PDA

View Full Version : anyone opt out of testing for gestational diabetes?



dukie41181
08-05-2010, 12:50 AM
We didn't test last time and have chosen not to do it this time either. I asked my midwife about signs to watch for and she talked about the signs being consistent with pregnancy so not always a good indicator but said some were more frequent urination, increased thirst and a few others. Well, I did notice an increased urination at one point but attributed it to the baby sitting low (which I can feel she is) and I don't feel I've been increasingly thirsty. I'm content with my choice to not test (I couldn't do a glucometer even if the result were positive) and iv rather chosen to focus on eating a good, lower sugar diet. Anyone else in a similar place?

essnce629
08-05-2010, 04:22 AM
I've had 2 homebirths and my midwives didn't do the test routinely unless there was a concern or other risk factors. So I've never had the test and didn't think twice about it.

brgnmom
08-05-2010, 04:28 AM
We didn't test last time and have chosen not to do it this time either. I asked my midwife about signs to watch for and she talked about the signs being consistent with pregnancy so not always a good indicator but said some were more frequent urination, increased thirst and a few others. Well, I did notice an increased urination at one point but attributed it to the baby sitting low (which I can feel she is) and I don't feel I've been increasingly thirsty. I'm content with my choice to not test (I couldn't do a glucometer even if the result were positive) and iv rather chosen to focus on eating a good, lower sugar diet. Anyone else in a similar place?

I wish I knew I had the choice to opt out of the test. I'm supposed to take it this Friday. I was negative for gestational diabetes the first time around, and I've been cautious about having a low-sugar well-balanced diet. I do know of many moms who have had GD, and so I think I'll still take the test this Friday. I called my OB's office and asked the nurse there whether I could take the standard fasting tast (which the OB had suggested as a possibility for me without having to take the glucola soln)... and the nurse said I should just fast for 5 hours prior to my morning appointment and still drink the soln an hour before the blood draw. I'm kind of frustrated by the conflicting advice.

It's nice how midwives are more open-minded about this test and not having to take it.

rkold
08-05-2010, 06:48 AM
I took the test (don't have gestational diabetes) and for the most part regret taking it. I mean it's nice having it confirmed that I don't have it, but the experience was really miserable for me. I've had a lot of nausea and vomiting during my pregnancy and the glucose solution really set me off. I had to lie down.

I hadn't really realized the test might be optional until the night before I was scheduled to take mine.

swissair81
08-05-2010, 07:49 AM
My Dr didn't let me opt out. He did, however, ensure that it was a more pleasant experience.

bcafe
08-05-2010, 08:16 AM
I have not done the test for my last 2 pgs. I have no risk factors and my midwife doesn't recommend them unless there are risk factors.

sste
08-05-2010, 10:46 AM
Isn't the initial test just urine or blood - - I can't recall but I remember it wasn't a big deal (the follow-up test does suck with having to drink so much of that solution).

What is the upside to opting out of the initial testing, esp. given it is not a big deal?

My understanding was that managing GD is one of the "biggie" advances in prenatal care that actually delivers in terms of improving maternal-fetal outcomes.

And its not clear to me that risk factors or symptoms absent testing would address this issue as well because there is so much overlap between pregnancy symptoms and GD symptoms and b/c I think traditional risk factors are less helpful for diabetes in light of the national "diabetes epidemic" we are now experiencing. Also I believe that even if you don't meet the diabetes def. you may be borderline or in a danger zone and that is helpful to know too in terms of lifestyle change.

What am I missing?

luckytwenty
08-05-2010, 10:55 AM
Why opt out? You just have to drink this gross drink and get your blood drawn--no biggie compared to everything else we go through during pregnancy, and gestational diabetes is pretty serious. I have mine next week and am hardly looking forward to it, but I don't understand why you'd opt out.

rkold
08-05-2010, 11:33 AM
Isn't the initial test just urine or blood - - I can't recall but I remember it wasn't a big deal (the follow-up test does suck with having to drink so much of that solution).

What is the upside to opting out of the initial testing, esp. given it is not a big deal?

My understanding was that managing GD is one of the "biggie" advances in prenatal care that actually delivers in terms of improving maternal-fetal outcomes.

And its not clear to me that risk factors or symptoms absent testing would address this issue as well because there is so much overlap between pregnancy symptoms and GD symptoms and b/c I think traditional risk factors are less helpful for diabetes in light of the national "diabetes epidemic" we are now experiencing. Also I believe that even if you don't meet the diabetes def. you may be borderline or in a danger zone and that is helpful to know too in terms of lifestyle change.

What am I missing?

Because of the nausea I've experienced during my pregnancy, taking the test wasn't no biggie for me. I had to spend the 20-30 minutes prior to and when they took blood lying down or I was going to vomit up all of the glucose solution ( which if it happened would mean I'd have to then pick another day to fast and take the glucose test and see if I could manage to not puke it up again.) I know of a lot of women it has given nausea to other than me.

And I sort of feel the opposite, after reading more about the test I feel like it doesn't really give you that much information. If you have gestational diabetes, you might be at a risk of a larger baby, you might be at risk of Preclampsia, you might be at risk for a baby with sugar issues or jaundice, but nothing is definitive.

It seems best to just try and eat a healthy diet while pregnant regardless of whether you have GD or not. ^^;

pb&j
08-05-2010, 11:36 AM
Sort of. I had very mild GD w/my pregnancy w/DS. It was totally diet and exercise controlled.

When I was preggo w/DD, since I had a previous diagnosis of GD, my doc requested that I take the test early (around 16 wks I think). I declined that test. As my GD was very mild (so mild as to be practically nonexistant, don't get me started), I didn't feel that it was worth putting myself through the test. If the outcome of finding out that I had GD was to adopt a GD-friendly diet and keep on exercising, well, I was already doing that, and there was no point in taking the test that early on. If I passed at 16 wks, I'd have to take the test again at 26ish weeks, anyway. I had no sugar in my urine, had minimal weight gain, was eating right, and was exercising (I ran/walked a 4 mi race in the 3rd trimester).

I did take the test later on in pregnancy, and passed w/flying colors.

sste
08-05-2010, 11:48 AM
Yikes, I can see why extreme nausea/hyper-emesis (sp?) would tip the scales.

But, if the sentiment is I won't take the test and I will just act as if I had GD through diet and exercise . . . well, aren't there additional screens/tests/monitoring that moms with GD, at least significant GD, are rec'd to have? Esp. since only *some* GD is controllable through diet/exercise (if I understand correctly - - I have never had gd).

Wouldn't one have all of the additional monitoring/testing/precautions too if the philosophy is I will just skip the test and treat myself like I have GD?

That would seem like it would end up being more intervention/testing, not less . . .

brgnmom
08-05-2010, 12:01 PM
I just talked to my dh (an m.d.) about some of my worries about testing for GD, and he is an advocate for getting tested, so that I would need to be monitored more carefully if I do have GD. I'm not at risk for GD (did not have gestational diabetes the 1st time and I don't have any risk factors), but looking at this issue more closely, I'd feel better knowing whether or not I have this condition. And my health care providers would be able to do a better job caring for me during my pregnancy and during the delivery with that knowledge, I think. So I'm going to get tested tomorrow, even though the glucola solution is difficult to swallow.

swissair81
08-05-2010, 12:47 PM
Why opt out? You just have to drink this gross drink and get your blood drawn--no biggie compared to everything else we go through during pregnancy, and gestational diabetes is pretty serious. I have mine next week and am hardly looking forward to it, but I don't understand why you'd opt out.

Well, I wanted to opt out because I have a history of hypoglycemia. The lower end of normal for the test is 65 (about) & my last 2 test results were 61 & 58. My Dr knew that without some kind of compromise, I just wouldn't touch the stuff.

rkold
08-05-2010, 12:58 PM
Yikes, I can see why extreme nausea/hyper-emesis (sp?) would tip the scales.

But, if the sentiment is I won't take the test and I will just act as if I had GD through diet and exercise . . . well, aren't there additional screens/tests/monitoring that moms with GD, at least significant GD, are rec'd to have? Esp. since only *some* GD is controllable through diet/exercise (if I understand correctly - - I have never had gd).

Wouldn't one have all of the additional monitoring/testing/precautions too if the philosophy is I will just skip the test and treat myself like I have GD?

That would seem like it would end up being more intervention/testing, not less . . .

Personally, I'm not eating as if I have GD, I still indulge in sweets when I feel in the mood for them, though in general my sweet tooth has vanished.

But I do try to mostly follow a healthy diet and exercise when I can. I try to eat as healthily as possible because I feel like it is better for me and my future DC. Since I personally have not had an easy time keeping things down, I want when I can keep things down for it to be something that is going to give us some sort of benefit.

If you have extreme GD you can be put on insulin. But usually someone who has such a bad case of GD will have more than likely had sugar in their urine before the GD test. The majority of people with GD while pregnant control w/diet and exercise.

Personally, it bothers me that pregnant women are forced to go through a much more difficult test than the simple glucometer (sp?) test that actual diabetics use.

luckytwenty
08-05-2010, 01:23 PM
It seems only reasonable that if you have a condition like hypoglycemia, the OB would go for an alternative route.

I wouldn't assume just eating a GD type diet and exercising means you don't have it. I have several otherwise non-diabetic friends who ate well, exercised and didn't gain much weight, and still were diagnosed with GD. I did not have it my other two pregnancies and the nurse actually told me she would bet I don't have it again because I'm slim/active/etc., but I'm still taking the test. It's not just a matter of getting on the diet. There are some complications during delivery and post-delivery for babies born to moms w/ GD. I'd want to know.

dukie41181
08-05-2010, 01:45 PM
I have not done the test for my last 2 pgs. I have no risk factors and my midwife doesn't recommend them unless there are risk factors.

What are the risk factors? I'm wondering if I have any...

Thanks!

swissair81
08-05-2010, 01:54 PM
Personally, it bothers me that pregnant women are forced to go through a much more difficult test than the simple glucometer (sp?) test that actual diabetics use.

There is a reason for that. Diabetics know they have blood sugar problems, so they don't have to test their tolerance to glucose. They know it's impaired. So they use the glucometer to check what their blood sugar is & deal with it according to their Dr's instructions.

When you test for diabetes (which is what the GTT is), you are introducing a high level of glucose in your system to see how your body deals with it. Are you producing enough insulin & reacting to it appropriately. Can it bring your blood sugar down to normal levels within the specified time period? If yes, that's great. If not, then why not? It's just not the same thing.

BabyBearsMom
08-05-2010, 04:13 PM
The stuff that I had to drink tasted like gatorade. I actually kind of liked it...I must be weird

Beth24
08-05-2010, 07:39 PM
What are the risk factors? I'm wondering if I have any...

Thanks!

I had my baby 5 weeks ago, my fourth and was diagnosed with GD at 18 weeks. I was 44 when I got pregnant and my doctor tested me early bc of my age. I hadn't had it with any of the other pregnancies. The risk factors as I understand it are age, over 35, being overweight and having family history of type 2 diabetes. There are also links to race-- I read that Filipino and African American women are more at risk. I may be missing a few risk factors due to my sleep deprived brain but i think those are the main ones For me it was my age. Luckily I was able to control it with diet and exercise. And bc I did control it from early on in my pregnancy my baby did not suffer any of the potential s ide effects from having a mom with GD--being too large, jaundice or low blood sugar after birth.

Hope this helps.

DebbieJ
08-05-2010, 08:54 PM
I opted out with DS1.

I planned to opt out with DS2, but my midwife had concerns about it because I am overweight. We agreed that I would test blood sugar 4x a day for a week. Wow, that was a PITA so then I just did the damn glucose test. I passed with flying colors.

HIU8
08-05-2010, 10:19 PM
I did not opt out. I have a massive family history of diabetes. I tested negative both times. I would do the test again with subsequent pregnancies though.

SnuggleBuggles
08-05-2010, 11:00 PM
I had it but my CNM practice offered 2 ways to do the test. The one was the drink and the other was a certain meal (eggs and some other stuff). The diet based one tended to have more false positives that would lead to the 3 hour test possibly so I went with the drink. I did feel horrible after the blood draw and it took about 20 minutes to recover (I almost fainted). I was glad I hadn't driven there b/c I just didn;t feel great for a while even after the recovery.

You always have choices- sometimes, unfortunately, you have to advocate for yourself (and baby) to get the choice. Ultimately your informed consent should be obtained before any test, procedure... That means that they are supposed to tell you what they want to do, why they want to do it, what the risks are, what the benefits are, and what the alternatives (including nothing) are as well as the risks and benefits of the alternative(s). If your Dr. or midwife is not giving this information then you need to step up and start asking the questions. You can then decide what makes the most sense for you.

Beth

MamaSnoo
08-06-2010, 01:14 PM
Personally, it bothers me that pregnant women are forced to go through a much more difficult test than the simple glucometer (sp?) test that actual diabetics use.

The other reason that meters should not be used is that they can have a 10-15% variability in the reading. That is an acceptable margin of error for management of known diabetes, but that level of variability could cause false positives (or negatives) on the glucola test in a pregant woman (or anyone else being tested for diabetes with a OGTT). The accuracy of the reading can also be affected by alcohol on the fingertips or food residue on the fingertips.

The OGTT was developed and the cutoffs defined using blood drawn from the vein, and that is how the test should be performed. A meter should not be used to diagnose diabetes (GDM or otherwise).

PHBrow
08-06-2010, 02:17 PM
I just took the test last week and didn't have any problems. I was expecting it to be much worse (based on what other people had said and what I had read on the web) but the glucose drink wasn't bad...it takes like a flat orange soda...and I didn't have to fast beforehand. I haven't had any morning sickness in my pregnancy so nausea wasn't an issue.

I'm glad I did it b/c the test was pretty easy and now I know that GD is not a concern.

Good luck on your decision.

Drag0nflygirl
08-07-2010, 06:26 PM
The stuff that I had to drink tasted like gatorade. I actually kind of liked it...I must be weird

Well if you are, I am too! Mine was like really good orange soda. Yum!

KpbS
08-07-2010, 08:59 PM
Well if you are, I am too! Mine was like really good orange soda. Yum!

I love orange soda too! I don't drink soda now so it is a pretty sugary experience but definitely brings back childhood memories :)

I have this test coming up sometime but I am not worried about it. To me, it's just not that bad.

lorinick
08-07-2010, 10:38 PM
I didn't think it was any big deal. I usually don't like drinking things like that. I thought it was no big deal. tasted pretty good. Wouldn't even think about opting out.

sunnyside
08-08-2010, 01:52 AM
I didn't necessarily enjoy it, but I didn't find it to be a big deal at all either.