to avoid carbs
> and sugar and go for protein.

I've been told to fast from midnight until my appointment at 9:00am. So,
maybe I'll have a hamburger at midnight.

> Like Em said, a lot of people "fail" the
> one-hour screening test but do fine on the three-hour diagnostic test.
> I hope that happens for you! Good luck.

Thanks. This is actually reassuring.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[Cheryl S.]

zeldabee > wrote in message
...
> This worries me, as I read that c-section rate is higher in
> women with GD, since they tend to have "big babies"...I
> really want to avoid a high-intervention birth. I'm worried
> that I might risk out of the birthing center I want to go to.

At the birth center I'm planning on going to, you're only risked out if
you require insulin treatments. If you have GD but it is
diet-controlled only, you are still OK. I think that the higher C rate
among women with GD is probably, at least somewhat, a case of
self-fulfilling prophecy on the part of the OBs involved. Also they
tend to induce women with GD, and as all we good mkp readers know ;-),
induction increases your risk of C-section. So maybe it's not
necessarily the fact they had GD, but that they were induced, that was
directly responsible for ending up with a C. GD would just be an
indirect factor, in leading to the doctor wanting to induce in the first
place.
--
Cheryl S.
Mom to Julie, 2 yr., 3 mo.
And a boy, EDD 4.Sept

Cleaning the house while your children are small is like
shoveling the sidewalk while it's still snowing.

[zeldabee]

Ericka Kammerer > wrote:
> zeldabee wrote:
>
[GD and interventions]
>
> Different places have different policies, but many birthing
> centers will still take you as long as you're not on insulin. Also,
> the higher c-section rate is as likely to do with overly aggressive
> management as with any actual *need* for a c-section. You *can* say
> no to the c-section if it doesn't seem warranted to you.

I think my chances are much better now with the midwife than with the OB. I
get the impression that this MW tends to avoid interventions.

> And while
> you are at slightly higher risk of having a larger baby if you have
> GD, the combination of pre-pregnancy weight and pregnancy weight
> gain is actually a better predictor of birth weight than GD status--
> and most big babies are born to non-GD women and most babies born
> to women with GD are not big.

Oh, well, I'm probably likely to have a big baby anyway, then. I was
overweight to start. I've gained about 25 lbs and I'm now 30 weeks. Then
again, my mother has been heavy her whole life, gained 80 lbs when she was
pg with me, and I was 6 lbs something when I was born. She gained a lot
with my siblings, too, and they were also average-sized.

> > This I've done, and AFAICS I'd probably have to monitor blood sugar,
> > and possibly even take insulin, in addition to modifying my diet, if I
> > do have GD.
>
> Why? Most women can control it with diet alone.

Well, I did say possibly...I'd hope I would be able to control it with
diet.

> Furthermore,
> the research on the efficacy and desirability of using insulin for GD
> is highly controversial, with several respected organizations
> questioning its use. (Note: this is just with true gestational
> diabetes--women with true diabetes are in a different boat and
> may well need insulin.)

This is interesting. Is there a way to tell if a pg woman might have had
undiagnosed diabetes pre-pregnancy? In other words, is there any difference
in response to the tests?

> And, of course, as others have mentioned,
> the 1 hour test is only a screening test, and not a very good one
> at that. Most people who fail the 1 hour test pass the 3 hour test.

Here's hoping.

> Personally, I really wouldn't borrow trouble on this one.
> *IF* you have gestational diabetes, it's not even clear from the
> literature that you *should* treat it, much less that you have to
> sign up for a whole slew of invasive procedures.

I won't sign up for anything without looking into it, but I don't know how
much I can resist pressure.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[zeldabee]

"Em" > wrote:
> "zeldabee" > wrote in message
> > [...]I really want to avoid a
> > high-intervention birth. I'm worried that I might risk out of the
> > birthing center I want to go to.
> <snip>
>
> [...] Apparently, they won't take a client who has
> pre-pregnancy insulin controlled diabetes. With regard to gestational
> diabetes, you will still be able to have your baby at the birth center as
> long as the diabetes is diet controlled. Even if it is diet controlled
> though, you are still required to have a "consulting physician" involved
> with your care & not just the birth center doctor.

This birthing center is actually in the hospital, one floor below the
regular L&D floor. Also, my OB and midwife work in the same practice, and I
*think* my OB is going to have some involvement in any case, though I'm not
clear on exactly how much, or how that works. I'll ask my MW the next time
I see her.

> This particular birth
> center doesn't do the traditional glucola GTT though, just a
> post-prandial, & I suspect that they are not so quick to "diagnose" as a
> more mainstream doctor may be.

Post-prandial would seem (intuitively) to give a more realistic picture,
but surely there must be some cut-off point for diagnosis, some point at
which the mother should watch her diet to avoid the baby getting too much
sugar...I mean, GD is real, right?

> Good luck! You will probably pass the 3-hour & can move on to worrying
> about what if you have pre-eclampsia and have to risk out, etc!

Oh, that's the next thing to obsess about, is it? :o) Ok, then.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[zeldabee]

"Cheryl S." > wrote:
> zeldabee > wrote...
> > This worries me, as I read that c-section rate is higher in
> > women with GD, since they tend to have "big babies"...I
> > really want to avoid a high-intervention birth. I'm worried
> > that I might risk out of the birthing center I want to go to.
>
> At the birth center I'm planning on going to, you're only risked out if
> you require insulin treatments. If you have GD but it is
> diet-controlled only, you are still OK. I think that the higher C rate
> among women with GD is probably, at least somewhat, a case of
> self-fulfilling prophecy on the part of the OBs involved.

But isn't that so often the case? I'm always amazed, when I watch
"Maternity Ward" or similar, how *necessary* the interventions always seem,
and how they're never questioned or really explained...they're just
routine. It makes it seem like before pitocin and c-sections and epidurals,
birth just wasn't possible. However did our ancestors manage?

Mind you, I'm grateful for the technology that allows diagnosis of
genuinely risky conditions, like placenta previa and so on, but it was so
refreshing at my last OB visit, which turned out to be my first midwife
visit, to have her just feel the baby and listen to his heart, rather than
automatically go for the ultrasound. But I digress...

> Also they
> tend to induce women with GD, and as all we good mkp readers know ;-),
> induction increases your risk of C-section. So maybe it's not
> necessarily the fact they had GD, but that they were induced, that was
> directly responsible for ending up with a C. GD would just be an
> indirect factor, in leading to the doctor wanting to induce in the first
> place.

Is it a valid reason to induce if the baby *is* big? Say I go all the way
to the average 41.5 or so weeks, and they think the baby is big. As long as
his head isn't really big, shouldn't I be able to get him out anyway? Would
the baby also tend to have larger shoulders, or just have more body fat?
I'm not especially tall, but fairly wide-hipped, if that makes a
difference.

Anyway, I'll go the the orientation for the birthing center next week, I
can ask them then what their policy is re GD.

--
z e l d a b e e @ p a n i x . c o m http://NewsReader.Com/

[Ericka Kammerer]

zeldabee wrote:


> Post-prandial would seem (intuitively) to give a more realistic picture,
> but surely there must be some cut-off point for diagnosis, some point at
> which the mother should watch her diet to avoid the baby getting too much
> sugar...I mean, GD is real, right?


Depends on whom you ask. Some would say it isn't--or that if
it is real, treatment doesn't make a significant difference anyway.
Personally, I think it likely that unless you are an undiagnosed
true diabetic (or on the brink), it probably isn't a significant
issue. Others would disagree ;-) There's a decent discussion of
the issue in _A Guide to Effective Care in Pregnancy and Childbirth_
by Enkins et al. and in Henci Goer's _Obstetric Myths versus Research
Realities_.

Best wishes,
Ericka

[Ericka Kammerer]

zeldabee wrote:


> This is interesting. Is there a way to tell if a pg woman might have had
> undiagnosed diabetes pre-pregnancy? In other words, is there any difference
> in response to the tests?


Not with the glucose challenge tests. Does anyone know if
the A1C (is that the right alphabet soup?) test would be of any
use in figuring out whether a pregnant woman was diabetic prior
to pregnancy?


> I won't sign up for anything without looking into it, but I don't know how
> much I can resist pressure.


Yes, that's always the rub, isn't it? I'm not very good at
resisting pressure, which is why I opted for homebirth and opted out
of the glucose challenge test all together ;-)

Best wishes,
Ericka