How important is the timing of glucose tolerance test?

[vonfirmath]

My previous provider was habitually "delayed" in what week they called me. I am due August 5, so am 29 weeks now.

 

They scheduled my glucose test at the VERY end of the 28th week (wednesday) and I failed it. My levels are "elevated" (Maybe I need to find the actual numbers?)

 

They want me to come back to take the 3-hr test in "the next week"

 

Except, the SAME day I found out that the only provider I actually connected with has left due to significant differences of opinions with her partner... and the rest of the practice has veered widely more crunchy than I am. And I can no longer go there. So I am switching ob-gyn providers to one that lines up better with my birth philosophy -- but she can't get me in until June 8th.

 

Will waiting three weeks to take the 3-hr test be a problem? That sounds like a LONG time to wait. Or should I call back and see if I can get in for the lab work before that?

Edited May 20, 2011 by vonfirmath
make the title clearer

[twoforjoy]

I have the same due date as you, and I also took my 1-hr GTT on Wednesday.

 

Do you need to see the provider to get the test? At the practice I go to, the lab is separate from ob/gyn, so I could go to the lab and get a test done without needing to see my ob.

 

I probably wouldn't wait three weeks for the test. Maybe call the new provider and see what they say? They might try to get you in earlier or have you do the test at their lab.

[Jean in Newcastle]

If it is a bit elevated, I would just watch my carbs. Do not drink fruit juices at all but you can eat fruit (your body metabolizes it differently). Go low carb if you can. Keeping your sugar lower for your baby is the real important thing here, not the test itself.

[vonfirmath]

If it is a bit elevated, I would just watch my carbs. Do not drink fruit juices at all but you can eat fruit (your body metabolizes it differently). Go low carb if you can. Keeping your sugar lower for your baby is the real important thing here, not the test itself.

 

I found out the results. I got a 147 and they want to see less than 140.

[Rosie_0801]

Go low carb if you can. Keeping your sugar lower for your baby is the real important thing here, not the test itself.

 

Yep. Eat as though you flunked the 3 hour test too. Substitute some of your usual grain intake for legumes, if you can. It helps.

 

Rosie

[kokotg]

You can also pick up a glucometer at the drug store and check your sugars yourself (the meters are very cheap; the test strips are pricy). I think getting a good idea of how your body reacts to the foods you typically eat is much better than drinking a giant dose of straight glucose anyway. FWIW, with a 147 it's very likely you'll pass the 3 hour. I always failed my 1 hour, but only failed the 3 hour once. I looked up the numbers once, and it's something like 80 or 90% of people with 1 hours under 150 pass the 3 hour. of course, the one time I did fail the 3 hour, my one hour was 143, so, as always, YMMV.

[chanda7]

Sounds like you are on the border, and you could very well pass the 3-hour test. I've read that the baby is putting on the fat layer between 28 to 32 weeks, so that is a critical time for you to have your diet under control if you are having glucose issues. Another vital period is the 6-weeks leading up to delivery, for weight but especially so the baby doesn't overproduce insulin and have hypoglycemia issues once born, etc.

 

By dumb luck (or not), sugar showed up in my urine at my 16-week appointment after a hefty serving of OJ (something I rarely drank but we were out of milk that morning). I failed the 1-hour with a 170-something and the 3-hour really badly (my second hour score was 250-ish). Despite the awful scores, I've been able to keep my numbers down with diet alone, and actually, I tend to go hypoglycemic if I don't eat every couple of hours. You may be able to get away with more carbs, but the basic diet is 15 grams per serving of carbs, 7 grams per serving of protein. You can do 1 to 2 carbs and at least 2 proteins for breakfast, 2-3 carbs and 3-4 proteins for lunch and dinner, 1 carb and 1 protein for snacks. The important thing is to have proteins with the carbs to slow down their absorption. Without doing glucose testing after your meals, it is hard to know how certain carbs affect you. For example, I can eat pasta and, of all things, baked potatoes without a problem. Bread is more iffy, and rice sends my blood sugar higher than it should be (but not ridiculously high). I've only gained 8 lbs. this pregnancy because I had terrible morning sickness until around 4-5 months, and I've been on the diet since then. I had no symptoms, no history of diabetes in the family, 2 children born on the smaller side of average, etc. My case is actually pretty mild, which is a tad bit shocking based on my testing numbers.

 

If you really have to wait that long for testing, you might want to buy a glucose monitor and start checking your numbers. Generally, they want your fasting under 95-100 (sometimes even 90), and 2 hours after the beginning of your meal, your numbers need to be under 120. The generic monitor available at Wal-Mart is supposed to be one of the cheapest (including strip costs) and has a reputation of being fairly accurate (as accurate as monitors get, but don't get me started on that).

 

Sorry for the book, but this is coming from the trenches. I'm at 33 weeks right now.

[chanda7]

Yep. Eat as though you flunked the 3 hour test too. Substitute some of your usual grain intake for legumes, if you can. It helps.

 

Rosie

 

Some diabetics cannot eat legumes, as the carbs will spike their blood sugar. YMMV.

[Aelwydd]

My previous provider was habitually "delayed" in what week they called me. I am due August 5, so am 29 weeks now.

 

They scheduled my glucose test at the VERY end of the 28th week (wednesday) and I failed it. My levels are "elevated" (Maybe I need to find the actual numbers?)

 

They want me to come back to take the 3-hr test in "the next week"

 

Except, the SAME day I found out that the only provider I actually connected with has left due to significant differences of opinions with her partner... and the rest of the practice has veered widely more crunchy than I am. And I can no longer go there. So I am switching ob-gyn providers to one that lines up better with my birth philosophy -- but she can't get me in until June 8th.

 

Will waiting three weeks to take the 3-hr test be a problem? That sounds like a LONG time to wait. Or should I call back and see if I can get in for the lab work before that?

 

 

I suppose that depends on how you feel about the relative risks of gestational diabetes, if you have it. The one hour test is merely a screen - it indicates that because the level was elevated, you require a more precise test to determine if your levels are actually elevated, and to what degree.

 

Once a diagnosis of GD is given, usually there are dietary instructions given to attempt to reduce the risks above. Therefore, if you suspect you may have it, there is no reason you can't research GD or ask your OB practice for a modified diet plan and eat as if you do have it. Unless there are complicated medical issues involved, there is no harm in adopting the GD diet. This way, you could have some peace of mind while waiting the three weeks to have confirmation or denial of the one hour screen. It is possible that you could have GD severe enough to require insulin shots; but your one hour was not that much higher than the limit. If it was over 200, I'd be more concerned.

 

However, I would probably seek the dietary advice from the "crunchy" providers before you leave, since, to be honest, it is usually these types of providers who tend to stay abreast of the best nutritional research. Generally, their philosophy is predicated upon supporting pregnancy and birth as a normal physiological process, and as such, tend to rely heavily upon a detailed nutritional approach as a way to reduce the risk of a number of complications. Conventional obstetrics will also make dietary recommendations, but these are usually generic, and not tailored to your specific situation. These providers operate (literally) on the premise that if things don't improve, well, they are ready and equipped to intervene directly to resolve the situation.

 

For example: whereas a "crunchy" provider might tend to expend more time and energy attempting to prevent GD from producing a macrosomic baby, the more conservative provider would likely consider that the best resolution to GD, whether it's well-controlled or not, is to increase the number of tests and interventions, up to and including early induction and c-section. As a result, each provider is likely to be more expert in their respective specialties.

 

Anyway, all that's to say that I don't think it's a terrible thing if you wait 3 weeks to get the 3 hour done! :)

[Rosie_0801]

Some diabetics cannot eat legumes, as the carbs will spike their blood sugar. YMMV.

 

It did! I couldn't eat grains because the carbs made my blood sugars spike!

 

If you can't eat grains or legumes without your blood sugar spiking, I guess you need to be on insulin!

 

Rosie

[kokotg]

It did! I couldn't eat grains because the carbs made my blood sugars spike!

 

If you can't eat grains or legumes without your blood sugar spiking, I guess you need to be on insulin!

 

Rosie

 

Why not just not eat grains OR legumes if they cause your blood sugar to spike?

[Rosie_0801]

Why not just not eat grains OR legumes if they cause your blood sugar to spike?

 

Well I assume someone who can eat one, but not the other, will eat the one they can eat. I can't imagine how someone who can't eat either would get enough carbs by skipping both. Pregnancy isn't the time to be losing weight, after all.

 

Perhaps I'm not understanding you.

 

Rosie

[ChandlerMom]

I'm not a big fan of GD (doesn't meet criteria for a disease, for example). Some studies haven't found it to useful:

"To determine if the results of glucose testing for diabetes are related to the outcome of the pregnancy, 608 pregnant women were studied. Eighty-eight of the women had abnormally high glucose levels detected by glucose screening. When GTTs were performed, 35 of the women had higher than normal levels of blood glucose (an abnormal GTT), and 48 had normal GTT. The mean infant birth weight and the incidence of infant morbidity and maternal morbidity were the same for those with normal GTTs and those who had abnormal GTTs. There was no relationship between the results of the GTTs and the incidence of birth trauma, cesarean delivery, or fetal macrosomia (oversized body). These findings indicate that the results of glucose testing had little relationship to the outcome of these pregnancies.

 

Read more: http://www.faqs.org/abstracts/Health/Glucose-challenge-testing-in-pregnancy-Which-cutoff-level-should-be-used-in-screening-for-glucose-in.html#ixzz1MwY75V40"

 

 

You are sooooo borderline and since bg rises in 3rd tri, if they'd done the screen at the recommended 24-26th week mark you'd probably have passed. The old cutoff (and still used by some) for "normal" is 185, so you would have passed that.

 

Was your test first thing in the am near-fasting? (what my NMW recommended to avoid false positives)? During my first pgc I had the test right after lunch and failed by a few points. Passed the 3hr test, but bg plunged afterward to the point I was shaking. Was sick as a dog and had to take the rest of the day off work. Swore I would NEVER take the 3hr test again. Fortunately passed my next 2 screens by not setting myself up to fail by doing the screen after lunch. :p

[kokotg]

Well I assume someone who can eat one, but not the other, will eat the one they can eat. I can't imagine how someone who can't eat either would get enough carbs by skipping both. Pregnancy isn't the time to be losing weight, after all.

 

Perhaps I'm not understanding you.

 

Rosie

 

Maybe our definitions of "enough carbs" are just different. I would consider enough carbs during pregnancy to be any amount that keeps you out of ketosis and doesn't cause you to lose weight....I don't think that would be hard to do at all without eating grains or legumes. I mean, suppose you want to eat 30 grams of carbs with a meal, and you know that grains and legumes are out. You can still eat, say, a small serving of potato and a big salad with your protein.

[vonfirmath]

I

Was your test first thing in the am near-fasting? (what my NMW recommended to avoid false positives)? During my first pgc I had the test right after lunch and failed by a few points. Passed the 3hr test, but bg plunged afterward to the point I was shaking. Was sick as a dog and had to take the rest of the day off work. Swore I would NEVER take the 3hr test again. Fortunately passed my next 2 screens by not setting myself up to fail by doing the screen after lunch. :p

 

First thing in the am, fasting. Yes.

But I'm over 35, overweight, with a previous baby over 8 pounds 13 oz, and a family history of diabetes (so a lot of risk factors)

[Rosie_0801]

Maybe our definitions of "enough carbs" are just different. I would consider enough carbs during pregnancy to be any amount that keeps you out of ketosis and doesn't cause you to lose weight....I don't think that would be hard to do at all without eating grains or legumes. I mean, suppose you want to eat 30 grams of carbs with a meal, and you know that grains and legumes are out. You can still eat, say, a small serving of potato and a big salad with your protein.

 

Not if you can't eat potatoes :lol:

 

During my last pregnancy, the only carbs I could eat to keep at the border of ketosis was beans. When you have to choose between a cup of beans per meal, or a quarter of a piece of toast, or half a packet of sweet potato chips, you choose the beans. I seem to have a higher requirement for carbs than others, so maybe that was the trouble. Oh well, at least I shan't have gestational diabetes ever again :)

 

It's so weird how differently bodies can react! I would never have imagined that a person who couldn't eat legumes would be able to eat potato!

 

Rosie

[kokotg]

Not if you can't eat potatoes :lol:

 

During my last pregnancy, the only carbs I could eat to keep at the border of ketosis was beans. When you have to choose between a cup of beans per meal, or a quarter of a piece of toast, or half a packet of sweet potato chips, you choose the beans. I seem to have a higher requirement for carbs than others, so maybe that was the trouble. Oh well, at least I shan't have gestational diabetes ever again :)

 

It's so weird how differently bodies can react! I would never have imagined that a person who couldn't eat legumes would be able to eat potato!

 

Rosie

 

Yeah, it's probably more an academic exercise than a real question (finding the right level of carbs w/o grains or legumes)...I imagine that most people who can't tolerate even small amounts of legumes or grains would probably have trouble controlling their sugar without insulin (and, you're right, not be able to eat potatoes). When I was diagnosed with GD (notice I don't say "when I had GD") the only thing that gave me trouble (other than eating tons of carbs of any sort in one sitting) was fruit juice. I'm doing a low-carb diet now (not pregnant!), and I eat almost no grains or legumes--it would be very easy for me to avoid them altogether--but I'm eating a lower level of carbs than I would be comfortable with if I were pregnant.