Tuesday, July 24, 2012

1st glucose tolerance test: FAIL


Last Thursday I took the one hour glucose test. My doctor said she would call the next day if there were any abnormality, so when I didn't hear from her, I figured all was well.

The hospital where my doctor works has an online records system so that you can see your lab results, medications, appointments, allergies, etc. I received a notice today that there was a new lab result in the system. So I checked.

Not only did I fail the one-hour test, but I failed by what I think is a lot. My value was 179. Yikes! (cut off, I think, is 140).

I was immediately worried, and also really disappointed that I hadn't heard from my physician's office. It reinforced the idea I sometimes already have that I have to be the one to be on top of all of my data myself, that I can't depend on others. And this is pretty disappointing because I love my doctor. It was significantly confidence-reducing to feel that if I hadn't caught this who knows how long it would be until I heard from them? And what if it had been something more urgent?

I called my OB's office and they said she wasn't in. That a nurse could return my call. Then they asked, Who had given me the initial results?

When I told them no one had contacted me, that I'd gotten the results myself online, they put me on hold.

A minute or two later, my OB was on the line. She's working in labor and delivery today and they had put my call through to her. She was deeply apologetic, said the results hadn't come in until Saturday and that the nurse was supposed to call me yesterday.

She also calmed me a lot about the test result. Said I need to do the three-hour test, but that it may be normal. And that just because I had a massive fail on the one-hour test does not mean I will fail the three-hour. I don't totally believe her, but it will be what it will be. She said if I have gestational diabetes, we will deal with it. That I won't have a 15-lb. baby. That it will be ok.

I just keep thinking I should have been much more careful about my diet up to this point. I don't think I've been terrible, but I haven't been monitoring every morsel I eat, and perhaps I should have been.

I hope that Ms. Magpie hasn't been adversely affected. I feel like I'm screwing up as a mother already and she's not even here yet!

I'm going in for the three hour test on Monday. I guess sometime next week I'll know the results.

Ugh. Count me as more than a little bit worried.

Mo

P.S. If interested, click here for a simply worded explanation of the risks of gestational diabetes to mom and baby.
More of this yummy (not!) stuff is in my future!


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51 comments:

S said...

Mo, don't blame yourself. I was diagnosed with gestational diabetes (GD) during my recent pregnancy, and it has nothing to do with food choices and everything to do with how your glucose metabolism is changed by pregnancy. (I ate almost no carbs my whole pregnancy because they made me physically ill and still had GD.)

There are lots of women who flunk the 1-hour and pass the 3-hour test, so don't despair yet. And GD is totally managable with diet for most patients, if you do have it.

MFA Mama said...

You won't NECESSARILY fail the 3-hr test. I clocked a 180 on the 1-hr test during my third pregnancy (after passing the first two pregnancies) and had to do the 3-hr AND PASSED. My third child was born at term weighing a completely average 7 pounds, 1 oz. So don't panic just yet.

Pale said...

Hi Mo,

I flunked the 1 hr challenge 3 times and each time I went on to pass the longer test literally with flying colors. Go figure. Diabetes does run in my family, so I thought I was in for it when I flunked the challenge. Not so.

Fingers crossed for you on Monday. Worst case, I know several people who have had to do the GD diet and they (and their babies) did very well on it. Personally, I was more concerned about what it implied for my overall risk of developing diabetes later on.

Sunny said...

I will echo the previous commenters -- tons of mamas (including myself) fail the 1-hour and pass the 3-hour just fine. I did have GD with my twin pregnancy, but I had two placentas and was on complete bedrest (think not even able to sit up unless I was going to the dr or going to the bathroom for 3 months). Good luck!!

KC said...

I had the same experience. Nobody called me either I just happened to see the results at one of my appointments and then called to follow up. I was soooo annoyed!
Not to be a Debbie Downer but my doctor didn't have me do the second test because my first test was high. He said when the results are high it is a good indication that I had gestational diabetes. Then when I went to the classes and tested my sugars my blood sugar was super high.
I hope you dodge the bullet but honestly it isn't that bad. The needles (if you have to use insulin are nothing). After IVF it seems like a walk in the park. I actually learned a lot about healthy eating and it helped me loose my weight after I had the babies because I felt great on the low sugar diet.
Anyways, good luck!

Jacksmom said...

Don't blame yourself, there isn't anything you can do unless you have a nutritionist who has laid out for you exactly how many grams of protein and carbs you can have for each snack and meal. I failed the 1 hour with both pregnancies (the second one was 180's) and passed both 3 hour ones. My OB said most of the time if you're less than 200 you'll probably pass. Hang in there!

Lara said...

Please give yourself permission to relax a little on this one. You didn't do anything to cause it, and plenty of people have GD and all is fine. You will take it seriously, IF it turns out you do have GD, and will take care of yourself and the baby--so don't borrow trouble you don't have yet!

PJ said...

Hopefully you'll go back and pass the 3 hour. Which is a bitch, btw.

Should I share? I flunked both, but I'm pretty sure part of that is because I was carrying twins. I actually ate really well while I was pregnant, honestly.

They sent me to a dietician who set me up with a meter and coached me on how to eat. I really had a hard time balancing it out though. I thought I had it under control but Lauren's blood sugar was a mess when she was born. They got her under control within a few hours and she has been fine ever since.

Not sure if I should have shared that, but to say that things will likely work themselves out and she'll be fine.

MrsSpock said...

I failed my first GTT with the boy, and was shocked. I took the 3 hour test (YUCK!), and passed with flying colors. They told me there were a fair number of abnormal 1 hour and normal 3 hour tests.

sprogblogger said...

Add me to the 'Failed GTT & Passed 3-hour with flying colors' column. My doctor said it was really really common, and that he wished it was cool with the insurance companies to ONLY do the 3-hour test. Would have saved me some serious stress!

Hope your 3 hour numbers turn out to be wonderful. (And everyone scared me about the nasty drink for the 3-hour test, but it really wasn't so bad. Like flat soda. Not something you'd drink for fun, but nothing to make you vomit.) Keep us posted on how your 3-hour test goes!

Trisha said...

Try not to worry! Another blogger that I follow recently failed her 1 hr. test but passed the 3 hr. with flying colors!

Anonymous said...

I also massively failed the 1 hour and passed the 3 hr with flying colors- not even the slightest hint of GD the second time around. Seemed absurd that I was even there! So really, don't worry.

Katerina said...

Hi Mo- Did you fast before the test? I was told not to fast and I did. I was just shy of the top of the range. I'm not sure how much difference fasting makes, probably depends on the person. My 2 hour glucose (when not pregnant) is much lower than my fasting glucose, so who knows.

Alexicographer said...

I agree, very annoying on the test- results non reporting. I have learned never to accept "we'll only let you know if it's bad" and "it was within normal range" as acceptable answers, but just to be clear, what you are describing, though annoying, sounds like standard oversight/delay not necessarily (?) something that wouldn't have gotten caught? In any case, you caught it, so that's done.

I too flunked the one hour and, like any good infertile (and I'd been through far less than you have in that realm) freaked right the F out. I went out and bought myself a glucose meter and started testing myself, and I also started doing obsessive PubMed searches. This was in 2007, but basically what I found (in the literature) was that glucose intolerance is a continuum, one end of which we have defined as gestational diabetes, but (as with so much else in medicine) not really something that operates as a step function. As it happened, I was having trouble scheduling the 3-hour test so I decided just to dx myself as having GD and go from there. Which I was allowed to do (by the medical system within which I was working, which of course typically prefers physician- over self-diagnosis). It produced a few dumb moments in terms of my continuing to work with the (OB supported) midwifery practice I was within, but all went OK overall ... I did monitor my diet and blood sugars and did not require medication. GD is serious if not managed and it is also phenomenally manageable -- not that you really need something to manage, but it is do-able, and you are well and fully capable of managing it if you find you need to.

(As noted in my previous post my son was born full-term and he was not at all a large baby -- 7lbs 4 oz at 40w5d gestation though he did in fact arrive, after a long and difficult labor, by c-section (more common with GD; who knows if it was that, or his weird position, or some combination, or just bad luck), and he did have postpartum hypoglycemia. In retrospect, I suspect that the stress of my unproductive labor caused my blood sugar to spike (because heaven knows I wasn't eating anything), leading to his hypoglycemia but, again, regardless: very, very manageable. A possibility to be irritated about, perhaps, but not one to be worried about. Really).

It Is What It Is said...

As others have said, don't beat yourself up as it really has more to do with you being pregnant than with how you are eating (although how you eat once diagnosed with GD can make a huge difference). I've actually thought of following the GD eating plan while pregnant just to help ward off the kind of weight gain that I had during my pregnancy with my son. Just responding to this post solidifies that I am going to do some research.

Good luck on Monday. I had to do the 3 hour test when I was 30 weeks (after passing the 1 hour test at 24 weeks) because my son was measuring 2 weeks ahead on some measurements. I assure you, the worst part of the 3 hour test is the waiting around so bring something to read or do.

myfertilityjourney said...

Obviously I have no experience with this BUT I do have 2 friends that failed the first test and passed the 3 hour one. Hopefully it will be the same for you. xo

MyTwoLines said...

It will all be ok. Worst case scenario you have GD but my advice would be to see an endocrinologist for management--we manage gestationals all the time and our patients don't have big babies! They have healthy happy normal sized ones because we help their mommas keep their sugars in check :)

BNessen said...

I had GD with my daughter, and I felt soooo guilty that I had made the wrong choices, that I thought at the time were the right choices. It is totally not what you eat, it is how your body processes it all. From reading your blog, you are already an amazing mommy!

Lavender Luz said...

I never got as far as you are, but the GD test was one of the things that caused me much anxiety. I trust that things are great with Miss Magpie and I admire how well you are dealing with all the testing.

Katie said...

I had to take the 1hr and 3hr test twice. I failed the 1 hr both times and passed the 3hr both times. I didn't know I'd be taking the first 1hr since I was only 10 weeks then, and I had eaten a bowl of Kix for breakfast. You are doing a great job taking care of Miss Magpie

Heather said...

Failed and then passed with at least one of my boys, so ditto on that.

I also have a doctor that has great bedside manner and who I adore but whose office does a lousy job with a lot of things, not just passing along important lab results. I've raised these concerns to the doctor often enough now that they make double/triple sure they've contacted me, I'll get a text, an email and calls at home, work and cell.

Anonymous said...

I haven't read any of the previous posts and I've never commented even though I have been reading for a long time! I just wanted to send some reassurance to let you know that I failed the 1 hour test with both my daughters and passed the 3 hour tests. So failing the 1 hour doesn't necessarily mean there is a problem. :)

Anonymous said...

I also failed the first and passed the 3 hour test..

Anonymous said...

Best wishes on the 3hr test. What your other commenting readers have said is true. GD has more to do with your genetics and this pregnancy than you realize. Even type 2 non-pregnant has a HUGE genetic component that our society ignores while blaming and guilting people that they made poor food choices. Nothing you have written says you ate cherry pie a la mode for dinner, and 7 chocolate bars for dessert.
IF you need to you will cope with this issue. What you have learned however is priceless for your babies. A) check always for lab results rather than relying on a busy person and B) ALWAYS keep your own and your children's hard copy or backed up computer medical records for your use all your life. It is amazing the things you will be asked about 40 years later.
Holding faith for you!

Laura said...

Mo, it's a placenta issue and how it responds to insulin. Entirely nothing you could do. No worries. And many people fail the one hour and pass the 3 hour. I had GD with both my kids. My first I ended up going on glyburide to control my fasting sugar. The second I may not truly have had GD, but refused to do the three hour. Really, it wasn't bad. Poking my finger 4 times a day wasn't the best, but there are worse things. You and Magpie will be just fine!

Erica said...

I am another than failed the 1 hour and then went on to pass the 3 hour. :) I failed the 1 hour with a 198!

Marti Kubena said...

Reading through the comments, I'm seeing a lot of people say they failed the 1 hour, but then passed the 3, so I just wanted to throw my situation out there since I did NOT pass the 3 hour. I didn't fail it horribly, just enough to qualify as being GD with my third pregnancy (I had no previous issues with diabetes, pregnancy or otherwise). To be honest, it REALLY threw me for a loop mentally. That was probably the worst part. Probably didn't help that I was diagnosed the week of Halloween for a January baby and had to do the diet over the holidays. Otherwise, it was more worry than anything else. She turned out to be my smallest baby at 6lbs, 10oz.

All the people saying the 3 hour wasn't bad....I'm pretty convinced that is only true if you are not actually GD. I had to do the 3 hour several times over the last trimester and it wiped me out every single time. It made me feel awful. I basically had to go home and spend the rest of the day recovering. Just wanted to give you a heads up about that.
Good luck. Found out this morning that #4 is on the way and I plan on following the diet from the beginning so I'm not blindsided by GD again. Anything to lower the odss, right?

Eileen said...

Another failed GTT, passed 3hr case with my first here. I have no idea if this tip helped or not, but I heard a rumor that sitting during the waiting periods might increase the numbers. So with this 1hr test I walked the halls of the hospital for 20 min. I sat the other 40 because by then I was tired, and I happened to pass this time.

Hope all goes well on Monday.

Dora said...

Listen to all these smart women. You did nothing wrong. Your reaction is totally understandable. You really are handling this pregnancy so well. You seem to be finding moments of true enjoyment in between the anxiety. You rock!

B. said...

I passed the 1-hour with my second, but failed the 3-hour. I had GD with both, though, and it was NEVER a problem. It actually gave me some interesting insight into how my body was metabolizing the food I ate as I played around with carb quantities and types to see what they did to my blood sugar. I tested religiously with my first; not so much with #2, but both girls were pretty normal sized (well, #2 was 2 pounds heavier than #1, but she was also 3-inches taller and that had nothing to do with GD).

Bottom line- EXERCISE in the form of a 10-20 minute walk (depending on how "bad" your meal was) just after eating may be all you need to keep your sugars in check. It worked for me!

Don't beat yourself up, and don't panic. GD is not a big deal unless you don't know you have it.

Rebecca said...

Ugh! First of all, I'm sorry more of that nasty drink is in your future. Definitely not fun.

If you don't pass the 3-hour test, don't beat yourself up over it. Women who are super healthy, super strict eaters can wind up with GD while other women who have a far less healthy than ideal diet don't get it. To a large degree, it's out of your control.

Also, I agree with B. above that having it and not knowing it is when it tends to be a big problem. If you know you have it and you're managing it closely (which of course you would), that goes a very long way in minimizing the issues associated with it.

If you do wind up being diagnosed with GD, one thing to know - apparently babies of GD moms tend to lose more weight than babies typically lose immediately after birth, and they lose it faster, because they've been retaining a little bit more fluid than they would otherwise. Usually the guideline is it's okay if they lose up to 10% of their body weight during the first 3-4 days, and then doctors start to get nervous if it's more than that. Miss A lost 11% of her body weight (went from 7 lb. 12 oz. to 6 lb. 14 oz.) within her first 29 hours after birth.

The on-call pediatrician made us start to formula feed at that point, and we didn't know any better, so we didn't question it. When we saw our regular pediatrician when she was 6 days old (we delivered at a hospital where he wasn't on staff, so he didn't see her in the hospital) he explained that it's common for GD babies to lose more weight and that he would have kept a close eye on it but wouldn't have forced us to formula feed just 1 day after she was born.

luna said...

hopefully the comments here will reassure you that it will all be fine. just wanted to add, in case no one else has mentioned, that if you are able to WALK after you eat, that really helps process the sugars and keeps blood sugar low. but you probably already knew that!

Katherine said...

I didn't read all the responses, but my understanding is that there is a margin of error to the 1 hr test. With in a certain range (like 140 to something) you may have GD or you mat not. The 3-hour test is more accurate, no point putting women through it if they pass or majorly fail the 1-hour.

Believe me, it is totally possible to majorly fail the 1-hour. My sister-in-law did at 16 weeks. She scored somewhere in the mid or high 200s. So, she was on insulin the next 23 weeks. (Note, she does have PCOS, her blood sugar skyrocketed when she stopped Metformin. Now she's on another diabetes medicine.)

Me, I passed the 1-hr at 20 weeks, then failed at 30 weeks (about the same score you had). Passed the 3-hour (actually failed the first hour of it, but passed the later two).

Be sure to bring something healthy to eat after the test, my blood sugar actually tanked after the 3-hour.

Mina said...

Long time lurker delurking.
I had GD during both my pregnancies. My boys were both a very normal weight, but very long, because parents are long. :-)
There are hogh chances that if you DO have GD, you can control it with diet. And diet is very different from what normal people think of diet. I actually had a hard time keeping up with my compulsory carb intake. The good thing was that I gained practically no weight during pregnancy and I am now quite pleased. I was not much over the normal weight to begin with, my body just reacts poorly during pregnancy to hormones and thus GD. Stop blaming yourself. It will all be fine, IF you do have it.

Maddy said...

You've gotten a lot of helpful comments already, but I echo the sentiments of everyone else. This is NOT your fault. Blame the placenta if you want to place blame anywhere.

I passed the 1 hour test with flying colors with my first pregnancy (boy) and so was shocked to find out that I failed miserably with my second pregnancy (girl). I went on to pass the 3 hour test just fine. It's not fun sitting there for 3 hours and getting poked with a needle 4 different times. But remember, it's way easier than what you've done to get here and it will certainly be easier than your IVIG treatments! Best of luck to you!

I Believe in Miracles said...

I love all these smart lady responses.

Yes, I have also heard failing the 1 hour does not mean failing the 3 hour. AND --- no matter what, it'll be ok. You can monitor what you eat and your little one will be just fine.

It does sound like your OB is fabulous! The fact that they patched you through to her in L&D was great. I'm so glad you're in good hands.

AND I'm THRILLED that you're at the point where they're testing you for GD. It means you're almost there!!! YEAH!!!

xoxo

kdactyl said...

Don't worry....the only way GD will have negative affects on magpie is if it goes untreated. They test at this stage in pregnancy for a reason. I was GD my last pregnancy and no matter how I managed my diet...I could not keep those sugars under control so I had to take the oral meds...but it worked and I manged it well. Baby was born completely healthy with no blood sugar problems at all and because I nursed her for at least 6 months...that basically reverses any of the risks she may have been exposed to. Don't worry....nothing you are doing is causing this...it is that darn placenta.
kd

Bionic said...

I hate that the words "pass" and "fail" are used in this context, or indeed in any health context. Pushes all of my good-student anxiety buttons.

As evidenced by the comments I've read, the one hour test has an immense rate of false positive -- many docs won't even use it anymore for that reason and go right to the three-hour. (also, I know of at least one NYC diagnosis of gd that a nutritionist later decided was a massive lab error, fwiw.).

If you do turn out to be diagnosed, it is not the end of the world. What I have read on the subject does do much to convince me that the popular-press panic is justified: the bad outcomes are generally in the people who have or nearly have diabetes outside of pregnancy. Meanwhile, I am confident that your doctor, despite this lapse of contact, is going to keep a very close eye on you. No surprise macrosomia.

I am sorry this is happening and that it is scary. I do not blame you for being scared or for worrying that it is your fault, but for the record, it is not your fault. You could not have prevented this by doing something different. You are doing all the right things with this information. You are not to blame.

Amy said...

I failed both the 1hour and 3hour tests...my bloodsugar was high after the 1hour and tanked after the 3hour (like it was 39!) and my little weighed 6lbs at birth.

Don't beat yourself up. You're doing everything you can.

CK said...

I know that the one hour test is not the most accurate test. I failed mine...and failed the three hour by a very narrow margin. I too felt like I should have been paying more attention to my diet. Having said that, you worked hard to get where you are so please don't beat yourself up.
I ended up controlling my GD with diet alone since the pill prescribed for those who are borderline is NOT approved by the FDA for use in pregnant women. I have more info on this should you need it...but hopefully you won't!

CK said...

PS-my daughter was born healthy at 7lbs.
As someone else mentioned, this is more about how your pregnant body metabolizes food than what you are actually eating!!

Rebecca said...

Definitely annoying about the results not being given to you right away. Glad OB was apologetic. Like so many readers, I failed miserably the 1-hour (with ALL three pregnancies) and passed the 3 hr with the first two. With my third, I failed the 1-hr and then threw up the orange drink during the 3-hr (all over the waiting room), which screwed up the test not to mention the couch. So, rather than subject me to it again, the dr just told me to get one of those glucose test kits and test my blood a few times a day. I got one from a friend and OB wrote a Rxn for the inserts, etc. I never once had a glucose level over the cut off with that test. In fact, if anything, I was low. I think they really need to perfect that test because SO many get a false positive. Really aggravating.

Wendi Kitsteiner said...

I failed the one hour and was so mad at myself and passed the three hour with flying colors. A lot of it is what you ate that day. P.s. bring a movie to watch for your three hour!

Andrea said...

I'm sorry you are going through this. I'll echo what others have said, you may well pass the second test. Plenty of women do! As someone who had GD for my first pregnancy (managed with diet alone and no exercise as I couldn't do it) and has just found out I have it again I can also say it had nothing to do with what you have eaten prior to the GD starting mid trimester 2. Some of us just have bodies that can't make enough insulin while pregnant. It is age related as well. I was 39 the first time around and 41 now. If you do have it, the bad news is that finger pricks 4 x a day are annoying. So is part of the diet for me - less fruit. I also agree with a previous poster that the long test (2 hours here in Australia) is really hard and wipes you out, but I suspect that is when you have it. Apart from that it really isn't a big deal. Honestly! It is annoying, but completely manageable. couple of things I found last time around - fears over my son's size were unfounded, via ultrasound they thought he was going to be 4kg plus, but he turned out to be 3.3kg. Also I ended up cheating the diet sometimes after being very strict for a few weeks (fruit!), this time around I am giving my self permission to have 1 meal a week I don't monitor. Hopefully you won't have to worry about it and will pass with flying colours, but if not it isn't your fault and is really ok to deal with!

jacky lavine said...

I had GD with both of my pregnancies. Don't beat yourself up, you're a doctor, you know its not your fault!! For some of us, we just can't make enough insulin to keep up. Hopefully you will pass the 3 hour test!!! If you don't, you should be able to manage via diet. The odds are great that if you had GD you will at some point get type 2 diabetes. For me it was 10 years after my second pregnancy (or 15 years after the first pregnancy) that type 2 caught up to me. I am also quite overweight, so that brings it on earlier. I take a pill and every 3 to 4 months check my a1c. No big deal.

Carrie1074 said...

Firsts things first.....regardless of the outcome on the glucose test, it has nothing to do with any choices you have made or anything you have or have not eaten. #2- everything may be just fine. It is a good possibility that you will pass your 3 hour, and if you don't, then you and your doctor will do what is necessary at that point and everything will be fine! Hang in there, everything will be OK!

sonja said...

I failed the 1 hour pretty badly but passed with flying colors on the 3 hour. I have heard it isn't uncommon. I will be keeping you and your little one in my thoughts and prayers!

Rachel woodward said...

Don't despair Mo,
I have an Oct 27 th due date too, and just failed my 1 hour and 3 hour glucose tests. I met with a dietician and nurse, and both gave me great information on how
many servings of carbs to eat, and more importantly, to spread them out thru the day. I've been on this new regimen for over a week, and along with the glucometer testing and urine test strips, have been doing great.
Don't feel guilty about what you have been eating, as everyone has said, it's nothing you did wrong, your body just can't make enough insulin to keep up with your sugar production.
I'm praying for good test results on Monday.

Kristen {www.buckupbuttercup.net} said...

Good luck with the three hour test. And don't worry about your baby. I had GD and was told it doesn't set in til about the time they test you so you haven't been walking around with GD for very long if you have it.
Also, if you do have it, it's not so bad, the diet and the fingersticks (or wasn't for me). And if you do what you're supposed to do I don't think your baby is affected badly by you having it. Also I think being on the diabetes diet has also helped me as far as getting my pre-pregnancy body back.
Hope you don't have it, though! Fingers crossed!

Anonymous said...

A friend of mine failed the 1 hr and went on to pass the 3 hr, but she very clearly had GD because she ended up having an 11 lb baby.

Had she been diagnosed and followed the GD diet I'm quite sure her baby would have been much smaller. I have another friend who was diagnosed with GD and followed the diet very strictly and had a very normal pregnancy from there on out.

If you do have it, it's not the end of the world, just something to be managed. Should be no sweat for you!

Emily Erin said...

Hoping that tomorrow's test goes well for you and that you are able to take some of the 3 hours to update your adoring fans. Hoping that you, Ms. Magpie & Will are all doing swimingly!

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