Navigating the Gestational Diabetes Test

Last week I was tested for gestational diabetes. This is now a pretty much required test for all expecting moms under obstetrical or midwifery care. I’ve never been good at tests, medical or otherwise, and was thus dreading this one. Partly because you have to chug a super-sweet “orange” (in color, not in having any actual orange in it) drink in five minutes. Partly because the test is not a diagnostic test, just a “screening,” which means it’s a large net that catches anywhere from 50-70% women with false positive results. And if you get one of those positive results, false or not, you are then usually required to move on to a three-hour diagnostic test, in which you chug three of those bottles and have your blood tested at intervals to see how your body is metabolizing the sugar. According to the American Diabetes Association, GD affects 18% of pregnancies; it usually vanishes after birth.

It’s stuff like this that makes me want to grab a midwife and a bearskin and my husband and just hang out in a cabin in the woods until I give birth in a warm pool outside under a full moon.

But alas. This is the age of highly medicalized pregnancies, for better and worse, and I have opted in for most of it.

The week before the test, I dropped all refined sugar (I was eating a treat a day—chocolate croissant, or a small bowl of chocolate ice cream, or some actual chocolate; can you see a theme?); lowered my carb intake (which mostly comprises veggies and some gluten-free pasta); and made sure to exercise more regularly, even if it was just a short walk after dinner. Not to “trick” the test, but to avoid getting caught in the false positive crowd. Of all the risk factors for GD, I have only two: being (well) over 25 and being pregnant. I’m not overweight, I have no family history, no diabetes history, and I’m Caucasian. Being older is a factor because, well, I don’t know why, but I’m guessing a combo of lifestyle choices and slowed metabolism. And pregnant is a factor because the placenta itself releases hormones that mess with insulin and blood sugar levels.

The morning of the test I drank the orange stuff, called simply “Glucose Drink,” (no money wasted on branding there!) which tastes like flat, slightly syrupy Sunkist dosed with something bitter and off. The ingredients freak me out—I had read online that some docs allowed their patients to brig in crazy-sweet natural drinks like grape juice; my docs said nope. But alas, organic me was swigging a blend of glucose, citric acid, natural and artificial flavors, sodium benzoate, and FD & C yellow #6. Stuff, in my opinion, no one, especially pregnant women, should be putting in their bodies. The best I can say is that it was cold. And cold was not to be underestimated—it was sweltering out.

That done, I waited for a while, we went in for a regular appointment, and when an hour had passed, they took my blood. I prayed and finger-crossed and still didn’t eat sugar. Next day, I called for the result and farginnabbit!: 134. A year or so ago, or in a different doctor’s office today, that would have been just fine. 140 used to be the recommended cut-off. No longer. Studies found they caught yes, more false positives, but also more women who actually had gestational diabetes, when they lowered the number to 130. So, being slightly over the new limit means I failed. Which in a practical sense means I have to be retested. My doc, though, goddess bless her, said that it would be fine with her if I just re-took the one-hour in a month, since I was just a hair over. Whew.

But still, emotionally, this result hit me in three key areas in my mind’s worry zone:

1)   Feeling like a failure. One of the reasons I choke on tests is because the specter of being judged by a neat external number feels so fundamentally wrong to my soul that I get nervous and rebellious and lose it. The idea that I failed at something often translates in my brain as, “I’m a failure.” Working on it. But this brought that up big time. (Which reminds me of my friend Dara who used to say, “Bring it up? What are you, puking a little?”)

2)   Food issues. Let’s just say my history with food has been rocky, once quite dramatic. Being told by a test that I might be doing it all wrong even though I put tons of energy into trying to do it right doesn’t go over so well. Guessing I’m not alone in this one either. And as a result I’m now worrying about everything I put into my mouth, something I’ve spent a lot of therapy money to not do.

3)   Feeling like a bad mom. Welcome to my first “I’m a bad mommy” thought! The main reason you want to catch gestational diabetes is that, as the ADA says, unchecked high blood sugar, “causes the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat. This can lead to macrosomia, or a ‘fat’ baby.” Oy. It can also potentially set them up for obesity and type 2 diabetes. Plus, a big, big baby is no fun to get out the birth door—for anyone involved.

After a day of wallowing in a swirl of the above (sadly, not a soft-serve swirl; too much sugar), I emailed my docs asking what I could do. One doc in the practice wrote, “If you do have diabetes of pregnancy there’s lots you can do, unlike many other problems where we are very limited. Remember that the problem is the hormones from the placenta so don’t be too hard on yourself.”

Aw. Ok. I was starting to feel better. The next day I spoke on the phone with the doc who had been lenient with me. She said I can track my carbohydrate intake via an iPad app called My Net Diary and aim for 150 to 200 grams of carbs a day or get a glucometer and test my sugar after eating, which is the only real way to see how foods are specifically affecting your blood sugar. And in general just eat fewer carbs and more healthy proteins—nuts, lean cheeses and meats, eggs. I’m opting for a blend of these—the glucometer prescription is in the mail, I’m working on my diet, I’ll buy the app once I have the glucometer so I’m tracking my food with a real-life test, not just arbitrary numbers that may or may not be affecting my blood sugar; every body is different. I’ve predictably rebelled the last few days though, eating a little more bread than usual and even some ice cream in anticipation of pretty much giving it up until this little guy is safely out of me in October. It’s a process.

Even though my number was only marginally over and I haven’t even been diagnosed with anything, I’m trying to be proactive because of my dedication to an unmedicated vaginal birth (more likely with a smaller little dude)—and a healthy baby.

We shall see how it goes. If you’re going through a similar GD-testing rollercoaster, let us echo the words of my kind doc: “If you do have diabetes of pregnancy there’s lots you can do unlike many other problems where we are very limited. Remember that the problem is the hormones from the placenta so don’t be too hard on yourself.”

Amen to that.

To learn more about gestational diabetes, talk to your doctor and check out the ADA website.

– What Is Gestational Diabetes?

– How to Treat Gestational Diabetes