Please talk to me about gestational diabetes

[Hollyhop17]

I have been awake since 2 and upset and distraught since yesterday. I have a severe needle phobia so instead of the GTT I was asked by Kings to self test at home for 3 days using the finger prick, which I did for 4 days.

I was told the normal parameters were between 4-7 an hour after eating. Out of 18 tests, 4 were 7, 7.2, 7.2 and 8. The rest were within. Despite this yesterday they told me I do have it, which came as a huge shock.

Has anyone else been diagnosed on such shaky data? I have read the NICE guidelines which clearly state the parameters for an hour after eating are between 4 and 7.8. Which means I actually had 1 test outside the margin.

I am petrified of what to do now. I have read that this diagnosis will have implications for my birth and they are insisting I test myself everyday until I give birth. This is hugely damaging to my mental health and I am angry that it is probably a mis diagnosis. I feel like I dont want to do it, yet dont want to harm my baby.

I have done nothing but cry since yesterday, I feel so lost.

Well an 8 would be a 'fail' on the GTT so it's not necessarily a mis diagnosis.

If you are uncomfortable with the finger prick test every day then you might be better taking the proper GTT which is 2 needles then that's it providing you pass. I'm not suggesting that's easy for you but it might be easier than prick tests multiple times a day if you can avoid.

I had gestational diabetes in 2012 with my first and had to finger prick first thing in the morning and after each meal so it was actually 4 times a day I had to do the test.

For me I actually scored 7.8 so only just failed - I didn't need any medication but it meant no midwife led unit etc etc and like you I was very upset but when I reached 36 weeks I had a growth scan and they discovered he was breech so I needed an ELCS anyway after all that!

DS was fine when he was born and his blood sugars were normal so it was all ok in the end.

Try not to worry, the diabetic team will be able to answer any questions. Have a think about maybe trying to take the test

I'm also getting caught in the new NICE guidelines but for the GTT. I've had two so far, both just in normal range, and a third booked for tomorrow (30 weeks). I challenged my consultant about this on Friday and she told me that although the guidelines have come down, the research they are based on suggested much lower levels should be the target. So, for a GTT it's gone down from 6.0 to 5.6, but the research recommend 5.0 (I think she said). If your consultant has read the same research they may also be operating under the same concerns that anything close to/just over the limit is a warning sign that shouldn't be ignored.

It's frustrating and frightening for me as she also thinks I have complications but, without a positive under the NICE guidelines, she isn't allowed to refer me to the specialist team. So I keep being sent to be tested in the hope I reach the guidance limit.

Perhaps it would be worth reconsidering the GTT as two needles in a controlled test may be better than one a day if it settles things?

I am worried that I will be forced to have a c section or at the very least will have to be monitored throughout labour, which will be restrictive and not at all what I want.

I feel like they were too quick to give the diagnosis and havent taken any other factors into consideration. Now I am stuck with a diagnosis that I dont believe and am terrified is going to rule the rest of my pregnancy, which is 9 weeks.

I have hyperemesis and in general a very complicated, trying pregnancy. This has just pushed me over the edge and I think its for nothing.

I am trying to decide if I can handle two full on blood tests only 2 hours apart. Each time I've given blood in this pregnancy it has been so traumatising and I have hard to find veins so its never straight forward. I'm tempted to not test anymore but cut out carbs and sugar and leave it at that.

Hollyhop, it's obviously been an enormous shock. I want to give you hope. I tested positive for GD in a pretty marginal way at Kings (who did have much stricter criteria than NICE and other hospitals but I think others are catching up). I was very upset indeed. When I went to the clinic I saw the obstetrician, Mr Marsh, and between us we agreed that if I remained unmedicated, controlling my blood sugars through diet alone, then he would agree to my having my baby at home with no additional requirements.

Kings had much lower criteria for medication than other hospitals so 90% of their GD women are on metformin or insulin. I kept to a very strict low carb no sugar diet and exercised regularly - just walking. You self-report your readings and I did fudge some fasting numbers as they were above Kings numbers but below NICE. All my other numbers were fine.

At 36 weeks my baby was average size and fluid normal (had either of those been off things might have been different) and I was signed off the GD clinic. I had my baby at home with no problems and I was a stone lighter than pre-pregnancy.

I've read a lot about GD since then and am part of an expert patient group too. The new numbers are based on research I know but even doctors are concerned that we are medicalising very very borderline cases at such low fasting numbers with knock on consequences for cost, services and normalised birth and mental health.

Holly I'm sorry it's adding to your anxiety, third trimester is rubbish. I'd suggest talking to your consultant again and raising your concerns about the diagnosis. It may be that your consultant has noticed other things which are contributing to this diagnosis. I hope all goes well for you

To be frank, they are only trying to look after you and your baby the best they can, so even if they are erring on the side of caution, surely that's no bad thing. I'd rather that than than a possible misdiagnosis be the other way round. You seem quite fixated on the past and how hard the pregnancy has been. Try and think about the fact that it's only another 9 weeks, and then you get to meet your child. If you're that worried about the GD, best to try and brave out a GTT as that's the only way you'd know for sure. Wouldn't go with "I'll just cut out carbs and not test" as that won't benefit anybody really.

I was diagnosed with GD at 26 weeks with a very borderline result like you OP. I'm now 38+6 and have managed it using diet and exercise. Yes I am booked in for an induction next week at 39+6 but my lovely community midwife is giving me regular sweeps to try to get me going before then which seems to be starting to work.
I also had a huge needle phobia so instead of using the pen thing to take my blood I just use the needles and test myself. Also as I've controlled my GD I don't test as much. 1 day I test pre meals, the next day I test an hour after meals then I have a day off. It's daunting at first but your doing the best for you and your baby and there's lots of help and support available. Try not to worry OP

Just to say, there's no reason to have a GTT as Kings will treat your finger pricks as diagnostic.

Thank you for your replies. Stiffy, that is exactly my concern, I read an article recently which talked about the overdiagnosis of GD and how its on the rise. I have a very unpleasant mental health condition and this potential misdiagnosis is having a real impact on it.

I am just leaving Kings MAU. I have been measured and my LO is bang on average and fluid is normal as well. They have given me an appt on Tuesday with an ob consultant who also specialises in diabetes to discuss my concerns and potential next steps. They are also scanning me on Friday to check his growth and so I have that to take with me to the appt on Tuesday.

I had borderline gestational diabetes with my first pregnancy. Mine was diet controlled and I had to test my blood a few times a day. It never really changed my birth plan although I was induced when I was 5 days overdue. Dd was born at a very normal 7lb 11oz.

P.s. I was induced but still had a normal vagjnal birth.

Thanks for your labour stories, that is helping. I know I might need a section anyway but would like to avoid if possible. I have HG so this will be my one and only pregnancy.