3 hour glucose test question (long)

My wife took her 1 hour test at 29 weeks, which is last week, and the
value was 145. Our OB says it should be below 140. So she took the 3
hours test this week. The results is not good.

1 hour: 198
2 hour: 158
3 hour: 109

OB nurse says the cutoff lines are 180, 155 and 145, if I remember
those number right. So they said she has gestational diabetes and need
to see a dietitian.

I looked on this forum and also diabetes forums, there seems to be
several scales:


NDDG (National Diabetes Data Group) - most common
Fasting - 105
One Hour - 190
Two Hour - 165
Three Hour - 145

Carpenter Scale
Fasting - 95
One Hour - 180
Two Hour - 155
Three Hour - 140

Coustan Cutoffs
Fasting - 95
One Hour - 180
Two Hour - 160
Three Hour 140


Which one should we follow. But I have to say that the test results
after 1 hour and 2 hour are not good, while the last one is very
normal.

BTW, my wife has a small figure, 5 feet 2" and 125lb now. Does that
have anything to do with those results. She is very healthy, better
than me. During the last two weeks, she's not gainning any weight.
Over 30 weeks, the weight gain is only about 10 lbs.

30 weeks is ultra sound scan, the original calculation is 32 weeks.

Thanks for any commons.
Chris

cfd-z wrote:

My wife took her 1 hour test at 29 weeks, which is last week, and the
value was 145. Our OB says it should be below 140. So she took the 3
hours test this week. The results is not good.

1 hour: 198
2 hour: 158
3 hour: 109

OB nurse says the cutoff lines are 180, 155 and 145, if I remember
those number right. So they said she has gestational diabetes and need
to see a dietitian.

I looked on this forum and also diabetes forums, there seems to be
several scales:


NDDG (National Diabetes Data Group) - most common
Fasting - 105
One Hour - 190
Two Hour - 165
Three Hour - 145

Carpenter Scale
Fasting - 95
One Hour - 180
Two Hour - 155
Three Hour - 140

Coustan Cutoffs
Fasting - 95
One Hour - 180
Two Hour - 160
Three Hour 140


Which one should we follow. But I have to say that the test results
after 1 hour and 2 hour are not good, while the last one is very
normal.

BTW, my wife has a small figure, 5 feet 2" and 125lb now. Does that
have anything to do with those results. She is very healthy, better
than me. During the last two weeks, she's not gainning any weight.
Over 30 weeks, the weight gain is only about 10 lbs.

30 weeks is ultra sound scan, the original calculation is 32 weeks.


Well, you've got a bit of a dilemma ;-) In general, most
of the research I've seen suggests that the more stringent criteria
don't improve outcomes relative to the looser criteria. So that
would argue for taking the loosest criteria you can find, which in
your above examples would have your wife barely exceeding the
limit on only one of the samples--which is a borderline failure
at best.
That said, there's a lot of debate about whether you need
to diagnose and treat gestational diabetes at all. If your wife
was not diabetic prior to pregnancy, there are quite a few studies
that suggest that a diagnosis of GD doesn't mean much, or even if
it does, treatment doesn't significantly improve outcomes. Clearly,
your wife is neither overweight nor gaining excessive weight with
the pregnancy. Those two facts are better predictors of
birth weight than GD status.
With true diabetes, blood sugars are out of whack from the
beginning of the pregnancy, which can lead to significant birth
defects. With gestational diabetes, however, blood sugars tend
to be elevated just during the third trimester. The risks
associated with GD are macrosomia (large baby owing to overfeeding
the baby) and neonatal hypoglycemia (low blood sugar owing to
excessive insulin levels in the baby who's had to process the
extra sugar). You'll find a lot of controversy about these things.
First, it's not clear that GD, as defined, is responsible for
these problems. The studies are very confounded with at least
two major factors: 1) women who are diagnosed with GD are more likely
to be overweight, and these problems may be the result of obesity
and 2) women who are diagnosed with GD may, in fact, be undiagnosed
true diabetics, which may account for the problems. Second, there
are many studies showing that treating GD (either with diet
or with insulin) has a miserable track record of improving outcomes.
So one really has to ask what is worth doing, particularly with
marginal test results.
The problem you're likely to find, though, is that now
that she has these test results on record, they're going to affect
her care. For instance, she may well be pressured to be induced
early (so the baby doesn't get too big) or may be pressured to have
a c-section (if they think the baby is too big--which is not at all
well supported by research). If she's perceived as being
non-compliant with treatment recommendations, that may also
strain her relationship with her caregivers. So it may be
challenging to decide what it's in her overall best interests to
do.
If you want some more information that's somewhat
skeptical of GD (but based on high quality, mainstream medical
research), check out Henci Goer's _Obstetric Myths versus Research
Realities_ or _A Guide to Effective Care in Pregnancy and Childbirth_
by Enkins, et al. You can also search Medline at PubMed, but that
can be a little confusing as the research is all over the map and
it's hard to tell which studies are more accurate without looking
at the whole study so you know the methodology involved. Henci
Goer provides an annotated bibliography that's an excellent
starting point for investigation, and the other book is a summary
of recommendations from one of the leading groups devoted to
evidence-based medicine (the Cochrane Group).

Best wishes,
Ericka

My wife does not have diabetes before and this is our first baby. So
we don't have any idea this could happen. Basically, what you said is
we don't need to worry too much besides there is not much can be done
to this problem, right? We will try to adjust our diet and keep an
extra eys on it. As to those possible Doctor's advices, we will think
about.

As a matter of fact, those blood tests, like AFP test and this one,
are supposed to help people in a better condition, but more likely
they only make us nervous for nothing. What ever the baby is, we will
take it.


Thanks again for your advice.

Chris

Ericka Kammerer wrote in message ...
cfd-z wrote:

My wife took her 1 hour test at 29 weeks, which is last week, and the
value was 145. Our OB says it should be below 140. So she took the 3
hours test this week. The results is not good.

1 hour: 198
2 hour: 158
3 hour: 109

OB nurse says the cutoff lines are 180, 155 and 145, if I remember
those number right. So they said she has gestational diabetes and need
to see a dietitian.

I looked on this forum and also diabetes forums, there seems to be
several scales:


NDDG (National Diabetes Data Group) - most common
Fasting - 105
One Hour - 190
Two Hour - 165
Three Hour - 145

Carpenter Scale
Fasting - 95
One Hour - 180
Two Hour - 155
Three Hour - 140

Coustan Cutoffs
Fasting - 95
One Hour - 180
Two Hour - 160
Three Hour 140


Which one should we follow. But I have to say that the test results
after 1 hour and 2 hour are not good, while the last one is very
normal.

BTW, my wife has a small figure, 5 feet 2" and 125lb now. Does that
have anything to do with those results. She is very healthy, better
than me. During the last two weeks, she's not gainning any weight.
Over 30 weeks, the weight gain is only about 10 lbs.

30 weeks is ultra sound scan, the original calculation is 32 weeks.


Well, you've got a bit of a dilemma ;-) In general, most
of the research I've seen suggests that the more stringent criteria
don't improve outcomes relative to the looser criteria. So that
would argue for taking the loosest criteria you can find, which in
your above examples would have your wife barely exceeding the
limit on only one of the samples--which is a borderline failure
at best.
That said, there's a lot of debate about whether you need
to diagnose and treat gestational diabetes at all. If your wife
was not diabetic prior to pregnancy, there are quite a few studies
that suggest that a diagnosis of GD doesn't mean much, or even if
it does, treatment doesn't significantly improve outcomes. Clearly,
your wife is neither overweight nor gaining excessive weight with
the pregnancy. Those two facts are better predictors of
birth weight than GD status.
With true diabetes, blood sugars are out of whack from the
beginning of the pregnancy, which can lead to significant birth
defects. With gestational diabetes, however, blood sugars tend
to be elevated just during the third trimester. The risks
associated with GD are macrosomia (large baby owing to overfeeding
the baby) and neonatal hypoglycemia (low blood sugar owing to
excessive insulin levels in the baby who's had to process the
extra sugar). You'll find a lot of controversy about these things.
First, it's not clear that GD, as defined, is responsible for
these problems. The studies are very confounded with at least
two major factors: 1) women who are diagnosed with GD are more likely
to be overweight, and these problems may be the result of obesity
and 2) women who are diagnosed with GD may, in fact, be undiagnosed
true diabetics, which may account for the problems. Second, there
are many studies showing that treating GD (either with diet
or with insulin) has a miserable track record of improving outcomes.
So one really has to ask what is worth doing, particularly with
marginal test results.
The problem you're likely to find, though, is that now
that she has these test results on record, they're going to affect
her care. For instance, she may well be pressured to be induced
early (so the baby doesn't get too big) or may be pressured to have
a c-section (if they think the baby is too big--which is not at all
well supported by research). If she's perceived as being
non-compliant with treatment recommendations, that may also
strain her relationship with her caregivers. So it may be
challenging to decide what it's in her overall best interests to
do.
If you want some more information that's somewhat
skeptical of GD (but based on high quality, mainstream medical
research), check out Henci Goer's _Obstetric Myths versus Research
Realities_ or _A Guide to Effective Care in Pregnancy and Childbirth_
by Enkins, et al. You can also search Medline at PubMed, but that
can be a little confusing as the research is all over the map and
it's hard to tell which studies are more accurate without looking
at the whole study so you know the methodology involved. Henci
Goer provides an annotated bibliography that's an excellent
starting point for investigation, and the other book is a summary
of recommendations from one of the leading groups devoted to
evidence-based medicine (the Cochrane Group).

Best wishes,
Ericka

cfd-z wrote:

My wife does not have diabetes before and this is our first baby. So
we don't have any idea this could happen. Basically, what you said is
we don't need to worry too much besides there is not much can be done
to this problem, right?


Well, you'll get different answers from different people on
that. Some doctors are adamant that GD is a significant problem
and requires treatment and that treatment is effective. However,
I don't think the research adequately supports that contention,
nor do some other people and organizations I have a lot of respect
for. On the other hand, if you want to find people or organizations
who are quick to aggressively treat GD, you can find those people
too. It would be nice if we had really definitive research, but
because so many jumped on the test & treat bandwagon in the US,
it's largely become the standard of care in the US, making it
nearly impossible to do the kind of controlled studies with
random assignment that you need to get good results (because most
people won't assign women to no testing or no treatment, even
without good evidence supporting the need for testing or treatment--
it's a bit of a catch-22).
After looking at the research, *MY* personal choice was
not to be tested at all (I'm not diabetic when not pregnant).
Others may well choose differently.

We will try to adjust our diet and keep an
extra eys on it.


In many ways, the diet isn't a particularly bad thing.
In many ways, it's the sort of thing you ought to be eating
regardless. Your wife should make sure she's getting enough
calories, as some find the diet restrictive enough that they
don't get as many calories and it sounds like your wife is
already not gaining very much (though that's not a problem
either--focus on eating a good, healthy diet, not on achieving
a particular weight gain goal). What may be trickier is if
she's testing her blood sugars regularly and the values don't
fall in line with what the doctors want to see. That may lead
them to try to treat more aggressively or suggest things like
early induction or c-section. If they're monitoring blood
sugars for the rest of pregnancy, you may want to read up a
bit and decide what you are and are not willing to do if you
get pressured in these directions.

As to those possible Doctor's advices, we will think
about.

As a matter of fact, those blood tests, like AFP test and this one,
are supposed to help people in a better condition, but more likely
they only make us nervous for nothing. What ever the baby is, we will
take it.


And that's certainly something important to keep in mind
when deciding about testing. You don't want to test just for the
sake of testing. Ideally, the results should make some sort of
real difference for you. If it wouldn't make a difference in
your decision making, it may well be the best idea for you to
refuse a particular test. I think they're all very personal
decisions, depending on one's particular situation, temperment,
and philosophy.

Best wishes,
Ericka