Gestational diabetes (GDM) is diabetes (inability to handle carbohydrates adequately and thus blood sugar levels can remain elevated) that is first diagnosed during pregnancy, and often goes away once the baby is born.
Many women will have higher than normal blood glucose levels anyway during pregnancy, as the hormones that are released (and elevated) during pregnancy have a tendency to affect the release and sensitivity of insulin, which is the hormone responsible for getting glucose into the cells and out of the bloodstream
Why do we become insulin resistant in pregnancy?
Because our mini-human needs a constant supply of glucose to feed his or her growing brain, so the body, in its infinite wisdom, sacrifices mum’s needs to make sure baby gets everything needed for optimal growth and development.
Any woman can be diagnosed with GDM, but some are at higher risk than others, such as those with a history of:
- Obesity
- Diabetes (including with other family members)
- GDM in a previous pregnancy
- A diet high in refined sugars and minimal fresh, whole produce
- Rapid and/or excessive weight gain during pregnancy
Why is GDM a problem?
It may be tempting to just fob GDM off if you do not fit into any of the high-risk categories, however there are a small percentage of healthy women who also are diagnosed with GDM, and it can have risks, including:
- Bubba growing too big, which can increase the likelihood of a difficult birth
- Increased risk of obesity and diabetes for bubba later on in life
- Newborn death
- Congenital malformation
- Respiratory distress syndrome
Hardly risks you really want to take, right?
But what about the testing?
The thing is, there is no universal agreement on which test should be used and when, and what the appropriate cut-off values for blood glucose levels should be. Well that’s poop, isn’t it!?
The “standard” test (called the Glucose Tolerance Test, or GTT) involves consumption of a 50-75g glucose (sugar) drink (often referred to as “Glucola”) at around 24-30 weeks gestation (that’s medical-speak for pregnancy, friends). Most countries will test the mother’s fasting blood glucose levels. Some countries will then test levels again at 1hr post-Glucola, others at 2hrs post-Glucola. Results are then compared to values which change depending on where you are in the world. If you’re above these values, you’ll probably be advised to take another test. OR, perhaps you just have a trigger-happy doctor who decides to diagnose you with (and treat you for) GDM right then and there.
Issues with the GTT
(Other than the glaringly obvious inability for a consensus to be reached on ideal screening guidelines):
- There is quite a high rate of false positives using the GTT, which means you might be diagnosed with GDM following the GTT, but you don’t actually have GDM. This sucks because 1) You may be treated unnecessarily with medications and 2) You’ll most likely freak out and/or feel pretty guilty that you might be putting the health of your baby at risk
- 50-75g of glucose is equivalent to about 600-800mL of Coke (in sugar-speak OR 12-19 TEASPOONS OF SUGAR!!). What pregnant lady, in their right mind, is EVER going to consume this amount of sugar in one go, let alone on an empty stomach?! If your body is not used to consuming this quantity of sugar, how can we reasonably expect it to produce an appropriate amount of insulin in response AND have the necessary insulin sensitivity to get all of that sugar out of the bloodstream? Madness, I say!
- Have you tried this glucose drink? HOLY CRAP it is horrible! I had to have it during a physiology class at university (as all the other slackers had eaten too close to class time – never mind the fact I freak out with needles, even tiny ones). Anywho – I had the drink. My blood sugar levels were fine. Awesome. I didn’t have diabetes. What I did have, however, was a massive come-down about 3-4hrs later which felt like, what I imagine to be, coming off heroin. I was pale, shaky, clammy, sweaty and moody. Would I willingly do again? Heck no!
So what’s a preg-bot gal supposed to do?
Well, first of all, know that you do not HAVE to do anything you don’t want to do in pregnancy, including getting tested for GDM at all! However, if, like me, you would like to be screened but definitely do not want to slam your body with a massive dose of sugar-water, you have an option.
I’m pretty grateful for the support of my doctor and midwife for this – it’s important to have them on-board and on the same page as you. If they aren’t, find someone else who you are comfortable with (seriously – do you want someone who you aren’t completely comfortable with hanging out around your lady garden during labour? Didn’t think so!).
OK – your option – BLOOD GLUCOSE MONITORING
Yes! Just like the peeps who actually HAVE diabetes have to test their blood sugar levels. I like this method as it involves consuming WHOLE, REAL FOOD in its natural state, and seeing how my body handles it. The only thing I don’t like about it? 2 needles, instead of 1 (but to be fair, they are only little finger pricks – it actually wasn’t that bad at all. I’m embarrassed to admit I made my hubby administer one of them. Yes, I’m that bad with needles).
How to do it
(guidelines provided by my doc – again check with yours about guidelines and appropriate values):
- 3 days prior to testing your blood glucose levels, consume an extra 15g of carbohydrates per day (this is about 1 small banana, 1 medium apple, ½ cup sweet potato or potato, 1/3 cup cooked basmati rice, OR ½ cup cooked quinoa)
- Fast (don’t eat!) for 8hrs overnight before testing
- Test your fasting (on an empty stomach) blood sugar levels via finger-prick using a glucometer (see image above; ask your doc if you can borrow one)
- Have a large, carby brekkie (I had quinoa and banana porridge, which worked out to be ~50g carbs) then go for a walk
- 2 hours later, re-test your blood sugar levels via finger-prick
Your levels should be as follows:
- Fasting < 6.6mmol/L
- 2hrs post-carby brekkie <7.7mmol/L
Using this method, my results came back as 5.3mmol/L fasting and 4.6mmol/L 2hrs post-brekkie. Sweet as (without the extreme sweetness of “Glucola”)!
That’s it! How easy and how much more gentle on the body (and baby)?
I hope this helps. Please do not feel pressured into doing anything you do not want to do – your body, your baby, your choice. K? xx
References
13 Comments on Gestational Diabetes Testing – An Alternative To The GTT
- Lauretta Hamilton February 25, 2015 at 6:14 am (1 year ago) Hi Kate, What a great article! Very insightful and what a great alternative for women who aren’t keen on the GTT, will definitely keep this in mind and especially love your message about “not doing anything you don’t want to do!”!so simple but oh so important, it’s scary how many women forget this! Of course everyone wants to do the best thing for their body and their baby’s but if it doesn’t feel right trust your gut and your own instincts! If only all healthcare organisations would offer this alternative. Thanks:) Kate Callaghan February 25, 2015 at 11:26 pm (1 year ago) You’re welcome! x Kate February 25, 2015 at 6:25 am (1 year ago) Do you know anything about having a hba1c test for this purpose? Kate Callaghan February 25, 2015 at 11:25 pm (1 year ago) Yes – this was going to be the test I opted for, however my doctor advised it was not the most accurate for testing how well your body deals with insulin and blood sugarlevels. It is a great marker for general blood sugar levels over a 3mth period, though – much better than a random glucose test for general health. Pam Olver June 17, 2015 at 10:21 pm (10 months ago) At a recent talk by an endocrinologist it was recommended that all women have an Hb A1C as part of the first antenatal screening or when they are trying to get pregnant. It has not formally been included in guidelines (yet). There are an increasing number of women with impaired glucose fasting glucose or undiagnosed T2DM falling pregnant unaware that they have a problem. They do very badly and need to be picked up as early as possible. For the general public we probably still have to recommend a GTT but on an individual patient basis I think we should be flexible to achieve the desired outcome especially with informed and motivated patients. February 25, 2015 at 4:35 pm (1 year ago) Gestational diabetes is often a metabolic disorder that commonly appears in the later stages of childbearingin women. Controlling gestational diabetes is important for the health with the unborn baby. Kate Callaghan February 25, 2015 at 11:24 pm (1 year ago) I agree – which is why I have still encouraged people to be tested for GDM (pointing out the risks etc), however women need to know there are options (supported by medical professionals) for testing which may actually be more reliable. Karli February 25, 2015 at 10:41 pm (1 year ago) Thanks so much for this post – I wish it had been around about 2 weeks ago! I am 28 weeks pregnant and had the OGTT early last week. The results came back that I have developed gestational diabetes. I spent the next 6 days stressing that I have “failed” pregnancy, the baby, put it in danger etc, with any hope of a natural un-induced birth quickly fading (due to the rise in interventions for GD pregnancies and birth). Yesterday I had my appointment with the midwives to find out more about my results and it turns out I am completely borderline – the onlyreading they’re basing the diagnosis on is the 2hour post-glucose drink one which came in 0.5 above the cut off. The other 2 readings were well below cut off. The same readings in Canada and I would not have been diagnosed. I don’t usually consume epic amounts of sugar and felt sick throughout the whole test – that part I didn’t mind as a one off, what I do mind is the stress and guilt that I’ve imposed on my body for the last week! And all the info I had to go on between now and then was online – so I immediately made changes to my diet and exercise regimes as recommended (particular grams of complex carbs spread over the day, 20min walk after every meal, no simple sugars). The midwives are very confident that I’ll be fine just as long as I don’t have any major sugar intake in 1 hit, and keep up consistent movement. I still have to go to the “diabetes education clinic” next week and do the finger prick testing throughout the pregnancy but if all is well until 38 weeks, I’ll be fine togo over if I do, and no induction. I do acknowledge that GD is a hugely serious issue for people that actually have it – and we should definitely screen in one way or another so that GD affected women can learn how to manage the risks. But I had no risk factors and am otherwise healthy, active, very normal size 10-12 with no excessive baby weight gain. All the test did was stress me out! I wish I’d researched an alternative way to do it such as what you’ve suggested. (PS one note on a bit in your article – I’ve seen a systemic review that concluded there is no connection between between congenital malformation and GD.. but I know there’s a lot of conflicting research out there about impacts of GD) Kate Callaghan February 25, 2015 at 11:23 pm (1 year ago) Hi Karli, Thank you for sharing your story, and I am sorry that you have felt guilty and stressed as a result of your test. By the sounds of it, I am completely confident that you will have a healthy baby and uncomplicated birth. Goodluck with everything! x Karli February 26, 2015 at 12:06 am (1 year ago) Thanks Kate, wishing the same for you! Katerina Prague July 2, 2015 at 6:41 am (10 months ago) Hi Kate, greetings from the Czech Republic! Thank you very much for your awesome article – I am about to visit my doctor tomorrow and get the invitation for the OGTT test – have been reading all kinds of articles online and yours made me finally happy! I don’t have a problem with the taste or discomfort, I just do not simply know WHY should I consume 75 g of sugar at once while not being able to drink water… happy to hear that there hopefully is another way… The problem is my doctor is not very much “on the same page” and is not really open to alternatives, but I am sure I do not want to boost my baby and my body with this ammount of sugar… Please wish me luck and again – thanks for your support, it helped! Kate Callaghan July 2, 2015 at 11:36 pm (9 months ago) Good luck! xx November 2, 2015 at 10:25 am (5 months ago)Thanks for finally writing about >Gestational Diabetes Testing – An Alternative To The GTT | The Holistic Nutritionist <Liked it!