One of the scariest moments of this pregnancy was being diagnosed with Gestational Diabetes (GD).
You can read about my related GD posts here. My previous posts have covered my initial reactions, my fears, my plans, things I eat, and pretty much dealing in general.
Before I even took the Glucose Screening Test (GST, also known as "the 1-hour" test), I did a lot of research about what GD is, how is it diagnosed, and how is it treated. I've touched a bit (ok, maybe closer to a lot) on GD before and you can check out some of the information on the Gestational Diabetes tab above.
What I want to get out in this post are some of the inconsistencies with diagnosing and treating GD. I found during my internet research that many people feel that GD isn't even a real disease and that the diagnosis is so flawed that treating this "so-called" disease is actually dangerous. The issue seems to stem from the fact that the guidelines for testing vary and the test results itself are questionable.
After being diagnosed with GD, I found an online support group of other moms to be, also due in December, and also battling with GD.
There are many threads posted within our group about meal plans, high numbers, strategies, work out plans, etc... that we quickly noticed that many of the women were being treated for GD differently. Of course, every pregnancy (and every woman) is different so there is no cookie cutter treatment plan but the plans varied greatly enough where an abnormal test result for one woman is completely acceptable to another and vice versa.
I dug a little deeper because I was curious about other differences or inconsistencies that existed between our treatment plans.
Here is a brief summary of what I found:
Glucose Screening and Glucose Tolerance Tests ("1-hour" and "3-hour" tests, respectively)
We were given different instructions prior to taking our tests. Wouldn't this affect our diagnosis? Before taking my 1 hour test, I was told to fast after midnight. Some of the women in my group were told to eat normally, others were told to fast, others were given no instructions. It seems to me that the difference in instruction could have greatly affected our results!
For the 3-hour test, I wasn't given any clear instructions. I took it up on myself to fast since that is what my Google results told me. (I should have just asked my doctor, I know, but too late now). Again, women were told to fast, eat normally, and others were told to increase their carb intake.
Shouldn't the guidelines before the screening and tolerance tests be identical? Wouldn't this be a type of control for the lab tests? I'm no science gal but I do not that basic instructions before a lab test should be consistent if we're going to use the results.
For a quick recap, during the 1-Hour exam a pregnant woman is told to drink 50g of glucose in this sweet syrupy drink. An hour later blood is drawn and glucose levels are measured. During the 3-Hour exam, a pregnant woman has her blood drawn first (called the fasting draw), then 100g of glucose is given in the form of a drink, and then later blood is drawn at 3 1-hour intervals.
During the 3-hour exam some women are not allowed to walk around or engage in physical activity. They have to just sit there during the whole ordeal. Other women are encouraged to walk around after drinking the glucose.
I now know that walking greatly decreases my glucose levels after a meal and can't help but wonder if I were allowed to walk around, would my numbers have been different?
Treatment of GD
After being diagnosed, most women are put on a GD friendly diet- low(er) carbs and more protein. Most attend a class with an RN and a Dietician. We learn how to eat and how to test our glucose levels in the morning (fasting) and after meals. Granted, since each woman is different, our meal plans will differ to some degree. Some women can't have fruit or milk in the morning or before noon, some have no restrictions in the morning.
So where are the significant inconsistencies? They lie in testing our glucose and whether our levels are abnormal or normal.
I test my glucose levels 4 times a day: fasting, 1-hour after my first bite for breakfast, lunch and dinner. I also have 3 snacks in between meals. My fasting number needs to be below 95 while my number after meals need to be below 140. Sometimes I can test 2 hours after my first bite if finishing my meal takes longer than 30 minutes (like at a restaurant). If I test 2 hours after a meal, my number needs to be below 120.
Some of the women in my group test after 1 hour, others after 2. Some women need their glucose levels to be below 135 and some below 130 an hour after a meal. Others only test at 2 hours (their glucose limit is the same, 120).
So some of my glucose results that are above 130 would raise a flag for their doctor but is perfectly acceptable by mine. *It's important to note that the levels of 95 and 140 were given to all the ladies in my diabetes education class, not just me*.
Same for the fasting number. Mine needs to be below 95 but other women were given limits of 90 or 100.
So why does this all matter?
If there were inconsistencies before, during, and after these tests- how do we know the test results are accurate? There seems to be some vital controls missing.
There are also some groups of thought that feel the treatment of GD through a restricted carb diet does more harm than good.
Don't get me wrong- I am NOT saying that we should throw GD out the window and forget about it. From what I've read, there are risks to the baby that result from insulin-dependent diabetes (pre-pregnancy). It seems that the diagnosis and treatment of GD stems from that.
When GD is not controlled and glucose levels are extremely high, not only does mom have to create more insulin but so does baby. Baby's pancreas goes to work overtime to deal with the high levels of glucose that cross the placenta. And that's normal- when we ingest too many carbs, a healthy pancreas goes into overdrive to break down the glucose. When the body no longer responds to the insulin or stops producing it that's when we have issues.
What's scary is that in uncontrolled glucose levels with baby's pancreas working overtime, once baby is out of that environment (high sugar in mom's blood), baby's blood sugar can dip dangerously low after birth. And that is scary.
I understand the risks but wonder if maybe just maybe there is a better way to diagnose and treat GD. Maybe something a bit more consistent?? I think I'd feel more confident in my treatment if I knew the diagnosis and treatment didn't vary so much from doctor to doctor.
There's not much I can do about it now though. So I'll keep trucking with my meal plan and exercise routines and trust that I'm doing the best for my baby. That's all a parent can do right?
I have an ultrasound appointment in a few weeks to check up on baby's growth. I'm praying all is normal and that my hard work is paying off!