must I do the glucose test????

[porcamiseria]

I am being bad I know, but I am only just over the age level (ie did not have it last time). I really dont fancy going without food all morning and its a really inconvenient day. what do people think the risk is, has anyone vetoed it? Thanks

I dont want to piss hospital about, and be ungrateful, just not sure why its necessary

They do it to pick up diabetes caused by being pregnant (gestational diabetes). Uncontrolled high blood sugars can cause the baby to grow too big and not in a good way and can be associated with a number of complications for mother and baby. Treating it can definitely reduce those complications.

Some places just check people based on risk factors, but others think that everyone should get one. I don't have any risk factors but I was glad that everyone gets tested in my area.

Diabetes UK have a information page about it if that helps to read: www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/Gestational_diabetes /

I never did it for the same reason.

I've done it twice now, it is a total pain in the arse, and I HATED having to starve for so long but I figured it was better to be safe than sorry.
GD can have quite devastating effects on baby and mum so if you can possibly grin and bear it then I would. But no one can force you to do it, its your decision

thanks all. its the day that my DC come from holiday and have not seen for 12 days , but seeing as I have booked the morning as medical leave I will do it

bloody annoying tho, just cos I am 36!

I have refused to have it each time. Age is not necessarily a oroblem, nor is weight. I was 40 during my last pgcy, and clinically obese. Although these are risk factors, they do not predict the condition. However, the ritical ussue is whether you can control your sugar levels by diet. If you can, then there is no danger for you or your baby. If not, then the GTT is important, as it allows proper management of your condition.

There is absolutely no benefit to being labeled with GD or a precursor to it. All this label will do is restrict your options for labour, and possibly increase the likelihood of being pressured to give formula.

PrettyCandles, can I just ask why you think being diagnosed with GD means you are more likely to be pressured to give formula?

I'm also wondering why you would say that there is "absolutely no benefit to being labeled with GD".

The critical issue is indeed whether you are control your sugars by diet alone, but surely you need to know if there is a problem with your sugar levels and what they are before you can know if you are controlling them.

I personally would do it. I've done it twice. 1st pgcy was clear. 2nd pgcy i got gestational diabetes. As above comment says you can control it by diet, but I couldn't and ended up having to have insulin. I was 32 at the time and 8st, so not necessarily someone they would have flagged.
Baby was fine btw: and was induced at 38 weeks as they often don't like you to go full term and I got 2 or 3 extra scans during the pgcy.

Posted in a rush, so was unclear.

At every checkup during your pregnancy your urine is checked fir the presence of sugar. If too much is detected, then it may be an indication that your body is not processing sugars properly. It is not an indication of GD, but a warning sign. If you cannot control the amount of sugar in your urine by diet alone, then and only then is it beneficial to do the GTT. Pg women can test positve for the GTT without going on to develop GD. Some drs think that a degree of glucose intolerance is normal in pgcy.

If you can control your sugar levels then neither you nor your baby are in danger. If not, then you must he treadted. However, being considered a diabetic mother can lead to a highly managed labour, or even induction. If you are considered diabetic, then the baby's glucose levels may be monitored after birth, and if the HCPs consider thm too low they may pressure you to give the baby formula until your milk comes in. This can happen even without testing the baby, purely on the opinion of the HCP.

Thanks for clarification candles. Just to add I developed type 1 diabetes in 1st pregnancy, and have had 3dc. All had blood sugars monitored after birth. Only one went below what was acceptable blood sugar level so I did agree to give him some formula from a feeding cup, after this he started feeding more effectively from the breast and I continued to breastfeed him with no problem. I am entirely happy that it was the right thing to do in the circumstances and not really a big deal.

As far as the GTT goes I must say I find it difficult to understand the antipathy to taking a non-invasive test which may identify an issue which may require further treatment to ensure the best outcome for your baby.

I do understand your point about getting on a medical conveyor belt prettycandles, but frankly surely it is best to find out if you NEED to get on that conveyor-belt to protect your unborn child?

IMO the GTT test should be applied when it is indicated, not as a catch-all. I have no objection to managed births or formula top-ups, as long as they are medically necessary and not applied as part of a standardised protocol with no regard to the individual. Using the GTT when there is no evidence of glucose intolerance causes women to be unecessarily defined as diabetic, and they then become subject to the protocol, rather than treated as their condition dictates.

As far as I understand - and I looked into this in detail with several qualified HCPs during each of my pregnancies - simply having sugar in your urine is not of itself dNgerous. Over a fewweeks it is a fairly good indicator of whether a GTT is necessary.

The urine test is only a really crude test for really quite high blood sugars. Unfortunately, even slightly high blood sugars can be problematic for mother and baby. Pregnancy can also cause glucose in the urine without there being diabetes, so I am not aware of anyone just using the urine tests to screen for GDM.

Pregnancy certainly does contribute to insulin resistance and can tip over into glucose intolerance, which is all the more reason to test everyone rather than just for certain risk factors. NICE guidance says otherwise but many units have continued to check everyone as otherwise a third of cases can be missed.

I don't understand what you mean when you say "using the GTT where there is no evidence of glucose intolerance causes women to be unnecessarily defined as diabetic". The diagnosis of GDM is only made when the sugars are high either at the beginning of or after a GTT, thereby only in the case of glucose intolerance.

Hopefully all women with a GDM diagnosis would be treated "as their condition dictates" with treatment options including diet, insulin, and, more recently, metformin.

Prettycandles "Using the GTT when there is no evidence of glucose intolerance causes women to be unecessarily defined as diabetic"

• but they'll only be considered to have GD if they fail GTT.

The urine tests can only be an indicator because it's not done that often, it's not particularly accurate, and may be carried out when woman has not eaten recently and therefore is not challenging insulin response.

This being the case it would seem sensible to me that higher risk women, be it due to age, weight, family history are offered an accurate test to measure their response to rule out this potentially damaging but treatable condition.

"and they then become subject to the protocol, rather than treated as their condition dictates"
The protocols in place are designed to minimise risks to babies based on medical research rather than for the hell of it. Of course every case is different and if anyone felt they were being treated in a way they felt was inappropriate for some reason they should question that and ask for the medical reasoning in their case. Certainly if the GD is marginal and fully controlled by diet for example early induction would seem unnecessary for example, but I think most doctors would agree with that.

In your case prettycandles it sounds as if you are negating the need for GTT by testing your blood sugar (which is far more accurate than urine test and can be carried out at crucial points through the day: upon waking, after meals etc. If you are advising others that the GTT is unnecessary you should perhaps also advise them to monitor blood sugar regularly instead so any GD is not missed.

When I was first offered a GTT (as a result of sugar appearing in my urine on two consecutive weeks) I asked what the consequences of the test would be. Among other things I was told that I would not be allowed an active birth as I would have to be on a drip. I would also be booked in for induction at term.

Why? Why should I be exposed to that sort of treatment if the baby and I are perfectly healthy? This treatment would have been applied regardless of whether or not I actually developed GD.

The midwife recommended that I try controling my blood sugar through diet, and I also had extra blood tests to confirm that I was succeeding.

If a woman 'fails' the GTT and controls her sugars so that she is not effectively diabetic, or even does not go on to develop GD, she is still treated in the same way as a diabetic mother in labour and immediately after. Surely such intervention is unwarranted?

The GTT should be applied if sugar appears in the urine and is not 'removed' by diet.

I refused it....

Actually, recent medical search has shown that there's no clinical benefit from having gestational diabetes diagnoses in terms of pregnancy outcomes. I.e. outcomes are no better whether or not the testing is undertaken.

As has been outlined above, it also results in intervention that might prevent an active birth, and statistically makes C sections and forceps use more likely.

Eat a healthy, low-sugar diet and you should be fine irrespective of whether or not you have GD.

prettycandles I have had a dry mouth and a thirst all day, which i put doen to commencing Sertraline. This is a common side effect. I did a quick BM today at mums (she is diabetic) and it was 9. i am 25 weeks pregnant, do you reckon I have GD ? I am booked in for the GTT in 2 weeks. I am considering eating as though I have GD in an attempt at damage limitation. Mum is diabetic, I am obese-ish and this is 3rd pregnancy, i dint have it in the last two. I had urine tested a couple of weeks ago which was ok.

Here's some information from the US National Institutes of Health. If you don't get diagnosed and the condition develops and goes on unchecked there can be negative consequences for both you and the baby.

I had GD with my 5th baby, at 36-37, and although I was induced bang on 40 weeks, breastfeeding was never questioned, formula topping up was never suggested (until her 2-week when DD had lost over 10% of her birthweight -- she was incredibly hard to keep awake during feedings and slept for long stretches, so got slightly jaundiced; it was only at that point that I supplemented, and once she gained the weight back I went back to excl bfing)

In fact, reading further on that site it says your child's risk of developing type 2 diabetes may be lower if you breastfeed.

This seems to be a recurring thread but as I always say you have nothing to lose from doing the test except a couple of hours time and maybe some nausea from fasting and everything to gain as undetected gestational diabetes is dangerous. Plus it can not be picked up all the time in urine tests. Change the date to something more convenient and have it done.

"Actually, recent medical search has shown that there's no clinical benefit from having gestational diabetes diagnoses in terms of pregnancy outcomes. I.e. outcomes are no better whether or not the testing is undertaken."

I'm afraid this is just wrong. Getting sugars down does reduce maternal and fetal complications. Please read some of the work from the HAPO study.

Onedge, I would suggest seeing your doctor to see whether you can get the GTT earlier. It might be a once off and everything is fine, but if not, the sooner you have GDM diagnosed, the better. Hope it is all just the sertraline.

Can I just add that many centres will NOT look for glucose in your urine as it is not considered an accurate screening method for impaired glucose tolerance. The risk factors for GD are a more sensitive marker than the urinalysis. The true GTT is a better indicator of how we are coping than urinalysis and random bm's.

I can't agree that true diabetes in pregnancy, be it pre-existing or gestational, is not capable of inflicting a negative impact on mum, baby or the labour.

I'm here to tell you it can as I have managed 3 very bloody sad situations , where uncontrolled [and in one case totally unknowingly so] sugars have had bed effects. I'm sure there are a few special care nurses who will tell us the same.
There is also good evidence to support the screening of pregnant women at risk - hence the NICE review of the evidence is generally implemented.

It may change, the screening and treatment may develop as knowledge and research emerges.

bed bad.

I do think it is dangerous and foolhardy to claim that gd has no impact on the baby or mother. It can be very serious and the thing is it can be so easily controlled. I actually find it appalling to treat gd so lightly.

I have developed GD on my second pregnancy. Had the full GTT after the "lucozade" blood test came back high. In my first pregnancy I also failed the lucozade test but GTT was fine and so there were absolutely no consequences to my having had that test.

Despite v high blood sugars I never had sugar in my urine (even on the day that the bloods were very elevated)

GD has been a pain in the arse and I have certainly felt that there is a level of pushing you to comply with protocol despite managing to control symptoms with diet and/or meds. Despite that I would never advocate the "not knowing" approach. The consequences of uncontrolled GD can be devastating.

In essence, OP, please do have the test. I'll keep my fingers crossed that you get a negative result