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30 week appt -- q about gd


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  #1  
January 7th, 2012, 01:32 AM
Mommy2Makenna's Avatar Mega Super Mommy
Join Date: Nov 2007
Location: Florida
Posts: 2,070
I had my 30 week appt today. I'm seeing the same midwife that I used with my dd who is 2 1/2 years old. Since my dd was born, the midwife section has grown from one midwife to 3 midwives. Occasionally, I have been seeing the other midwives for appointments because mine is not available (usually because she is in l&d with another patient). I remember with dd I kept getting annoyed because I would show up for an appointment and they would have to reschedule when she was in l&d. It's been more convenient this time not having to come back in frequently, but I'm not used to being seen by multiple people. I'm not used to being seen by multiple people or dealing with multiple opinions.

Let me give you a little background. At one of my early appointments, I saw one of the other midwives and she scheduled my glucose screening. I didn't realize until after I had it that it was considered an "early" screening and she was goign to do 2 of them. I had the screening done on 11/1 (20w 3d). When I called to get the results (I didn't want to wait until my next visit to know the status) I was told it was normal. I went to my first appt after the test and said, it's borderline high, but still considered normal. We will just keep a close eye on you. Because of my multiple high risk factors (1 - I'm overweight, 2 both my parents are diabetic, 3 my dd was born at 8lb 14oz at 41 weeks). She was surprised that I'd had the test that early because she wouldn't have scheduled it that early, but didn't think it was necessary to have a repeat one (the other midwife planned on two).

So yesterday, I saw the 3rd midwife (first time I've seen her). She also said she wanted to repeat the 1 hour glucose test because if I had seen her with the 130 result she would have immediately ordered the 3 hour test. After Bobbi's post about the "sugar shock" that is given to the babies, I've been thinking more and more about these tests and started asking her questions. I asked what the benefit was of all of the sugar tests. I asked her to ASSUME that I would have failed the 3 hour test and THEN what would they do. She said they would have me check my bloodsugars 4 times per day to determine how my body was really handling things. This seems to me like it's much more of a pain for me to do, but much less "impact" to the baby. If I failed the 1 hour test, they would do a 3 hour test. So I could go through 2 more "sugar loads" for my baby. She said I could just skip right to the 4 day testing and she has had several other mothers do the same thing recently (for the same reasons). She recommended I take the results for 2 weeks and then if I get numbers over 90 (fasting) or 140 (1 hour after meals) then they would have to take additional action and order insullin. It seemed logical to me that checking my bloodsugars 4 times per day would give the same information to us as the glucose tollerance tests, so leaving the office yesterday, I opted for that. She gave me a Rx for all the stuff I needed to check my bloodsugars 4 time pers per day.

On the way home I stopped at the pharmacy to fill my script. They indicated that the script didn't say on it how many times per day, so insurance wouldn't cover it without that information. He tried to call the office, but they had just closed. Can't get an answer until Monday. So I will go back on Monday to pick up all my stuff.

So then I came home and was talking with dh about my appointment. His response was kinda WTH? Do you have gd or not? I'm like, I don't know? I guess this will tell me. He wanted to know why I don't just go with what my ORIGINAL midwife said and just montior. (By the way, I have not gained ANY weight since my 1 hour test. I know baby is getting bigger-- I'm just losing my own weight. Same thing happened with dd. I actually left the hospital weighing less than when I got pregnant. I've been working on eating right -- better than I normally do, because of the increased risk of gd and it's just healthier for the baby). I told him that now that 2 other midwives have had a different opinion of my original midwife, maybe I should pay a little more attention. According to my midwife yesterday, I was measuring 32 weeks from belly measurement.

I don't see any harm in checking my bloodsugars multiple times per day -- it would probably force me to think even more about everything I put into my mouth, which isn't a bad thing. I think it is kinda freaking dh out though.

What do you ladies think? Should I do what my original midwife and dh want me to do and just kind of keep going as I've been doing and we will see, or take the 3 hour (the definitive test of if I have gd) or just go straight to daily blood testing of my sugars? My next appt is scheduled for 1/24. I will be 32w 3d.

Thanks for listening to the long story...
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  #2  
January 7th, 2012, 06:23 AM
lindsey2000k's Avatar Platinum Supermommy
Join Date: Nov 2010
Location: Ohio
Posts: 5,965
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WOW sorry they have you so confused. I have no experiance with GD.
I would go with what Advice your gut tells you to.
The office I am at has 2 drs and 6 midwives and they have all seemed to be on the same page with everything.
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  #3  
January 7th, 2012, 07:28 AM
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Posts: 7,039
My doctor does two tests (and early one and one at the normal time) for women that are at higher risk of GD. It's a pain, but the risks of undetected GD are what lead her to do it. She considers the fact that my nausea/vomiting lingers around much longer than typical to be a risk factor and usually pushes me to do it twice.

With my son I had a borderline high reading for the 1-hour at the normal time and even though I passed, I still took the 3-hour (and passed). The 1-hour has a pretty high false positive rate, so if I were you I'd either go to the 3-hour (skipping the 1-hour) or test your sugars at home for a week and see.

Another option would be to follow the GD diet without any testing, but there is then the risk that you may need insulin and wouldn't know without the at home testing.
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  #4  
January 7th, 2012, 09:33 AM
L-SBB's Avatar Bébé Cowgirl
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Location: Texas
Posts: 9,810
i had my glucose challenge test with Savannah i thought before 20 weeks, which is when my OB regularly does them for all patients as far as i know (i didn't realize that was "early")

if it were me and i didn't feel comfortable doing the 3 hour challenge, then i'd do the daily monitoring and modify diet. I think a fair number of women who have GD just end up with diet modification...but I agree that if you only do that then you won't know if you need more monitoring or insulin.

tough decision Sacha, but i think you should do whatever makes you feel most comfortable. I think my OB expected me to have GD starting around 30 weeks when they kept measuring me 2 weeks ahead (and i didn't have it, and Savannah was normal weight despite all their worries about sizing)....i'll bet the fact that Makenna was at a higher weight when born (but not crazy high considering she was 41 weeks) also leans them toward being overly cautious with you now, but that doesn't mean you actually will have a GD issue.
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