Sunday, August 1, 2010

A word about gestational diabetes

This is the second time around I've refused to do the standard glucose screening test that is recommended in Israel for all pregnant women. It involves swallowing 50 gr  of glucose in one gulp after a night's fast; many women are found "suspicious" of gestational diabetes and sent forward to do another test, this time with 100 gr of glucose.

Why did I refuse this test, which is done for free here and is considered to be perfectly safe?

1. I don't believe it's necessary for me. Last time I was pregnant and this time too, I've had doctors tell me a lot about the horrors of undiagnosed gestational diabetes. I agree that if you have gestational diabetes it's very important to know. However, they try to present it as though each pregnant woman has equal odds of getting gestational diabetes, which is simply not true. Like for pretty much every medical condition, there are risk factors.

If, like me, you are young, not overweight (and have not gained excessively during pregnancy), do not have any family history of Type 2 diabetes, do not have high blood pressure, have not previously delivered large babies, your fasting blood glucose is normal and you have not had glucose detected in your urine, you are in the low-risk group and the chances of you getting gestational diabetes are slim. I'm not saying this means you won't get gestational diabetes. But your chances are far, far lower than of someone who is overweight and has family history of Type 2 diabetes. My doctor had tried to make it sound as though it doesn't matter – which was, of course, a lie made to frighten me into doing the test.

For most women, gestational diabetes is kept under control with a healthy, balanced diet and exercise. Only some need insulin shots. However a healthy diet and exercise should be the practice for every pregnant woman anyway. I have the advantage of a degree in nutrition, which helps me not only to keep a balanced diet, but to also be well aware of potential signs of gestational diabetes.

2. I suspect it's not completely risk-free. 50 gr of glucose equals, to my estimate, to about 10 teaspoons of sugar. I do not eat a lot of simple sugars and do not touch soft and fizzy drinks. As far as I remember I have never swallowed 10 teaspoons of sugar in one go, certainly not after a night's fast; taking in so much sugar in one go isn't natural for our bodies and I wouldn't say it's healthy for a pregnant woman. Yes, I have heard the arguments that our bodies are sturdier than that, that it's just one time, that the test shouldn't be associated with any damage. It is admitted there is a risk your blood glucose may drop drastically low after it skyrockets when you take the glucose, but doctors usually brush this off. However if your blood glucose drops very low you may faint. During pregnancy, our bodies are far more sensitive. Has someone really researched the long-term risks? I realize I'm just speculating here, but I find it extremely off-putting to load my body with a large quantity of glucose in one go.    

27 comments:

Anonymous said...

Hi Anna,

Interesting post...

Of course it is entirely up to you what you do with your body at this time, but the reason doctors encourage women to take this test is because gestational diabetes can affect any woman, it can be symptom-less and although certain factors increase the risk of developing the condition, up to 60% of women who have gestational diabetes have no demonstrable risk factor (such as being overweight, smoking etc).

So in the eyes of the medical profession, the risks involved in not being able to diagnose and treat diabetes in a pregnant woman are far greater than the very short term effects of the test.

Of course pregnant woman should have the right to refuse testing and treatment if they wish to do so, but the testing exists for a very important reason. The medical profession does not know everything, but they do know an awful lot.

Martha

Anonymous said...

Hi Anna,

During my 6th pregnancy I was diagnosed with GD. The blood-letting to test my sugars was so painful I didn't want to eat so I didn't have to do it. I managed to lose 3 pounds in one week and my husband told me this was ridiculous. He was absolutely right. I stoppped testing and just made up the numbers the doctor wanted to hear at my exams. My precious baby was born perfectly healthy and so am I. I agree with you, since you know about nutrition, this test is a waste of your time and could very well be harmful! Good luck.

in His peace,
Marie

Anonymous said...

Hi Anna,
This question really has nothing to do with this post, but would you mind doing a post on breastfeeding only during the first year for a baby? I think this is what you chose to do and what I want to do myself but am getting lots of "information", read unsolicited advice, about how bad this is for my child and how I will just have to supplement with formula and other foods. I want to know your take on this issue.
Thanks!
Kristin Shoemaker

domestichippie said...

I was diabetic before Igot pregnant I'm very well controlled but since the pregancy I have been put on once a day low dose of insulin.

I took the fasting glucose test pirior to pregnancy to diagnose me in the first place. It was awful and I almost passed out. I suspect I wouldn't be as hard on a healthy woman. But I imagine if you are not used to quick sugar in large doses it could be rough.

However what many non-diabetics don't know is that diabetic friendly diet doesn't just mean limitng quick sugars but also carbohydrates that break down. Bread pasta, espescially rice can cause BG spikes if not eaten in the proper portions. Also not all diabetics react the same way Rice always spikes me while cake icing does virtually nothing. I'm very weel controlled but it took about a year to really understand things and figure out what my body likes.

However I grateful we got it under control before I got pregnant my doctors are continually amazed at how low I still am going into my third trimester.

K said...

Anna,

Your points are wonderfully made, thoughtful and make 100% sense. Thank you for sharing them. This issue indicates, to me, a larger breakdown in gestational "obstetrical" care.

Mrs. Reverend Doctor said...

I am overweight but have had two average weight babies and am expecting a third, my midwife here does a finger prick test, then I drink a Sunny Delight drink then an hour later she does another finger prick. Of course she also comes to my home for all my prenatal visits.

BellaMama said...

I am in complete agreement with you, Anna! I got chills when the docs wanted me to eat jelly beans or drink orange juice with added sugars for a tolerance test. I don't drink sugar drinks of any kind or even eat processed foods with all sorts of simple sugars/carbohydrates, so I refused the test. The majority of women think they can eat a side of vegetables and that's enough to say they're eating healthy or stop drinking or smoking, etc. They don't realize the huge role they play in getting the required building blocks to help their child grow in the womb into the perfect baby! I think that most believe the docs will let them know what they need to do and then just "try" to the right thing. Those are the women with the horror stories...,"but now that baby is 5 weeks old we can take him home and that nightmare is over." They could have avoided so much just by educating themselves and truly working at creating the perfect environment for an intelligent, happy and healthy baby!
It really saddens me that these women won't hear the easy way of taking care of themselves and reducing their troubles, but I guess everyone is different and needs to learn the hard way.

Hope you have an enjoyable last bit of pregnancy & I, too, look forward to seeing pics of your new little one!! Blessings of a easy and joyful birth!!

Mrs. Anna T said...

Kristin,

I did exclusive breastfeeding for the first six months of my baby's life, when we introduced complementary foods. Most babies are quite eager and curious to try solids around that age and that's good for them; a few are satisfied with breast milk only until they are older. Not all babies are the same and I think the best is always to listen to your baby's cues.

By the time my daughter was one year old, she was eating pretty much anything. However we never gave her formula. You don't "need" formula, which is just an inferior substitute to breast milk. In my eyes any baby or toddler who drinks formula should still, ideally, have been breastfed. There is, however, a point when real whole foods should be introduced.

My daughter gradually moved towards depending more on solids in her diet and eventually self-weaned at 15 months.

Mrs. Anna T said...

PS: It should be noted that I was nearing my second trimester of pregnancy by that time, so my milk supply dwindled. No doubt that prompted weaning, too.

Mrs. Anna T said...

Domestichippie,

You are absolutely right about the intake of carbohydrates and not just simple sugar. It depends on *how* fast those carbs break down. We did a postprandial glucose test when we were students (as part of our lab) and I saw that glucose levels aren't very different after eating white bread compared to simple sugars.

By the way I believe postprandial glucose (checking glucose after a normal meal) could be a healthier replacement for the currently performed glucose tolerance test. It would not overload the body with sugar and it would still be a good indicator for diabetes. It isn't done because it's "more difficult to standardize", meaning that it would require more planning, individual approach and just plain common sense from the medical staff.

Karen said...

Anna it's so weird that you said this:
"I suspect it's not completely risk-free."

So do I!! One of my friends unfortunately lost her child to stillbirth ON THE DAY OF taking this test. They told her to fast all morning long, and shortly after was when labor began. It turned out the placenta had clots in it, so perhaps this would've happened anyway - BUT the child was a normal weight for his age. On the off chance your child isn't getting enough nutrition, I think starving a woman for several hours is EXTREMELY dangerous!!

Mrs. R said...

I have been wondering about this as well. More worried about the ingredients, though. We don't eat a lot of artificial ingredients, and I can't help but wonder how much HFCS, artificial dyes, etc. are in that stuff.

Anonymous said...

Thank you for this post! I'm not married, but I always find your posts treasures of wisdom that can(G-d Willing) be put to use later. Thank you, Megan

Daughter of Eve said...

I totally agree. During my last pregnancy I had to have this test done, I did it out of ignorance, and of cores fear. I actually had to go at it twice since the first time the sugar hit me so bad, plus got car sick that I threw it all up. In the end I had a healthy little baby girl.. I hate wish I hadn't gone through some awful things like that.

Blessings.

Anonymous said...

I can't say I "never" eat sugar, but I certainly don't indulge in a lot of soda or jelly bread, etc. A surgeon I was seeing had me take a glucose tolerance test, and then told me I had diabetes. I was due for a D&C and called my gyn to let him know this, and he asked me "Who the hell told you THAT?" I told him, and he snorted. "He tells ALL his female patients they are diabetic. If you didn't kick into gestational diabetes with two pregnancies, I'm not going to worry about it - and you shouldn't either." After the D&C, my gyn suggested I have a sticky bun, or something equally sweey every other day for a week, and then retake the test, which HE checked. Perfectly normal. He said that because my system wasn't used to large doses of sweey stuff, it sort of "flipped out", but once I had given my system a "warm up period", the glucose didn't affect it. And I hope that made sense.

Anyway, Mrs. T, if you don't eat a lot of sweet stuff, I wouldn't bother with the test. You may very well get a false positive, as I did. Not that I'm a doctor, but you know your own body better than anybody else.

Lady Anne

Leah Brand-Burks said...

When I had mine, another pregnant woman had to cancel her glucose test because after less than one hour of taking it (but very close to 1 hour) she vomited the solution. She'd spent all that time nauseous, and ended up having to come back the next day and try again! I hated those tests.

Belinda said...

Anna,
A friend of mine has had several miscarriages. The last one was at 19 weeks which was getting a little late to have been progesterone related(she had been having progesterone issues). Her midwife had said that leaps in blood sugar temporarily cuts off the placentas blood supply which if done often enough could cause the placenta to detach completely. Gestational diabetics are at a higher risk for still birth. Could this be the cause? More thoughtful research should be done.
Thank you for raising awareness.

Lady M said...

I have always done this test, not knowing until this pregnancy that I could have declined it (duh - why would I not know that I could decline it - I used to work there!!). But anyway, the last pregnancy, it left me feeling icky afterwards (and it was not even the fasting one) and then this one was worse - I failed it. I knew I should have gone with my gut and skipped it that day and done it later. I had had a nasty cough for 2 weeks & then just 40 min prior to the drink, I had had homemade waffles w/non-maple syrup (we ran out of the good stuff and made do with a simple sugar syrup with maple flavoring). I knew better - another big duh. So, I got stuck doing the fasting one with the 100g drink. Uhm, yeah. Pregnant lady who is used to a small meal with protein before bed has to fast instead. I did not sleep well because my stomach woke me up growling all night long. My veins were not cooperative (they are not fabulous under normal circumstances) & I felt worse & worse as that 3 hours post drink wore one. I passed the thing, but I was sapped of all energy for the rest of the weekend! Ugh! I felt rotten! The fasting one just is not a good idea. I do not eat much in the way of processed foods, let along a huge amount of sugar like that.

After doing some research online & in a couple of alternative pregnancy books (the ones with the good information in them) after that, I have found that that this testing is actually controversial within the medical community as to whether it is truly necessary or not and if there is truly has much danger as they hype it up to be - even if you are in the high risk group.

Gothelittle Rose said...

Karen: My condolences to your friend and that was a dreadful thing, but I am certain that the fasting did not cause it. Women have healthy babies all the time in countries where they can only spare a small bowlful of rice per day for nutrition. Women who look almost skeletal have plump little six-month-olds drinking away on Mommy's milk. The baby/pregnancy takes what it needs first, and the mother takes what she can get afterwards. I'd be more concerned about the sugar rush than the fast.

Kristin: I've heard that mother's milk tastes very much like a sort of sweet and milky version of whatever she's been eating, so the baby gets a variety of tastes simply from nursing. Doctors who talk about supplementing usually do so from the viewpoint of a formula-fed baby, who needs to start experiencing different tastes by 6mo or so or he/she may reject them later.

I breastfed near-exclusively (one 2oz solids jar a day) until about 10mo because my baby was a reflux baby. She's less picky than I was at her age and I wasn't a reflux baby. All in all, the extra nursing didn't hurt her any and probably helped a lot.

LeAnna said...

I can't believe they would have you fast the night before, that is absolutely ridiculous! I would have declined in that case also. We never have to fast prior to taking our test, and our Dr's/midwives will tell you to eat normally (though to avoid a pancake breakfast the day of!). Fasting seems to me like a) one surefire way to ensure you fail the test, sending you in for the 3 or 4 hour test later and b.) a great way to make more money off the government! A sad state our health care systems are. I still hope and pray the US doesn't head down that path...

MacKenzie said...

I didn't do it either, for the same reasons. I'm not sure if I would have even thought to decline it at a doctor's appt but my midwife explained why she didn't think it was necessary and I agreed.

Ghost said...

50 grams!!?

I wouldn't do that either, and I DO have a family history of type II diabetes, and sugar metabolism issues. I use a glucometer regularly to keep track of what my food is doing to my blood sugar levels. My reactions are not severe enough (yet) to classify me as diabetic. But I KNOW that 50g of glucose in one go would put my blood sugar through the roof. I don't need a GTT to tell me that! That is why I avoid the sugar and sweets (and even fruit, like bananas!). I can't imagine deliberately doing that to myself, even for a medical test.

Anonymous said...

Anna and Gothelittlerose,
Thank you for your input. I appreciate your time and answers to my question.
Kristin

Anonymous said...

Anna, our midwives here in Florida USA do not require either a fast or the vile glucose solution prior to the glucose test; instead they suggest you eat a "50 gram carb breakfast" two hours before your test, which they do in their own office. The breakfast consists of two cooked eggs, two slices of whole grain toast, 4oz unsweetened juice and 8oz skim or low-fat milk. It was a pleasure to take the test this time; no sitting around in a lab for an hour either, just in & out at my regular appointment.

Karen said...

You ladies are so smart. I have read that prolonged fasting can cause miscarriage, particularly if your body isn't used to it. But what one of you was saying about the blood sugar rush cutting off placental blood flow...that would make perfect sense with what happened. That is just way too much of a coincidence her fasting all night and all morning then drinking that stuff and saying she didn't feel good and going into labor that very afternoon. I'm not sure what to tell her tho bc I know she wants more babies but she is high risk for GD? Maybe a diet change? I know her diet is poor.

It's been especially hard on her as she just lost a baby to SIDS last winter, so I don't want to sound preachy when giving advice.

Mrs. Anna T said...

Karen, if I were this lady, I wouldn't risk taking the test again. I would simply go on a diet fit for diabetics, from the beginning of pregnancy or even before. It's not supposed to be a very restrictive diet and it's good for everyone. It simply includes eating healthy whole foods in balanced proportions, little to no refined sugars, and a controlled intake of carbs in *small* portions throughout the day to keep glucose level even. She should see a nutritionist to help guide her if she isn't sure how to do it on her own.

Sasha said...

Wow!!!!I totally agree with you!!!This is just crazy...