Monday, July 30, 2012

3 hour glucose tolerance testing


I just completed my three-hour glucose tolerance testing. Things are not looking promising, I have to say.

The official bloods are being whisked to the lab at this moment, with results pending, but my husband Will recommended I start checking my blood sugars as soon as I failed the one hour test, and immediately provided me with a glucometer for that fun task. The values have been pretty ok the past week...sometimes a point or two over the ideal, but nothing too alarming.

But today. Today. Yikes.

According to my finger sticks, my fasting blood level today was between 95 and 102, the highest it has been all week (I tested twice - right when I got out of bed, and at the doctor's office. Weirdly, the higher level was at the doctor's office...I would have thought your glucose would continue to decline the longer you were fasting, but what do I know).

My one hour blood level after drinking the 100g of glucola (yuck!!) was 233. Seriously out of bounds, even if this meter isn't perfect.

My two hour blood level was 225.

And my three hour blood level was 176. I decided to wash my hands and do it again...resulting in an even more abysmal 184.


Here are the cutoffs to reach a diagnosis of GD...and my worrisome levels:


TIME OF SAMPLE COLLECTION
CURRENT American Congress of Obstetricians and gynecologists (ACOG)  TARGET LEVEL
Mo’s Levels according to her glucometer

Glucose load: Samples drawn after 100-gram glucose drink

Fasting (prior to glucose load)
< 95 mg/dL (5.3 mmol/L)
95-102 mg/dL
1 hour after glucose load
< 180 mg/dL (10.0 mmol/L)
233 mg/dL
2 hours after glucose load
< 155 mg/dL (8.6 mmol/L)
225 mg/dL
3 hours after glucose load
< 140 mg/dL (7.8 mmol/L)
176-184 mg/dL
Results interpretation
If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed. 



We will see how these values line up with the official venipuncture results, but you see what I mean about things not looking good?

I have only two risk factors for gestational diabetes: my age, and a family history of diabetes. I guess that is enough.

I'm thinking whether I meet formal diagnostic criteria or not, I should handle this aggressively. Honestly, I can't imagine passing the test with numbers like these showing up on my finger sticks (yes, we calibrated the machine correctly), but I suppose you never know. Maybe my glucometer is waaaay broken. I can only hope.

Needless to say, I am seriously, seriously bummed.

So I ask you folks: What would you recommend in terms of optimal maintenance of this situation going forward? Is a nutritionist/dietitian all I need, or could I benefit even more from a consult with an endocrinologist? Do any endocrinologists specialize in pregnancy-related diabetes/glucose tolerance issues? Or is just having my OB as the only MD enough? I want to take care of this as thoroughly as possible to reduce my and Magpie's risks now and after delivery.

One thing I'll have to ask my doctor....I was really sick last night - simultaneous vomiting and diarrhea (I'm guessing food poisoning). It was really not pretty. I thought I was going to die, but felt better enough by this morning to go in and do the screening. I wonder if being sick like that could have screwed up the test in any way?

I go in for my next OB appointment on Wednesday. I am hoping the test results will be in by then.

All thoughts in the meantime are most welcome.

Mo


Interesting graph of the difference in blood levels for diabetic versus nondiabetic.


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37 comments:

Allison said...

I know several ladies who have been fine with diet maintenance only. No need for any type of insulin. It's very random, and I hate that you have to deal with it. The good news is that I haven't seen anyone have complications from it. And so sorry about the stomach yuckies. That's the worst!! :(

R. said...

I had the GD and Im not going to lie- it sucked. My OB took an aggressive approach. He sent me to the endocrine unit that specializes in GD. I was monitored every two weeks for the remainder of my pg. it started off with excersize (walks) and diet changes, but very quickly we added the insulin. If you are not afraid of needles like me, the insulin is good because you can control your sugars way better and easier. Takes out the stress. I also got more frequent US which I loved so not all bad. Good luck. If you want any recipe ideas just ask!

Em said...

I would definitely ask about seeing an endocrinologist. I'm a more info the better kind of gal. The good news is that if you follow your diet, you shouldn't gain much more weight.

Jen said...

I don't have much advice. But I do know of someone who was able to control her gestational diabetes beyond the doctor's expectations with diet alone. Good luck!

Jesse said...

I had GD with my 2nd child (total of 4 pregnancies and she was the only one I had it with). It was controlled with diet and a pill called Glyburide. It was annoying to have to prick myself 3+ times a day, but in the end, I knew it was what I had to do.
Doc was concerned with a big baby so I was induced a week early...and funny thing is, she was my smallest child (6 lb 14 oz)
Good luck to you :) Thinking about you! :)

S said...

I had GD during my recent twin pregnancy (I had so many risk factors, it would've been a shocker had I *not* developed it), and I was able to manage it through dietary changes alone and never needed insulin. For many patients, control through diet and monitoring is possible.

My OB had me monitor my blood glucose level four times a day and see a MFM who treats lots of patients with GD for extra monitoring. (If I had it to do over, I might also see a nutritionist, as I found I needed to tweak things a bit on my own after only receiving instruction from the MFM's nurse on diet.)

Our sons never had any complications related to my GD, and the doctors and nurses who cared for me in the hospital--I was hospitalized pre-delivery due to preeclampsia--were very favorably impressed at how well-controlled my blood sugar levels were. I was told that this tight control is likely why the GD had no negative effect on my babies.

TheThirtiesGirl said...

I'm completely diet controlled. I was a pretty borderline diagnosis (not sure if that makes a difference or not). Starting with a dietician is a good first step. Then it's just trying different foods and figuring out whether they are triggers for you or not. Hoping that you get lucky also and can stay away from the insulin.

Anonymous said...

Yes, being sick the day before CAN, not will, impact your responses the next day. Your body releases 'energy' or 'sugars' when you do not eat for prolonged times, which is why fasting blood tests are informative.
How wonderful that medicine can now control these things and keep the baby safer than in years ago.
As long as you hold the goal firmly in mind you will manage with what ever comes your way in order to have your baby.
Using the meter before, and correctly timed after, meals can give you information that will help you control your weight and your blood sugars post baby. If you can see a specialist you will learn lots of helpful information.
Best wishes~ There is a silver lining and I HATE looking for silver linings too.

Jay said...

Ouch. This is new stuff, but run a pubmed search for pinitol/myo-inositol for controlling gestational diabetes, there was one interesting study showing what, I thought on a quick scan, was a significant effect. Worth discussing with your doctor.

Miss Megan said...

I was diagnosed with GD with my twin pregnancy after my epic fail of the three hour test as well. I was seemingly able to control it with diet alone, luckily. I suspect they will have you meet with a nutritionist and go over the GD diet, and start monitoring your blood sugars regularly (they had me monitor 5x a day). If after a week or two of monitoring if the diet didn't "fix" the problem then they may recommend medication. That's my understanding of how the process works anyway.
The fact that your blood sugars that you have been monitoring have been normal or very close to normal makes me think you will probably be able to just regulate it by diet.
Actually, I never did get any abnormal results when I was testing my blood sugars, even after eating something that should have made them spike (like pancakes with lots of syrup). A couple of months ago when they requested that I do the 1 hour test when I was pregnant with my son I refused it. I told them I would rather go ahead and monitor my blood sugars on a daily basis. They had me test my sugars for two weeks straight and bring in the results. I passed with flying colors, so they didn't make me take the actual GCT this time around.
I wonder...are your results on your glucometer normal because you are eating a normal well balanced diet? I mean, they do the test by giving you a glucose drink to see how well your body is able to regulate the glucose in the drink. But if you are fasting, and that is all you are eating/drinking, I guess I don't understand how they can expect to apply that to your body's ability to regulate blood sugar when you are eating normally. I mean, if you were regularly eating nothing but sugar it would make sense that your blood sugar levels would spike, but since you aren't normally eating that way, your levels on the glucometer aren't spiking (and appear normal). And that makes sense to me. Perhaps that is entirely too simplistic though? Eat right and your levels will be fine? Eat nothing but sugar and carbs and junk and your levels will spike?
Okay, I thought I was being helpful, but maybe not. Regardless, I hope you can "fix" it with diet alone! Hang in there Mo! Just a tiny bump in the road =).

Anonymous said...

I was diagnosed with gestational diabetis and got horrible numbers during the test. However I did not need to do anything apart from eating as normal/healthy (well skipped all fruit juice and made sure to eat not to much of fruit or simple carbohydrates). I just made sure to eat enough protein, complex carbohydrates , lot of vegetables and fruit and simple carbohydrates in moderate amounts (maybe 3-4 fruit a day). I made sure to eat very regularly. Found that I could not eat very much in the morning or after dinner but apart from that I could eat as normal. I usually started with oatmeal or bread in the morning and 1 fruit (07-08:00). Then at 10 clock I snacked on something. Then at nonn ( 11:30-12:30) I would eat chicken breast or some other meat (at least 100grams) and lots of vegetables and some carbohydrates (sometimes it was though hamburger and fries and had no impact on my glucosa levels at this meal) then snack at 15:00, then dinner at 18:30 and maybe some snack in the evening but couldn´t be much or else my glucosa levels next day would be slightly elevated

I was very detirmined to not need insulin so it was no problem to stick to the correct diet.

The endocrinologist that I saw looked at my 3 week blood glucosa levels and said I had nothing to worry about if I kept the levels within the normal range (one or two measurements slightly above) but that I should be aware for type 2 diabetis in the future and recommended that I excercised everyday (least 30 minutes) for the rest of my life and conintued to eat healthy to avoid type 2 diabetis.

My babygirl was normal sized and she was slightly low in blod sugar when born, but they told me not to worry as most children are that when they are born and that just children with mothers with gestational diabetis are measured for blood sugar. She was measured the first 24 hours and it slowly rised.. and I was told that was normal. Went home after 24 hours with my healthy baby girl and she has has hardly ever been sick , she will be 2 next week, already talking and very bright girl (normal weight) and nothing that suggests that this will impact her (apart from extensive family history of type II diabetis... but I hope she got her fathers geens regarding that)

I´m currently pregnant at 18 weeks with my second child after ICSI again, and I have been dreading my glucosa test, I have not been a good girl regarding the diet... :(

just wanted to say that it is very possible to control with diet alone.

sprogblogger said...

Ugh. Sorry you're dealing with this stress & hope that it's controllable with diet alone. I'm pretty sure I remember that Aisha was able to control hers through diet--she might be someone to talk to about recipes, eating strategies, etc.

If it aint one thing, it's another. Fortunately, this one is well-documented and with diligence on your part, can be totally controlled. Thinking of you.

newbie said...

Yuck, sorry Mo. Am hoping your actual results turn out better than the ones you recorded. But this is manageable, as many others have said. Am bracing myself for the same result because twin pregnancies are much higher risk for this stuff. Hope you get some good news soon.

MyTwoLines said...

Since I work in endocrinology I always suggest seeing an endocrinologist :) You have been to the most expert of experts for everything else related to this pregnancy so why not let the experts handle this part? Good luck!

Mon said...

I had no risk factor, better numbers than you and I still ended up on insulin even though I did so good with the diet. Go figure! However, due to the diet and excersice i got so fit that a labour was a blast. I dont think ive ever been more fit in my life lol ... Good luck to you !

Two Shorten the Road said...

I controlled mine with diet. It was a serious bummer, especially because I was confined on hospital bedrest. Not only could I not leave my room, I couldn't choose what to eat anymore either AND I was stuck with the hospital menu. Since you're still mobile and live in a place with a ton of options, you should be fine (my husband would bring me the occasional cheese cubes and olives). And it goes away immediately upon childbirth.

Laura said...

My OB had me see a diabetic educator/nutritionist. I went on a diabetic diet that included 2-3 carb choices for breakfast, 3-4 for lunch and 3-4 for supper with two snacks during the day that counted as 2-3 carb choices each. Honestly. Its s lot of food. I also had to test my sugar 4x a day. Fasting and after meals. My goal numbers were to be under 95 fasting and under 120 2 hours post meals. With my daughter, my fastings were high and I went on a small dose of glyburide that controlled it. That's it. You'll be fine Mo! And your baby won't be gigantic. I promise!

kdactyl said...

I had GD in my last pregnancy. I had no risk factors other than my age (I was 43). But...it was pretty easily controlled through diet up until the last few weeks where I had to take an oral medicine once a day in the morning. Baby did great, I did great...all is well and all risk factors for both of us pretty much go away as long as you can control it. I was automatically referred to a program designed just for GD patients where they monitored my diet and my blood sugars. I sent them my food charts and blood glucose levels once a week by email and met with them every other week. It was pretty easy and it actually kept me from gaining as much weight as I did with my first....so that was a small bonus :). I'm sure you and magpie will do just great.
kd

Sunny said...

I hope it doesn't turn out that you have GD! But it's not the end of the world if you do. When I was diagnosed with it, I met with a nutritionist. She gave me an easy-to-follow healthy diet, and I followed it to the letter. It wasn't FUN, but it wasn't all that difficult either. (I just have the belief that a pregnant woman should be able to indulge in a pan of brownies if/when she chooses.) Anyway, they looked over my numbers a week after I started the diet, and they were perfect. So I continued throughout my pregnancy, and they looked at my numbers every time I went in. Luckily I did not need insulin.

Wendy said...

I'm a type 2 diabetic. Most definitely YES will being sick the night before will most likely affect your blood sugars the next day or two (or three or four).

Honestly, I'd start with a licensed dietician and a diabetic educator. You can often find pairs of them that work together and they will get you in to see an Endo if need be. a diabetic educator often goes over the info with an Endo as well.

A word of note: the acceptable margin of error for blood sugar meters is 20%. Your 184 could have really been as low as 148. Particularly if you're using a Freestyle lite, which seems to run high for everyone.

Check out these links:

http://sixuntilme.com/blog2/2011/08/the_glucose_meter_shuffle.html

http://sixuntilme.com/blog2/2010/03/accuracy_in_glucose_meters.html

Pale said...

Hi Mo,

Just following along here to cheer you on. Others can speak better to these things ... so sorry you may have to have an extra concerns. Hang in there ... I know if you do have to deal with this issue, you are more than up to the task. !!

Much love.

Pale said...

Hi Mo,

Just following along here to cheer you on. Others can speak better to these things ... so sorry you may have to have an extra concerns. Hang in there ... I know if you do have to deal with this issue, you are more than up to the task. !!

Much love.

PJ said...

I kind of think the drs should have been more aggressive with mine, since they both had trouble at birth with their sugars being too low. My fasting blood sugars were always super low - like 65ish. So when I didn't eat for like 30 hrs because I was in labor from 8am - 1am the next morning, my girls needed sugar water to get their levels up. So maybe I needed insulin?

Then again I was already doing Lovonox 2x a day, so I probably would not have liked another injection.

I was also on bedrest so-no exercise.

Short answer is that I think a dietician wasn't enough.

Anonymous said...

Hi Mo,

I'm delurking to comment. First I am so happy for you guys! And so excited for you. I was diagnosed with GD (no risk factors) and was totally blown away by it. It freaked me out, but I was able to control my blood sugar levels through diet. I met with a nutritionist twice after I was diagnosed, but that was it. Once I had a good idea of what my body could tolerate, I just ate according to that. It was hard, but definitely healthy. I couldn't tolerate any carbs in the morning but would do better in the evening, so I just tailored my meals so my levels stayed in the good zone. My son was just fine. I guess I'm at a higher risk for diabetes later in life, and will be checking with my doc in a few months when my son is a bit older. Good luck and try not to worry too much.

B. said...

I'd be in favor of getting as much info as you can, but know that you may be able to control your sugars quite well with diet and exercise. I mentioned once before and will again- I had GD with both of my pregnancies and learned that a 10-20 minute walk could drop my blood sugar by as much as 40 points. Any time I got a "high" number (never as high as a "real" diabetic) 1-hour after a meal, I would take a walk then test again 2-hours post-meal. My 2-hour sugars were never high. Never. If I ate something I probably should not have (I needed ice cream a couple of times), I went for a walk immediately after eating, and my blood sugar would be fine. I learned a lot about my body through GD. It was a nuisance, but not all bad. And both of my babies were perfectly fine.

Barefoot said...

Ugh, I am so sorry, both about the test and your illness. (I had food poisoning while about 28 weeks pregnant, and it seriously sucked). Fingers crossed that the test results surprise you (in a good way).

Alexicographer said...

I think I'm only singing along with the choir here but -- yes, being sick could affect your results (so sorry, and glad you are feeling better). Our bodies keep secret stores of sugar in places like our livers (who knew) that they break out when we are stressed. As noted above, generally it's possible to control GD through diet alone (the 3 hour test is a BIG test of how your body can manage a big sugar hit, your daily life is not ...). I didn't see an endocrinologist myself (and did end up being OK with diet + exercise alone); OTOH, I am (generally) a fan of seeing specialists, so I'd say do whatever you are comfortable with. There may be an advantage to getting in with a specialist now even if you can control it just with diet now, just in case that changes later (OTOH, you are clearly well connected to be able to access good medical care, and there is a short list of things that the medical system takes pretty seriously. I'm pretty sure uncontrollable GD would be one.). I will say that I contemplated the assorted drug options when navigating GD in a sort of "what if" way and found I was much more comfortable with the thought of insulin while PG than ... anything else. It's a product our bodies make naturally, and something we've been using a long, long time so it seemed unlikely we'd suddenly discover it caused ... some previously unrealized problem. But obviously that's me and you may have other thoughts on the pros/cons of the various options.

And yes, as others have noted (above) while it's true that GD generally disappears postpartum, it does also seem to mean we are at elevated risk of developing type II diabetes, sigh.

Hang in there, Mo -- you've come so far, this *is* navigable (and *you* can manage it), and of course, you've got us Internets rooting for you.

Aisha said...

Hi Mo, I just wanted to chime in that I had such high blood sugar levels on my one hour that they didn't even test me for the three hour. It was in the high 200's. I was able to control it with diet and exercise [a 20 minute walk after dinner each day] and my son was born 7lb 12oz which is exactly how much I was when I was born and my mother did NOT have GD.

It will truly be okay. Very common and very manageable!

~M said...

I don't have much time right now - am headed off to bed, but I wanted to say that you definitely need to discuss your illness from last night with your doctor. That can affect your sugar levels.
When fasting goes too long, the liver does a sugar dump - when your BG got too low (maybe because you were ill the night before), the body dumps a reserve of energy into your system. This is what caused your early spike - and could throw the whole test off.
Even if that is not the case, don't fear - good monitoring through diet CAN help a great many people with GD. They will do a great job monitoring you - and I know you'll stay on top of it. If diet does not help bring your levels down, you'll get the other help you need. Chances are good that they'll send you to a specialist - and the doctors are VERY good at managing GD when they have an engaged and proactive patient.
Good luck!

jenicini said...

I haven't had experience with GD, but my husband was (not anymore!) prediabetic. He never ate breakfast which actually made his levels higher each morning. Eating consistently helped him. :) Random, but just FYI. :)

Mina said...

Diet works in 90% of the GD cases. I hope you are not in those 10% thtat need insulin. I agree with who said that GD makes you eat healthy and stay fit - if only I were able to keep the habits after pregnancy... But the motivation is not the same. :-)
Cheer up. It may suck, but is not the end of the world.
I met with a doctor specialised in diabetes and more precisely GD. But in germany you have to go to a specialist no matter what.

Lydia said...

I had no risk factors, and still developed GD. I was able to control it through diet and exercise alone. Breakfast was the trickiest time though, I usually had eggs and veggie sausages, as even All Bran was enough to shoot my levels up too high. The rest of the day I could eat a small portion of complex carbs and be okay.

I would recommend not only seeing an specialist, but seeing if you can find someone who specialises in GD, not just diabetes - they are quite different situations.

Also, be aware that after your beautiful baby girl is born, they will be conducting skin pricks and glucose tests on her every four hours or so for the first couple of days.

Best wishes to you and little Magpie.

Kaitake said...

Hi Mo, damn, what a diagnosis. I would, however, simply love to have your test results. See, I am a type 1 diabetic. Have been for over 24 yrs now. I do a blood sugar test about 8 to 15 times per day, and inject myself 5 or more times per day. I offer you any help you may need, answers to your diabetes questions, direction to resources, just flick me an email and I'll do what I can for you. It's about now one starts to truly appreciate the pancreas, and how mind-blowingly complex the body is. :P You asked about seeing an endocrinologist? Yes, as soon as possible do that. Best wishes and good luck.

Augusta said...

I'm sorry that the test did not have the results that you hoped for. I suspect that you will become very familiar with GD and do everything in your power to manage it and mitigate the effects on yourself and your wee Magpie. It sounds also like you have great health professionals accessible to you, and that will serve you well.

Rachel Woodward said...

Mo,
I just met with my dietician yesterday for my final GB appointment. She told me that being sick can raise your blood sugar levels. This would make sense in your case. Having pretty normal readings all week, then really high the day of your GTT. Smart of you to start monitoring immediately. Good luck with your results.

Cat said...

I know I'm a week late to the party, but I had GD with my triplet pregnancy. My MFM preferred that I still get all the calories I needed to grow the babies, so he medicated me to keep my numbers in check. It wasn't insulin, but a pill that I can't remember the name of. Message me if you want me to dig it up. I still followed the diet, but was able to eat more servings because of the medication. For my situation that was important, but I also know there were a number of other triplet moms that managed it with diet only.

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