Does anyone think gestational diabetes is over diagnosed?

[CathyandHeathcliff]

Simply that.
It seems I know a lot of people who have had the test and been told they have it, despite being borderline and have to diet control, not take meds.

I don't think it's overdiagnosed. I was outraged when I discovered I had it - I mean genuinely infuriated. I've always been a healthy fatty, by which I mean that I'm very big but all of the tests that you'd expect to show any sort of adverse fat-related effects have always been normal or better than normal. So it was a bit of a shock although it probably shouldn't have been.

I felt initially that it was a massive overreaction, but actually it makes sense. The demands of the baby only increase during pregnancy, so if they test you at 28 weeks or whenever it is and you're borderline or only just over, how will your blood sugar look at 32 weeks or 34 weeks? As it was, I was caught in this sort of constant battle between the GD nursing lead, who kept trying to put me on Metformin, and the endocrinologist and fetal medicine consultant - basically the doctors thought that it was ok for me to have the very occasional spike if it was obviously due to a "treat" meal once a week or so, whereas the GD nurse (who was in fairness following the NICE guidelines) wanted me on it the moment I got a high reading.

I was very invested in controlling it by diet at the time, and I'm still very mildly smug because the GD nurse kept telling me I'd be on insulin by the end of my pregnancy. But only very mildly smug, because GD is much more to do with the demands of the growing baby than it is with anything you're doing or not doing. I think I was just lucky. And actually in retrospect if I could do it again I think I'd just take the Metformin, to be honest, but I was on quite a lot of pregnancy related meds by then (I had obs chole too) and I think I was just fed up with pills.

PS Baby was on the small side (not unexpected for unrelated reasons) and her blood sugar was absolutely fine. Mine was back to normal within a couple of hours of giving birth and has been normal ever since (GP weirdly resistant to giving me a GD blood test but I do a fingerprick test every so often as I still have all the kit!).

If anyone's looking for tips on managing GD through diet, the main things that worked for me were

(a) being very cautious with fruit and veg - in particular do not be fooled into baking a sweet potato, they are not low GI if they're baked to gooey caramelisation!

(b) restricting carbs to 100g at breakfast and at lunch, and eating them with plenty of protein and a bit of fat which slows down sugar release; then only salad or non-sweet veg with protein at supper. Ordinary potatoes and rice were absolutely fine, weirdly, provided I didn't eat more than 100g ish. I could also eat yoghurt and the odd scoop of ice cream as long as I had them in between meals.

(c) best thing for controlling fasting blood sugar: protein snack at midnight just before bed - usually a BabyBel - that brought my fasting bloods right down to normal.

I don't believe it's 'over-diagnosed. At all.

It's more common now as diets are worse and obesity more common.

You seem to think if it can be controlled by diet then it's not diabetes, it's only diabetes if you're on medication. That's obviously not the case. For some people, diet IS the treatment they need for the diabetes they've been correctly diagnosed with.

Do you have a thing about whether ill people are ill enough for you normally? Or is it restricted to diabetes? Why? It's weird.

The levels they identify as GD are lower than those for normal people. That's what I don't understand. And they keep lowering them.
It would surprise me if a pregnant woman naturally had lower blood glucose than when she isn't pregnant. I'd think it would be the same or slightly higher.
The truth is that very little is known about the borderline cases and the benefits of lowering blood glucose in those women.

Of course you can never ask a midwife or ob about this because the only thing they know is how to do the test and what numbers to look out for. The diabetes specialist, then, doesn't really deal with pregnancy.

Where I am, they don't even prescribe medication, so the only remedy is insulin and diet. Needless to say that insulin, unless you are really seriously diabetic, carries the permanent risk of hypos. Which is definitely worse than slightly raised BG levels.

Gestational diabetes has nothing to do with diet and stuffing your face with crap. Highly ignorant comment. Its due to the hormones being released from your placenta that effects your body producing insulin. Thats why gd goes away as soon as the placenta is delivered.

My mother has type 1 diabetes so I've been tested for diabetes with every pregnancy. This is my 4th pregnancy and also the only pregnancy Ive had gd.

The consequences of undiagnosed gd can be fatal to an unborn baby. I don't believe it is over diagnosed but even if it was theres absolutely no harm in eating a healthy diet. Better safe than sorry. I don't understand people you play Russian roulette with their babies lives.

@Geraldeen I’ve got lots of risks factors, age, BMI of 41, fourth pregnancy, previous large babies including one over 10 pounds, amd type 1 in the family. My GP is also registered in obstetrics and knows my weight issues and stuff so we decided to was worth doing early.

@Poptart a crap diet is more likely to lead to a high BMI which is one of the risk factors for GD.

My consultant told me that if I’d done blood glucose tests after 2 hours, not 1, I’d probably not have ended up on insulin at all. He told me this as he wasn’t prepared to raise my insulin dose after breakfast any higher to bring down my glucose because I was having hypos every days, so he was happy for my blood sugar to remain high for those few hours each day. I was only ever on it in the mornings anyway (google the dawn phenomenon) and never failed the gtt. I was only ever sent to the diabetes team because I had pcos - otherwise they would never have identified it at all. My boys were both born at 38 weeks and although they were big (8.10 and 8.15) they weren’t huge.

As a result of having gd I was induced with my second baby- failed induction led to c-section- therefore c-section with my third baby too. Post section complications and both babies in neonatal unit for c-section related issues, such as water on lungs etc. (As an aside, baby 3 was given huge doses of antibiotics for this which I also believe has affected his immunity, further costing the nhs, but that’s another thread....!)

I do think that in some cases gd is over diagnosed and that the blanket procedure of putting women on meds which then open up a series of protocols such as induction at 38/40 weeks automatically increases the chance of interventions. The dietary advice I received (which may have changed now) certainly and without a doubt in my mind, contributed to my high sugar readings in the mornings- brown toast, bran flakes, fruit. Just look at the food options on the hospital wards for diabetic mothers/ pregnant women.

It is incredibly common in diabetics especially those under hormonal stress to experience elevated sugars in the mornings as a result of other hormones that kick in as you wake. I have only learned this after the event unfortunately, but I feel that the consultant team should have known this.

I wonder how many people had it before the test was introduced as standard

My aunt has it before the test was introduced. Her baby died.

In my 1st pregnancy I always had sugar in my urine and few other symptoms, and I always wondered why the didn’t test me. I have no risk factors but surely always having sugar in your wee can’t be great or is this normal? Have been clear in this pregnancy so far but had a glucose reading the other day, but I had eaten some choc biscuits before hand! I was thinking if anything it’s probably under-diagnosed as they only seem to test those with specific risk factors?

So according to your logic, if they didn't do the test as standard then GD wouldn't exist? By that logic then my general practice patients diagnosed with diabetes wouldn't have it if I hadn't have tested them. Yeah ok then

It's not over diagnosed. It's better diagnosed.

I didn't have it with my first, did with my second. Mainly controlled with diet but ultimately metformin and then a small dose of nightly insulin.

The potential consequences of missing a diagnosis and failing to control can be catastrophic and as such I'm glad that wider testing is available now. I also think the NHS's dietary advice is woefully inadequate so sought my own information and found this wonderful site (and the associated FB page) invaluable.

www.gestationaldiabetes.co.uk

The levels they identify as GD are lower than those for normal people. That's what I don't understand. And they keep lowering them.

That's because there is a risk to the baby. If you are not pregnant then the risk is only to you and only you are medicated.

It's like X-rays. Pregnant women are not more susceptible to damage from X-rays but a baby/ foetus is.

@bluebug a high bmi is only one risk factor for gd. There are many factors including a family history, age, previously having a big baby etc

Ive always been a size 10 or under and the majority of women at my first diabetes clinic appointment were of a healthy weight so to make a blanket statement that gd is caused by overweight mothers is ignorant and insulting to the thousands of women who get it through no fault of their own.

I had a bit of a cry to the endocrinologist about having put the baby at risk because of being fat therefore having GD, and he said that the vast majority of women with GD do not have a high BMI. He actually made me go and look at the other women sitting in the waiting room because I said he was just trying to make me feel better.

I’m not sure either that it is correct to zero in on being overweight as a ‘cause’. That seems too crude and simplistic a statement to me, based on many fortnightly visits to the antenatal diabetic clinic and conversations with the doctors there. My BMI was 24.5 at the start of my first pregnancy which was within the green zone for my age and height. I ate well and exercised regularly before as well as during pregnancy. The diabetologist said that for some women the placental hormones are simply so strong that the woman’s sugars continue to go up throughout the pregnancy notwithstanding any lifestyle measures the woman tries.
(But of course poor diet and inadequate levels of exercise are not going to be beneficial generally in life.)

Everyone here is saying it isn't over diagnosed but this is actually a very hot topic in maternity care. There is no definite consensus on what the cut off numbers should be, or how it should be diagnosed, and they are different in different countries... so someone diagnosed with GD in one place might not have it in another place. And the new lower numbers brought in have led to a huge increase in diagnoses without very clear evidence that it improves outcomes. You can read about this in the British medical journal.

No. My cousin ended up with her baby in special care, due to undiagnosed GD.

I have to agree with Bue. Borderline cases don't generally lead to massive babies (I think defined as 5.5 kg and above), but there tends to be more intervention because GD sets off alarm bells in maternity care health professionals as they are only familiar with the outcomes for full-blown GD (which admittedly is dangerous).

My results were upper level of normal in my second pregnancy. So officially I didn’t have GD. However my hospital was doing a trial where women with upper normal levels were randomised to either standard GD treatment or continue as though the test had been negative. I was randomised to the treatment arm and needed metformin. I almost ended up on insulin by the end of my pregnancy despite being very strict with my diet and on large doses of metformin. My fasting sugar was too high every morning. (The rest of my BMs were ok).
I have to say I was very glad I was in that trial. Elsewhere I would have been classed as not having GD and would have ended up with high sugars that myself and the medics would have been entirely unaware of.

I’ve only just come back to read this thread as I’ve been away.
I see it’s stirred up a lot of emotions in people. I wasn’t meaning to upset anybody, I was genuinely interested in it. I’m certainly not advocating not getting tested or not getting treated. I just thought I’d heard of a lot of women who have it lately and wondered if there was a significant rise. Maybe I worded it wrong. Again, I’m sorry if I upset anyone.