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Article about the lack of Consensus among diagnosis and treatment of GD


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  #1  
January 30th, 2011, 06:51 AM
bre4thewin's Avatar Platinum Supermommy
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very frustrating to those who have been tagged.

Treatment for Gestational Diabetes | 40 Years of Research and No Consensus
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  #2  
January 30th, 2011, 01:02 PM
JustLiz's Avatar Mega Super Mommy
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Thanks for posting. I agree, it's totally frustrating. I have no problem trying to keep the blood sugar levels in a reasonable range because I think it's probably best for mom and baby anyway, but the quickness to induce/c-section is very troubling to me.

I am actually enrolled in a long-term study right now. I think it's soooo important to get better data! I am hoping they follow up and track my baby's progress as he grows up, because the other scary stuff out there is all about how having GD will make your baby have diabetes and obesity later in life. While I'm sure it's true that if your sugars are sky high it's not great for baby, there are tons of other factors in that. Like what you feed your baby after he/she is born, for example!!
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  #3  
January 30th, 2011, 01:33 PM
bre4thewin's Avatar Platinum Supermommy
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Article by Henci Goer on the Uselessness of Standard Management of Gestational Diabetes - FROM RONNIE Falcăo's MIDWIFE ARCHIVES


Here is another one. The lack of evidence based research is very disturbing to me. For instance treating a woman who has fastings in the high 90's the same as a woman who's fastings are in the 130's. Also the lack of evidence regarding effectivness. Obviously woman with diabetes need to be even more carful about there numbers when pregnant, but why are woman diagnosed with GD have to have numbers lower then that of non pregnant diabetics when it is known that pregnant woman have higher sugar numbers in the third...that is whith out being diagnosed with GD...its normal pregnancy. So many woman who are boarderline are treated the same as woman who actually do have sever insulin resistance.....i think that this is more dangerous then anything. What it does n to your confidence being "diagnosed", and the risk of having cesarean. sigh.
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  #4  
January 30th, 2011, 02:21 PM
bre4thewin's Avatar Platinum Supermommy
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"Gestational Diabetes - Controversial

This is perhaps the most controversial test recommended during standard medical management of pregnancy. The facts that most people seem to agree on are:
True diabetes, diagnosed before pregnancy, should be managed very closely during pregnancy because abnormally high levels of sugar in the blood can cause miscarriage or stillbirth or hypoglycemia in the baby immediately after birth.
In a healthy woman, the hormones of pregnancy will increase her normal blood sugar levels to provide nutrition for the baby.
Women with higher levels of blood sugar tend to grow bigger babies; bigger babies are associated with a slightly higher increase of some birth complications, such as shoulder dystocia.
That's where the agreement seems to end. Proponents of testing for and managing gestational diabetes point out that a strict diet does decrease the baby's size by about 8 ounces. Opponents point out that this doesn't reduce any of the complications attributed to a "big baby", and that this may simply be a form of starving the baby.
Internationally, the United States is one of the few countries where the medical establishment has defined gestational diabetes, i.e. a form of diabetes that exists only during pregnancy and disappears when the pregnancy ends. Most medical professionals worldwide recognize that changes in blood sugar metabolism are normal in pregnancy. Within the United States, there are disagreements over when and whom to screen or test, and which numbers signify a disease condition. The Cochrane Collaboration is an international committee of medical experts who review and summarize the available medical research. On the subject of different methods for screening for gestational diabetes, the committee concludes, "As no benefit has yet been established for glucose screening during pregnancy, the method used for this screening is irrelevant". An abstract of the review of "Dietary regulation for 'gestational diabetes'" is available online.
Additional Web Resources:

Gestational Diabetes section from the Midwife Archives (contains many links to online resources)
Gestational Diabetes: The Emperor Has No Clothes by Henci Goer
Debate over screening for gestational diabetes - Letters in the British Medical Journal, March, 1998


Risks from the Test Itself - The glucose screen and the glucose tolerance test involve drinking a sugar drink (Glucola) that contains a very high amount of sugar; blood is drawn within a few hours to see how much sugar remains in the bloodstream. Many pregnant women make a point of eating particularly well during their pregnancy, and the Glucola contains more sugar than they would normally eat. Some women faint from the sugar overload, and others report feeling lousy for a week afterwards. (As with any blood test, there are very small additional risks from the venipuncture.)
Risks from a Positive Result - About 4% of women tested will be diagnosed as having gestational diabetes. They will be advised to follow a very strict diet and to test their blood sugar regularly through a self-administered fingerstick, possibly many times each day. Even though the treatment does not improve outcomes, these women will be designated as high risk. They may then be considered ineligible for midwifery care, or may be risked out of birthing at home or in a birth center. Their baby will have numerous heelsticks immediately after birth and within the next few days to test the baby's blood sugar levels, even if the baby does not show any symptoms of blood sugar problems. It may be recommended that the baby be fed a bottle of sugar water immediately after birth, even if the baby is fine.

Benefits of Being Tested - For women who are seeing mainstream medical care providers, the primary benefit of agreeing to be tested is that you will appear to be a compliant patient, and your care provider may behave more pleasantly towards you if you are in full compliance with the guidelines from their malpractice insurance company.

Benefits from a Positive Result - None. The treatment for gestational diabetes does not improve outcomes."
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  #5  
January 30th, 2011, 05:16 PM
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They had better leave my sweet baby alone after birth. And I swear to you, if they even try to give him sugar water, I'll raise holy hell.
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  #6  
January 30th, 2011, 06:05 PM
bre4thewin's Avatar Platinum Supermommy
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They never tried with my daughter. they did poke her heal to take her sugars..but her sugars were fine....of coarse. Mine sugars on the other hand dropped to 40 right before pushing time...not that surprising figuring the wouldnt let me eat for a day.
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  #7  
January 31st, 2011, 03:09 PM
Khara
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Thank you so much for posting this.

This is what really gets to me... that gestational diabetes is "a form of diabetes that exists only during pregnancy and disappears when the pregnancy ends"

It does not "disappear"... even if your blood sugar levels stay the same as when you were pregnant, they would not consider you to have diabetes because TRUE diabetes is diagnosed with numbers much higher than with GD.

After my youngest son was born (I had GD with him) my numbers stayed pretty much the same, but they did not consider me to have type2 diabetes. And as soon as I got pregnant again, of course I'm considered to have GD. Even though my numbers are no higher than they were before pregnancy.

I tried asking today why the numbers to diagnose GD are so much lower than regular diabetes and of course they can not provide a decent answer to this question.
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  #8  
January 31st, 2011, 03:53 PM
bre4thewin's Avatar Platinum Supermommy
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Exactly. Glucose levels rise in pregnant woman to bring nutrient to the baby....for a woman with low risk factors and no history of diabetes...why cant we just trust our bodies? I think the thing that really bothers be the most is how it makes you feel like you cant trust your body. Diabetes is scary. It is a disease that needs treatment, so of coarse a diabetic woman who is pregnant needs to be monitored and treated closely. But what of those whose numbers are boarderline? I know that i was boarderline last time and due to 2 or 3 fasting in the high 90's i was but on insulin. It never really budged my night time. I still had a healthy 7 lb baby that they took a week early. Why? Its very very frustrating. However this time....this wont happen. Ive been testing myself and keeping a food log for the past month. My numbers fastings are boarderline, and hopefully my midwife gives me the clear to stop testing.
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  #9  
January 31st, 2011, 05:34 PM
JustLiz's Avatar Mega Super Mommy
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It's also incredibly insane to keep a laboring woman from eating or drinking something with calories in it. My sugar occasionally dips into the 50s when i'm NOT exerting myself. They will have to arrest me to keep me from drinking some juice during labor.
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  #10  
January 31st, 2011, 05:52 PM
bre4thewin's Avatar Platinum Supermommy
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They didnt let me eat for 24 hours! When it was finally time to push my sugar dropped to 40! They had to give me sugar water..jerks. I will be eating through out my whole labor this time thank you.
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  #11  
February 1st, 2011, 04:12 PM
Khara
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I agree, I'm going to eat as well even if I have to have someone sneak it when the nurses aren't looking. A laboring woman needs to keep her energy level up, I was so exhausted with my first labor lasting 23 hours and nothing to eat or drink the whole time, no wonder I couldn't push him out after all that I had no energy left.
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  #12  
February 8th, 2011, 11:15 PM
Adriana's Mommy's Avatar I <3 my kids
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Wow.. They wouldn't let you eat?

I ate the whole time I was induced.. My numbers stayed in the 70's the whole time.. What's crazy is during my pregnancy, I was on insulin for my FBS, a high dose too.. But when those contraction start, it's like the diabetes disappears.
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