GD again (FAO Ericka)

Hi ericka

This is from the ivillage site that you put forward to look at, and my
comments in

"The standard GD diet is a good one; adequate calories, limit simple sugars,
moderate fat intake, eat whole grains and plenty of fruits and vegetables
and eat smaller meals more frequently. Also beneficial is the advice to
engage in moderate, regular exercise. If that was all that happened,
identification as a gestational diabetic would be a good thing. This is
what happened for me in 2nd pg and not 1st

Some tracking of blood sugars to make sure they aren't drifting into the
true diabetic range is probably also a good thing, as is identifying the one
in a thousand women who has or will develop glucose values in that range.
However, most women will find themselves caught up in frequent doctor
visits, multiple daily blood tests yes and yes, but i dont mind
overcautious, restrictive diets yes, but i think it is what i needed and
wouldnt have strict enough without the gd dx and prescrbited treatment ,
possibly insulin injections no luckily, repeated fetal surveillance tests
again, i wont argue against over cautiousness and a considerable chance of
a labor induction or cesarean section had an elective c. "

i thought that article was really interesting ericka, thanks. so many
things there rang true, like the dx of gd being so arbitrary.

i am curious, if you dont mind me asking, why are you against the GTT for
yourself? DO you do the regular blood test yourself? IF the answer is yes,
i am with you on that - the test is revolting, i am planning to screen, and
i guess do regular screening 20 weeks +.

anyway, i respect your views on this topic ericka, thanks for posting them.
keep them coming, it is going to be a long 35 more weeks!

christine
#3 edd 16 april 05

Mamma Mia wrote:

i am curious, if you dont mind me asking, why are you against the GTT for
yourself? DO you do the regular blood test yourself? IF the answer is yes,
i am with you on that - the test is revolting, i am planning to screen, and
i guess do regular screening 20 weeks +.

You didn't ask me, but I thought I would share anyway, so I hope you
don't mind. ;-) I personally didn't do the test because I pee on test
sticks all the time. Seriously, if anything were to actually go wrong,
it would show up right away. We (i.e. DH, the midwife, and myself) all
decided to use this method of detection rather than go for a test that
will do nothing but make them keep checking to see if I'm peeing sugar.
;-) Well, I'm checking for that all the time already... As it turns
out, I suddenly started feeling like crap (lately) and have had massive
thirst, so we did a quick blood test, but as the midwife expected, all
was perfectly normal. (I now suspect that the massive thirst is really
just me loving the cold water going down my throat, plus my mouth is
*always* dry because I'm unable to breathe properly through my nose)

Mamma Mia wrote:

i am curious, if you dont mind me asking, why are you against the GTT for
yourself? DO you do the regular blood test yourself? IF the answer is yes,
i am with you on that - the test is revolting, i am planning to screen, and
i guess do regular screening 20 weeks +.

I know that my blood sugars are normal when I am
not pregnant, so I am not dealing with diagnosing true
diabetes (or near-diabetes) during pregnancy. Since
treatment for GD doesn't significantly improve outcomes,
the only benefit I see is that it could give me a heads
up about a risk of future type 2 diabetes; however,
other risk factors predict that equally well and I am
certainly capable of being screened for that again if
I wish at another time when the results will not
negatively affect my pregnancy or birth. On the flip
side, if I *did* screen or test positive for GD, there
would be a whole can of worms to deal with, which
could have (unjustifiably, in my opinion) limited my
birth options and been all around annoying. With
nothing useful to balance them against, I chose not
to do it. I do strive for a healthy diet while
pregnant anyway, so I don't see the point of having
a test result just to reinforce that decision. Knowing
I do not have true diabetes, I would not consider
insulin regardless.

Best wishes,
Ericka

Vicky Bilaniuk wrote:


You didn't ask me, but I thought I would share anyway, so I hope you
don't mind. ;-) I personally didn't do the test because I pee on test
sticks all the time. Seriously, if anything were to actually go wrong,
it would show up right away.

You know, that's not really valid at all. Many diabetics
do not spill sugar in their urine, and many women who spill sugar
in their urine have normal glucose metabolism. Of course, it
doesn't bother me not to screen in situations where true
diabetes is unlikely (and if it is likely, screening needs to
start much earlier), but testing urine is not an effective
screening method.

Best wishes,
Ericka

Eur J Obstet Gynecol Reprod Biol. 2004 Apr 15;113(2):145-8.
The usefulness of glycosuria and the influence of maternal
blood pressure in screening for gestational diabetes.
Buhling KJ, Elze L, Henrich W, Starr E, Stein U, Siebert G,
Dudenhausen JW.
Clinic of Obstetrics, Charite Campus Virchow-Klinikum, Humboldt
University, Augustenburger Platz 1, D-13353 Berlin, Germany.


OBJECTIVE: Although gestational diabetes is among the most common
diseases arising during pregnancy, glucose stix is the only screening
test to date in Germany. Our goal was to evaluate the sensitivity of the
glucose-stix for diabetes screening and the possible influence of other
parameters. METHODS: 1001 patients who underwent the 50 g glucose
screening test between June 1, 1997 and January 5, 2000 as part of
prenatal care were asked to participate. In accordance with the
guidelines of the American Diabetes Association, patients with a
screening test [Formula: see text] mg/dl underwent a oral glucose
tolerance test (Carpenter/Coustan criteria). A urine sample was
collected prior to the test. The glucose content of the urine was
semiquantitatively analyzed using a test strip (Multistix 10 SG Bayer),
Munich, Germany). Blood pressure was measured in 349 consecutive cases
according to the criteria of the National Institute of Health. RESULTS:
The overall frequency of gestational diabetes was 4.1% (37/912). 8.2% of
the women presented with glycosuria (82/1001, 36 before screening, 46
based on the pregnancy medical records booklet). 30/82 (37%) of these
patients had a pathological screening test (P = 0.029). 7.1% (52/729) of
the healthy patients and 10.8% (4/37) of the gestational diabetics had
glycosuria at least once. Therefore, the sensitivity of glycosuria is
10.8%, the positive predictive value is 6.6%. The systolic blood
pressure was 116+/- 12 mmHg and the diastolic blood pressure 72 +/- 9
mmHg. Three of 349 (0.9%) patients were documented with preexisting
hypertension, 14/349 (4.0%) patients with "pregnancy induced
hypertension". Patients with glycosuria were both significantly more
advanced in gestational age (34.4 +/- 2.8 versus 33.7 +/- 2.9, P =
0.673) and had higher diastolic blood pressure (79 +/- 9 versus 71 +/-
9, P = 0.005). The 50 g glucose screening test results showed only a
tendency to differ (131 +/- 23 versus 127 +/- 24, P = 0.073). A
multivariate analysis of these factors showed a significant influence of
the diastolic blood pressure (P = 0.016) and the 50 g glucose screening
test (P = 0.032), whereas the gestational week had no influence (P =
0.673). CONCLUSIONS: Urine glucose dip stick analysis is not useful in
the detection of gestational diabetes because of its low sensitivity and
negative predictive value. Our study suggests that glycosuria is not
only dependent on the blood glucose level, but highly influenced by
diastolic blood pressure. The results clearly underscore the need for
standardized, routine testing of every pregnant woman.

Ericka Kammerer" wrote
On the flip
side, if I *did* screen or test positive for GD, there
would be a whole can of worms to deal with, which
could have (unjustifiably, in my opinion) limited my
birth options and been all around annoying.

I wish I had asked you last time. AFTER I was diagnosed I did a lot of
research and realized that I was on the cusp (and wouldn't have been
diagnosed with a slightly different set of numbers, which vary by
practitioner). I kept to a reasonably good diet but just couldn't get my
breakfast number low. OTOH, first thing in the morning was always really low
(like 65) so I knew that I wasn't a true diabetic. SIL had high numbers all
of the time (even if she tested in the middle of the night) so I knew my GD
was different. I also knew that the diagnosis made everything more difficult
from having to convince the practice that I could use the midwives (instead
of the OB), that I would not allow a late term u/s to determine the size of
the baby, that there were times (like business meetings) where one cannot
control as much as one might like what one eats and that I was eating well.
The more I think about it, the more I bet that part of the reason that E was
early and reasonably small was that I was eating virtually no carbs (not so
healthy) to keep my sugars low.

This time, I'm going to refuse the test and track my blood sugar myself.
I'll keep some carbs in my diet and expect my sugars to be a bit higher than
usual. Unlike the doctors, I won't freak at an occasional 120 as long as it
is occasional. I also plan to keep doing that research.

Thank you so much!!!!!
--
Melissa (in Los Angeles)
Mum to Elizabeth 4/13/03
and ??? due early 3/05

Ericka Kammerer wrote:

nothing useful to balance them against, I chose not
to do it. I do strive for a healthy diet while
pregnant anyway, so I don't see the point of having
a test result just to reinforce that decision.

Needless ice cream restriction.

G

Mary S.

Ericka Kammerer wrote:

Vicky Bilaniuk wrote:


You didn't ask me, but I thought I would share anyway, so I hope you
don't mind. ;-) I personally didn't do the test because I pee on
test sticks all the time. Seriously, if anything were to actually go
wrong, it would show up right away.


You know, that's not really valid at all. Many diabetics
do not spill sugar in their urine, and many women who spill sugar
in their urine have normal glucose metabolism. Of course, it
doesn't bother me not to screen in situations where true
diabetes is unlikely (and if it is likely, screening needs to
start much earlier), but testing urine is not an effective
screening method.

Oh sorry I probably should have added that they are watching for other
signs, too. They're not doing anything special, though - just the
standard stuff they do at every visit. Anyway, we just didn't think
that it was necessary to do the test. There is also my history, which
contributed to my belief that the test wasn't necessary (I've been
tested many times for diabetes, as part of the long list of tests I went
through before finally being diagnosed with pernicious anemia, and my
glucose levels were always perfectly normal). I told them that I was
willing to take the risk of not getting the test done, and they seemed
fine with just relying on everything else. We figured that if anything
showed up on the test sticks, it would be an indication that the problem
was already well at hand and needing investigation.

Thanks for the article.

Vicky Bilaniuk wrote:

Oh sorry I probably should have added that they are watching for other
signs, too.

There really aren't any signs of GD. If you believe
it is essential to diagnose GD, then the only way to do it
with any reliability at all is by blood test.

They're not doing anything special, though - just the
standard stuff they do at every visit. Anyway, we just didn't think
that it was necessary to do the test.

Well, *that* I agree with, because I don't think
it's important to diagnose GD ;-)

There is also my history, which
contributed to my belief that the test wasn't necessary (I've been
tested many times for diabetes, as part of the long list of tests I went
through before finally being diagnosed with pernicious anemia, and my
glucose levels were always perfectly normal).

Which would absolutely reinforce my decision not
to screen or test for GD. But if you *do* believe that
true GD (rather than actual diabetes just being diagnosed
for the first time in pregnancy) is necessary to diagnose,
then you could easily miss it without a blood test.

In other words, I think your care is absolutely
great. I just don't think it'll pick up GD if you have
it, but I don't think it's important for you to pick it
up if you have it, so it's a rather moot point in my
book ;-)

Best wishes,
Ericka

Ericka Kammerer wrote:

Vicky Bilaniuk wrote:

Oh sorry I probably should have added that they are watching for other
signs, too.


There really aren't any signs of GD. If you believe

Well they told me to watch out for things like increased thirst. There
was something else, but I might be confusing it with preeclampsia
symptoms (weight gain?).

it is essential to diagnose GD, then the only way to do it
with any reliability at all is by blood test.

And sadly, even that can be unreliable, if it's anything like testing
for normal diabetes, at least. That's why I got tested multiple times,
in the past. They wouldn't trust just one no. I forget now, but I know
I was tested at least 2 or 3 times. My results were always so normal
that I never had to do a 3 hour test.

In other words, I think your care is absolutely
great. I just don't think it'll pick up GD if you have
it, but I don't think it's important for you to pick it
up if you have it, so it's a rather moot point in my
book ;-)

Um, yeah, I think that's pretty much what we all arrived at. ;-)

Is there any good reason for me to test for GD, since I know this will be a
C-section anyway? I can't see where having a large baby is a problem, and
from what I've read, that's the only thing which seems conclusively linked
to GD. I'm having enough blood drawn and testing done in this pregnancy, it
would be really nice to be able to skip SOMETHING and avoid the stress!