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Would you / should I decline the glucose tolerance test (GTT)?

(71 Posts)

I don't normally hold with saying no to medical tests etc. but this pregnancy I have been advised to have the GTT because my dad has just been diagnosed with type 2 diabetes. We know why he has diabetes - he has chronic pancreatitis. But this finding gives me a 'family history' so I've been sent an appointment letter.
My BMI is about 22 when pregnant (!), my last baby was very small for dates (5lb 1oz at 38 weeks, induced for lack of growth) and I've had no sugar in my urine so far. Oh, and my amniotic fluid looks normal (not excessive).
In these circumstances, would you stick your neck out and say no? I'm willing to frequently check my own urine for sugar (DH a GP so we can get some cheap NHS dip sticks) to make sure that i'm not endangering the baby in any way - DH says this is just as effective as the GTT.
I guess I feel like the test is unneccessary and, with my continued morning sickness, will definitely definitely have me throwing up all over the ob/gynae department since it involves fasting, drinking a sugary drink, then more fasting ... I give the sugary drink a maximum of 15 minutes before it reappears.
Anyhow, all this to ask - would I be reasonable vs irresponsible to say no to this test? Anyone got any experience of the GTT to share?

IneedacleanerIamalazyslattern Sat 17-Oct-09 12:19:48

I think it's up to you.
I have declined them in the past as I always have sugar in my urine when pregnant right up until the week I give birth, I have had so many GTT tests that towards the end I actually ended up declining them.

Don't think it would be irrisponsible as such, your dh is a medical professional and has given you his professional opinion on it.

Maybe decline it for now find out a bit more about the risks involved and the liklihood of you developing diabetes and if sugar does appear in your sample agree you will get one done asap.

SCARYspicemonster Sat 17-Oct-09 12:29:43

It was standard practice in my antenatal care and so I just had it. But if you know you're going to be sick and your DP is a GP and you're both keeping an eye on your glucose levels, I can't see that you would be putting yourself or your baby in any danger.

FWIW I didn't have the triple test because I didn't want to terminate unless the baby had a condition incompatible with life which would have been picked up at the anomaly scan.

Your body, your pregnancy

IneedacleanerIamalazyslattern Sat 17-Oct-09 12:34:33

Oh and pointless other bit of information one of the reasons I did agree to so many of them in the first place before I gave up was that it was not something that was routinely checked for when my mum was having us and she had huge babies and so did her mother so it was a distinct possibility that they had GD.

reikizen Sat 17-Oct-09 12:39:40

IUGR can also be as a result of diabetes, but I agree your family history is shaky to say the least! I think as long as you and partner feel happy without the test you can always have a GTT at a later date if things change (glucose in urine etc.) I agree we test too many women for diabetes, we are determined to find something wrong with them! wink

It's up to you, I'm sure something would crop up if you were to develop diabetes. I would say that the checking the urine for glucose is not reliable at all, I have gestational diabetes atm and have never had glucose in my urine. Would be better off getting a blood glucose monitor and doing the occasional fasting or random suger.

Weegle Sat 17-Oct-09 13:01:24

I'm not commenting on whether you should/shouldn't go for the test... but just wanted to say, I'm having a GTT in a couple of weeks and spoke to the obs and midwives at my appt this week about the sickness issue - I too am worried that early start+fasting+driving+sugary liquid drink spells disaster. As I said to them "how's it going to work when the sugar isn't going to be in my bloodstream, it's going to be in one of your cardboard vomit bowls?!" grin. I've been told to take double my dose of anti-emetics the night before and they will also give me some at the hospital before taking the drink. They also said you can be given a different sort of drink?? I didn't go in to it further because I figured I'd highlighted the potential problem, it's now for them to deal with - but they didn't seem bothered about the sickness affecting the actual test too much.

bigcar Sat 17-Oct-09 17:39:56

can't say whether you should go for the test, but as blackletterday said, I had gd and only had sugar in urine once, so it's not a reliable indicator. A blood glucose monitor would be the way to go.

LeonieBooCreepy Sat 17-Oct-09 18:16:45

Declined for no. 1. When they discovered she was big at 36w, they blamed me. Consultant said, verbatim: "Well if you'd taken the GTT we could've been doing something about this all along. now all we can do is damage control.

Fucking bitch that she was.

She sent me to diabetic midwife, who made me check my sugars for a week, 5x / day (fasting, after meals, and random). None were over 7. Most were nearer 4. I was discharged as non diabetic. I never got an apology.

They told me i'd have to feed DD1 formula because any big baby HAS to have formula because their sugar goes low. Hers never did.

I told them categorically to fuck off and don't even mention the word 'diabetes' to me when preg with DD2, even though i was 5 years older, 1.5 stone heavier, and both of my parents are now type2s.

I was again not diabetic. I had a meter, was quite capable of checking my sugar. DD2 was fine. They tested her sugar day 2 because she was trembly but it was 3.8, so they were happy.

Skip the GTT if you want - there are TONS of articles about it at pubmed saying how useless it is during pregnancy. Also Henci Goer writes a good article about how glucose tolerance is SUPPOSED to change, and all these GTTs just make patients out of women who don't need to be.

Also i have a friend who is type 2 and during her 3rd pregnancy they put her on insulin at 6 weeks after a GTT, and her baby couldnt keep his sugar up even though hers was well controlled, and spent a week in SBCU.

Sounds like 'dont mess with mother nature' if i ever heard it.

bubblesincambridge Mon 19-Oct-09 09:31:59

For god's sakes its only a blood test.

It'll do you and the baby no good whatsoever if you have diabetes and it goes undiagnosed, just because you couldn't be bothered to have a blood test!

4madboys Fri 02-Apr-10 17:44:17

bump, bit early to be asking about this as i am only 6 wks preg, but as i had a big baby last time 10lb 13oz they are wanting me to have the gtt at 26wks preg.

all my babies have been over 9lbs, yet none of the boys were fat, just long and big, they all are still big for their age, but my partner is tall, and they take after him, not me at only 5 2!

anyhow my bumps ALWAYS measures SMALL for dates, i have no signs of being diabetic, never had sugar in wee etc, no family history and nothing really to indicate that its an issue.

my midwife says she doesnt think i sufferer from gd, but its 'protocol' after a baby as big as ds4 was.

i delivered him easily in less than an hour in a birthing pool, my midwife just says my body is good at pregnancy and designed for childbirth as i birth easily, even big babies.

so i am wondering if i should/could refuse the test? i tend to get very low blood pressure in pregnancy which leads to me feeling dizzy etc, and starving myself for a blood test will pretty much guarantee that i faint or feel very ill.

ds4 was also tested after he was born and he showed NO signs of having any problems with his blood sugars, they just decided he was a big baby.

if anyone could tell me a bit more about the test? and if they think its worth having it done or if they have declined it, i would be very grateful

thanks

memorylapse Fri 02-Apr-10 17:55:37

tbh..I would have the GTT..if anything just to prove you dont have diabetes..undiagnosed gestational diabetes can have far reaching implications for your unborn baby so its better to be diagnosed..

Ive had 4 babies, all big, one was 9lb 7 at 38 weeks..never had diabetes..this pregnancy I was gobsmacked to be diagnosed with diabetes at 14 weeks pregnant..Ive been on insulin since 20 weeks.
I had hyperemesis and was in a state about the fasting..but it wasnt too bad..I got to the hospital at 9am..had my blood test straight away, then the drink..which wasnt too bad..not nice..but not too bad..and sat quietly for 2 hours..I was allowed to drink water though which helped stave the sick feeling off..when I got home I hurled my guts up but was glad I had the GTT as I had diabetes and it could have easily gone undetected..oh and just for the record..I dont always have sugar in my wee...a more accurate way of checking your sugars is to use a BM machine

4madboys Fri 02-Apr-10 19:54:30

yeah i guess its a kind of better safe than sorry thing? i just hate having to conform to 'protocol' and i also have shite veins so they always have a pita getting blood out of me!

its still early days so i shall talk to my midwife again etc and do a bit of research, my mum is also a nurse so i shall ask her, once i have told her i am pregnant that is!

Whelk Fri 02-Apr-10 20:04:28

I think that in the west we are actually very lucky to be offered such good medical care to help ensure a healthy pregnancy, mother and baby.

The great thing about this test is that if it is found to be positive you can do things to prevent it becoming a problem.

Of course this will include testing people who turn out not to have diabetes.

Its about a balance of risks. For me being able to find out whether there was a potential problem outweighed the discomfort and inconvenience of the fast, sugary drink (vomit faint for me!!) then fast!

vanitypear Fri 02-Apr-10 20:12:00

My consultant OB (at major London teaching hosp) didn't see the point of the GTT and preferred just one random blood test - he said this was just as accurate and didn't agree with giving a massive shot of sugar. So in that knowledge I'd quite happily decline if you are testing otherwise as you suggest.

MumtoF Fri 02-Apr-10 20:12:26

Undiagnosed diabetes is very dangerous - there are a lot of complications and dangers that many people aren't even aware of (everyone thinks it is just big babies) and in the US they are now introducing stricter perameters as they think diagnosis of GD is so important. If you prefer to do a couple of days of needlepricks before and after meals to confirm you don't have it then do that instead but if I were you I wouldn't not find out. The NHS avoid spending money where they can so if it wasn't a big deal they wouldn't test so many people. It was never picked up in my urine, just a GTT because of family history of type 2. It can be controlled with diet and to be honest following a GD diet will be good for you especially if you suffer from sickness as that is connected to blood sugars.

Shaz10 Fri 02-Apr-10 20:14:11

I have crap veins and blood tests are a nightmare. I did the GTT and it was ok. I was really dreading it but I found it a lot easier than some blood tests.

becksydee Sat 03-Apr-10 21:40:54

i have to say, if i ever have another baby i'll be declining the GTT. i had very well controlled (by diet) GD & all it ended up doing was labelling me as high risk for no good reason, causing me a lot if stress & upset in the last few weeks of my pregnancy.

what i would do however is 1hr post prandial blood glucose testing + fasting blood glucose first thing in the morning, keeping a diary of the readings, & if the numbers went out of control then i would ask to be referred to the diabetes nurse/endocrinologist asap. agree with all the posters above that urine testing is inaccurate (i never had glucose in my urine)

i think just declining it would be a bit irresponsible given your family history, uncontrolled GD can cause lots of problems, but monitoring your blood glucose regularly with a glucometer should be ok, assuming the readings are within the normal range of course.

ArthurPewty Sat 03-Apr-10 21:45:07

I declined it both times, despite a personal history of big babies, and both my parents being type 2 diabetics.

I had a glocometer and i KNEW i didnt have GD the first time despite a 10lb baby, so i told them not to even mention GD the second time. They did not, and I didnt have it the second time either.

Your body. I dont believe in GD as an entity anyway - my best mate took a shitload of insulin in the last part of her pregnancy prescribed, because her blood sugar was very high, but her baby ended up in NICU for a week anyway despite the insulin, was small, skinny, etc. Starved, basically, IMHO. He couldnt keep his sugar up and he was cold / trouble regulating body temp.

I'll stick with my big babies who come out perfectly healthy, thanks very much.

Henci Goer has a good article on why GD may not be real... google her name.

ChangeNameChangeLife Sat 03-Apr-10 21:48:02

GD is not about weight. Many women who have g diabetes are not overweight nor have a family history of diabetes. It is not an invasive test although I sympathise it will be difficult for you due to the sickness, I have experienced that too.

HOWEVER undiagnosed G diabetes is a terrible heaslth risk and one that can be easily averted. I would strongly recommend you take the test if they have asked. For a couple of hours of bad nausea (and believe me I do know how hidoeus it is) you could avert much more serious problems. I really recommend you rethink your position on this.

Rockbird Sat 03-Apr-10 21:49:09

Sorry for the thread hijack but I asked this ages ago and no one replied <sob>

I had very very late onset GD with DD two years ago (plus v overweight - still am and father type 2 so prime candidate). From 38.5 weeks onwards it was non stop intervention ending in induction which I was too uninformed to know that I could refuse. Anyway, next month we start ttc dc2 and what I would like to know is, having had a first pg with GD, do they leave you alone until the inevitable GTT at 26 weeks or will the diabetic clinic be on my case from day one?

Thanks, sorry again blush

ChangeNameChangeLife Sat 03-Apr-10 21:49:46

Oh and by the way my babies were normal to small sized so again you can not take that as an indicator. Only a GTT will tell. Honestly it is not worth the risk.

Mooncupflowethover Sat 03-Apr-10 21:52:15

Why wouldn't you? What if you DID have GD? I've had the test, it was no great shakes. Turned out I did have it.

dizzydixies Sat 03-Apr-10 21:55:28

Rockbird, in answer to yours am not sure as yet as I'm only 9+5 with DC4 but I had GD with DD3, late stage and managed through diet and went after. Am still overweight blush and was told at my booking in that the consultant might want me in sooner - will let you know when I do!

OP - I've had 3 large babies, DD1 was 10lb4 without GD although I had the test, DD2 was 11lb1oz without GD and when I was pregnant with DD3 I refused the test only to be talked round by the charming consultant - I'm glad I did as I had GD this time and was better treated in the diabetic clinic than the normal ANC. I know I'll have to have it again this time and frankly I don't have a problem with it if it effects the health or either me or the baby

MumNWLondon Sat 03-Apr-10 22:00:11

I declined GTT - my granddad had type 2 diabetes (he was v overweight though) and I have very mild pcos and hypothyroidism..... but I am not overweight at all. I had full GTT twice in first pregnancy and didn't have GD. Both my DC normal size (7 5 and 7 14)

I said I'd have a random non fasting gloucose test in this pregnancy and if it was abnormal or even borderline or close I'd do a full GTT - they were happy with this. The test came back very normal so they said it was very unlikely I had it and didn't recommend the full GTT. If they had really pushed (ie if I had any real risk factors I would have had the test).

Rockbird - at my hospital they'd be on to you from your booking in appointment - anyone with history of GD gets referred to diabetic clinic at start and full GTT in each trimester.

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