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Gestational diabetes!

Gestational diabetes stats

6% : the percentage of pregnant women that will be diagnosed with gestational diabetes (commonly called GDM, and AKA diabetes of pregnancy). Pregnancy itself puts women in an insulin resistant state, which subsequently increases the risk of developing diabetes (temporarily).

10%: percentage of women in the US are considered “low risk” for developing GDM given baseline health status. That means 90% of us have some risk factor that makes it possible, and sometimes even likely, that we will develop GDM. Even low risk women may develop some potential risk factors during pregnancy  – hello significant weight gain. That means universal screening is recommended – that means screening for every.single.one.of.you (and me during both of my pregnancies). 

24-28 weeks of pregnancy: normal screening window. If you have significant risk factors, such as a history of GDM or very large baby in a previous pregnancy, first degree relative with diabetes, obesity, and/or insulin resistance before pregnancy, I recommend screening early in pregnancy and again during the normal window.

Testing and screening for gestational diabetes:

To screen for gestational diabetes, nearly every OBGYN office uses a pre-formulated glucose load in the form of a Fanta-esque drink, sin gas. Most women tolerate it, some women fear it, others refuse it.

2 common screening options

The “2 hour” screening test – a fasting blood test, a 75g glucose load (more about this in the next post!), a second blood test 2 hours later. If you pass, you’re done. If you fail, you are diagnosed with GDM. 

The “2 step” screening test. First step: a 50g glucose load followed by a blood test 1 hour later. If you pass, you’re done. If you fail, you need the 3 hour test – a fasting blood test, a 100g glucose load, then blood tests at 1 hour, 2 hours, and 3 hours. This is the kind of testing I do – it’s onerous for women who have to do the additional 3 hour for confirmation, but the 1hr test is relatively painless if you don’t mind the and tolerated well. 

Tips to make the drink more tolerable:

  • serve it chilled or over ice.
  • You are allowed to drink water, so follow it with a big swig of water too.
  • Bring a protein snack to eat once the blood draw is done
  • Make the time go by faster: my office gives the patient the glucose drink at their previous appointment with strict instructions. They drink it on the way in and with LA traffic that can be a long car ride. This way patients aren’t waiting in the waiting room for an hour. Also, schedule your doctor appointment, if possible, during that  time too
  • If you’re waiting at a lab: plan to watch a show, or read a magazine, or catch up on your gossip rags in that time. Whatever it is, just plan it as a treat so you have something to look forward to!

 

Can you really refuse to do the test?

Of course you can. I don’t suggest it unless there is a medical indication (such as history of gastric bypass surgery). This is because the glucose load is the most accurate way to diagnose GDM, and GDM can have severe effects on the pregnancy and baby. Knowing whether or not you have GDM is extremely important for the health of you and your baby (which is why we screen everyone).

But if the thought of that orange drink makes you throw up, or you actually do throw up and can’t do the test, here are some alternatives:

  • Checking accuchecks every day. You use a glucometer (available from most pharmacies, and often covered by insurance), lancets (the small sharp prick to draw blood), and test strips to check your sugar level multiple times a day – I usually start with 4 times daily – fasting and then 1 hour after each meal.
  • The 50g or 75g or 100g glucose load (see previous post about the differences) in a different form. When my mom was pregnant, she was instructed to have a “big pancake breakfast”. Jelly beans, gummy bears, main stream sodas, and candy twists have all been proposed. Unfortunately these alternatives aren’t as accurate and sugar content not as predictable. None have been studied as extensively as the traditional glucose load. Some potential issues: multiple candies can take longer to consume than a small juice bottle. Some candy alternatives, like a Snickers bar, have additional protein and fiber, which may alter the metabolism of sugar in your body. It really needs to be a simple sugar. 

Questions? Let me know!

 

 

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Dec 29, 2020

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