Friday, February 13, 2015

Adventures in Gestational Diabetes Testing

I needed a hug!
It has recently become standard practice to test every pregnant woman for gestational diabetes (GD) somewhere between 24-28 weeks along. There are many good things about this, mostly because once identified, there are real tangible things one can do to prevent the associated complications, often only with changes in diet and lifestyle.

My objection, personally, only came up to the method of testing. In an effort to make the process uniform, they use a glucose solution called Glucola to give you a set amount of sugar. The first screening test involves drinking the solution (50g of glucose from dextrose/corn sugar) within 5 minutes, waiting an hour, and then having blood drawn to test glucose levels. If your levels are high for this (over 140), you go on to do a similar procedure with 100g solution. This time, you have to come in fasted, have blood drawn, drink the solution, and get tested each hour for 3 hours. If any two of your values are considered high, you are officially diagnosed as having GD.

I get why this would be a very convenient and standardized way to do this for the medical community. You can compare data across populations and have very clear procedures. However, as an individual patient with my own needs, concerns, and medical history, this procedure was not in my best interest. As someone who has followed a whole foods based diet low in processed sugar and grains for several years (four now), I know that my body does not handle those things well at all. And I'm not alone in this. I am in no way perfect with my eating, but I do eat far less than the average amount of refined sugar. As a result, my system isn’t used to having to deal with large doses of glucose all at once and takes a bit longer to clear such occasional occurrences. I don’t believe this to be a pathological state or any problem for my overall health. Ironically, if I was eating an unhealthy diet of processed food, my body would probably be better equipped to deal with the sugar load, in the short term. The problem with this, though, is that over time my system would get worn out from such a taxing business and that is how Type 2 diabetes develops. You basically get burned out. With my former habits and family history, I know that would have inevitably been my fate, had I not changed my ways.

So back to this whole GD thing. I was pretty sure I was going to fail that test. I talked with my doctor about an alternative – what *I* care about is how *my* body is handling the actual food I eat every day, not how I handle a glass of flat sugary soda I’d never drink willingly in a million years. I bought a blood glucose meter and told her I’d be willing to test my sugars 4 times a day for a couple weeks to see how my body was handling what I actually eat. No dice. I was told I must do the glucose tolerance test. I know in theory that all health procedures are, in the end, up to the patient and that no one could force me to do anything. But that’s not how it feels. It felt like I had no choice, no options. I debated what to do and finally decided just to do the initial screening test. I have to say that I felt very pressured and uncomfortable with the whole thing.

And… I failed the screening test. Of course. This left me staring at the next step of the 3 hour test, which would be quite unpleasant. Try telling a pregnant lady she can’t eat anything when she gets up, has to make it to the lab, drink sugar, and sit for 3 hours – and get 4 blood draws. Women do this all the time and I am so sorry for that. That sounds like a lousy day. Couple that with how large amounts of sugar make me feel (exhausted, light headed, sometimes nauseated) and that just is not something I wanted to do. All so they could tell me I have GD based on completely abnormal behavior *for me*.

I should say that I don’t fear having to test blood sugar or monitoring it on my own at all. I certainly don’t fear the diet and lifestyle recommendations they’d give me (ironically to basically eat how I normally do and exercise). What I fear is a needless diagnosis on my medical history that would open me up for additional interventions and higher probability for things like being induced or even a C-section. Don’t get me wrong, I don’t think any of those things are bad, they’re just overused and not optimal, if they can be safely avoided. I do not want to be classified high risk if my actual lifestyle, behavior, and health do not warrant it.

As a result, I started testing my blood sugar (BS) 4 times a day – fasting (goal of 95 or less) and 2 hours after meals (120 or less). I did that for a couple days between failing the screening test and seeing my doctor. (All but one of the values was in range – the outlier? The night I had gluten free pizza, a processed food that I eat occasionally – proving that I do not handle processed food well). I did this to show her not only that my numbers were fine based on what I actually eat, but also that I’m willing to be proactive about my health. Refusing the 3 hour test (which is what I went in to the appointment determined to do), was not about putting my head in the sand and pretending I don’t have a problem that might harm my baby. It was about individualizing my care and making sure I’m not treated for a disease I do not have.

It was an uncomfortable appointment and it was upsetting to me that the doctor was most concerned about checking things off her list – she just couldn’t fathom not doing B after A (if you fail the one hour, you do the three hour test). She barely looked at my BS numbers and food diary or even commented on the fact that they were almost all perfect, which would be impossible for anyone with gestational diabetes that wasn’t already being treated. I finally just had to say, “I’m not going to do it” – as an emphatic statement regarding the 3 hour test. Multiple times she threatened that I’d have to test my BS 4 times a day for the rest of my pregnancy, as if that was the worst thing in the world (people with GS do this, of course). Every time she said that, I just replied that would be fine with me. I love data and the info is very interesting to me, in any case.

In the end, she wrapped her head around the fact that I wasn’t going to budge and agreed to treat me like a gestational diabetic, in terms of monitoring BS, education, etc. but hold off on any official diagnosis until such time that I demonstrated that my numbers were not staying in range. This, was all I wanted. It was hard won, but totally worth it.

Coincidentally, my doctor is also expecting a baby so I will have to switch providers soon anyway. I will be asking about how the next one feels about this plan of action first thing!

The info I’m getting from testing has already been so enlightening. Knowing that pizza is not my friend (is anyone surprised?) is good to know since it is something I indulge in every so often. I’m going to test after making my own crust at home from this Paleo Spirit recipe which I love, to see if I tolerate that. If not, I will just avoid it, but it’s good to know either way. Another cool thing I’ve noticed is that putting maple syrup, honey, or dates in hot cocoa, tea, and protein shakes does not spike my BS at all. I don’t use a lot at any given time, but still, it’s good to know that I don’t have to go down to very low carb, something I was avoiding during pregnancy. Brown rice is fine, too. I will check on potatoes and sweet potatoes as they come up in my diet. I’ve had a few apples and a banana at one point, none of which pushed me over, either.

Overall, this has been a really interesting experience. It was frustrating to feel so misunderstood about something so important to my health and our little Cute Baby. I’m sure it won’t be the last time I’ll have to stand up for what should be common sense in this Bizarro world of ours. Personally, I hate confrontation and dealing with this was super tough on me. I definitely don’t do any of this lightly. For me, drinking something not-optimal once or twice isn’t the issue or a big deal. We are resilient beings, thank goodness. But, I don’t think it’s crazy to want to avoid all the potential downstream effects. So in the end, I’m glad I bothered to take a stand and I hope this might just make it a little bit easier on the next crazy lady who doesn’t want to drink the Kool-Aid Glucola.


6 comments:

Boris Miller said...

Thanks for the post you shared. Good to see it..!! Thanks mate..
diabetes destroyer

Jhon Marshal said...
This comment has been removed by a blog administrator.
HEALTHY AMELIA said...

I found a succinct post on why low carbers fail the glucose tolerance test: http://nutritionasiknowit.com/blog/2015/04/a-tale-of-low-carb-diets-and.html.

Really, I should have taken a week to eat high carb beforehand to prevent the false positive I got... Oh, well. Hope this can help someone else.

From the above link:

"So if you are on a low carb diet (approximately less than 130g a day) you have probably developed something called peripheral insulin resistance (AKA physiological insulin resistance). During this state, any carbohydrate that you eat is most likely going to be diverted to your brain because the tissues in the rest of your body will not be taking up glucose as readily [4].

If you take either the one or two step test while on a low carb diet the results are more than likely to indicate you have gestational diabetes. This is because the muscles and adipose tissues will not be able to absorb the large dose of glucose provided in these tests, thus causing your blood glucose levels to remain high.

In order to prevent a false positive, 5-7 days before the test starts make sure you are eating plenty of carbs, 250-300+ grams a day. Go ham with those sweet and white potatoes, rice, oats, squash, grains, etc., especially on workout days. If you are already eating sufficient carbs then this shouldn’t be a problem."

Morgan Miller said...

Can you get Type 2 diabetes if you're thin?
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Jhon Marshal said...

I was very pleased to find this site.I wanted to thank you for this great read!! I definitely enjoying every little bit of it and I have you bookmarked to check out new stuff you post.
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Food Jaunts said...

Same thing happened to me :) Failed both the 1 and 3 hour tests. Started monitoring with 4 pricks a day and ironically every number was always fine except my fasting number - which you can't "control". I agreed to taking a low dose of glyburide right before bed and that brought my fasting numbers down enough to what they thought was acceptable. Still annoyed by the whole process though. Next time I intend to refuse the tests and just do the monitoring.