Last week, I left you hanging about the results of my glucola.
One of my readers emailed me:
“Damn cliff hanger!! I want to know your results. Lol. This is why I binge watch tv shows after the whole season is out. The suspense is killing me.”
Who knew a glucose tolerance test could be described as “suspenseful?!” (other than me, of course…)
I was certainly curious to get the results of my test. When the lab technician said they could run the analysis in office, I decided to stick around for a few extra minutes. (Plus, I just had to finish the riveting article I was reading in Alaska Sporting Magazine…)
I was sure I had passed, so when the lab tech said:
“You should have studied better.”
I knew he was joking.
But he wasn’t.
I got a 141.
Passing is <140.
I was kind of shocked.
I failed the glucola. Now what?
Now, the 1-hour, 50 gram glucola is NOT diagnostic of gestational diabetes on its own. It is a screening test to identify those at “high risk” and determine who should get further testing.
He said my next step was to come back again for the 3-hour test. Of course, since I specialize in gestational diabetes, I knew all that.
I had already discussed testing options with my doctor and had decided that regardless of the results of the 1-hour, 50g screening that I would check my blood sugar at home with a glucometer for 2 weeks just for my own knowledge. In fact, I already had my prescription for blood sugar testing supplies in hand before I drank the glucola.
Still, I walked out of the office feeling like a failure.
How could I not feel that way? The official medical terminology is “passing” or “failing.”
I cursed under my breath as I made my way to the car.
A million thoughts raced through my head:
- Should I have opted out of the dumb test and just done home glucose monitoring?
- Now are they going to pressure me into doing the 3-hour test (with double the sugar)?
- What if I really do have gestational diabetes? I know how to manage it, but would my birthing options be limited? Would I be treated differently by my doctor?
- Why didn’t I carb-load for the past week?! I knew my moderately low-carb, low-glycemic diet made it more likely for me to get a false positive. I’m such an idiot.
- I shouldn’t have skipped my walk this morning. If I had exercised, like usual, I would have had better insulin sensitivity. Maybe I should have done squats in the bathroom?!
And then the other part of me was thinking…
- If you had carb-loaded for a week, technically you would have been “cheating the test.” Yes, you likely would have passed, but YOU were the one who wanted to see the results based on what you usually eat and here you have ‘em. You confirmed what’s been well-documented in the literature for decades. (See NEJM, 1960)
- If you had exercised immediately before – or during – the test, yes, you may have gotten a lower reading… But there are days when you don’t walk or exercise, and now I know how my blood sugar would respond on those days IF I ate 50g of pure sugar. (I’m sure as hell glad I DON’T eat 50g of sugar, pretty much EVER. Now I know how my body responds to it.)
- Your first trimester A1c was low, so you definitely didn’t have prediabetes, and your weight gain is within normal, so the likelihood that you have GD is still pretty slim.
- Numbers are simply information, not “good” or “bad.” Just like you tell your clients, you need to test at home and see where your blood sugar is at before you choose your next steps.
- Of all people, you know what to do. No matter what you find out from testing your blood sugar at home, you’ll be able to manage it.
I’m usually a pretty rational person, but my mind was all over the place.
Maybe my erratic blood sugar was clouding my judgement.
By the time I had picked up my blood sugar testing supplies and got home, I felt like I was having reactive hypoglycemia. Hungry, moody, a little shaky… It had been a long time since I felt that.
So the first thing I did when I got home was wash my hands and test my blood sugar.
I got a 129.
This was now 2 hours after I drank the glucola.
“Holy shit. I really DO have gestational diabetes! I’m insanely insulin resistant.”
So I got myself a low-carb snack (figuring I didn’t want to spike my blood sugar any higher), then dinner a few hours later, and anxiously anticipated my blood sugar reading after my meal.
It was 87.
Granted, that meal was real food – not 50g of sugar – but I still didn’t understand why my insulin response 2 hours after the glucola was so dismal. Plus, I was hungry at that time. If you’re hungry, it’s usually a good sign your blood sugar is on the lower end, especially if you have normal insulin sensitivity.
My pancreas must suck.
I was stumped.
And then I got thinking… I had recently refilled my hand soap at the kitchen sink. That’s what I washed my hands with when I tested my blood sugar the first time. After dinner, I washed my hands in the bathroom with different soap.
I hunted down the original bottle for the Burt’s Bees liquid soap I had used to refill the kitchen hand soap.
And let me tell you, I laughed as I read the ingredients. Among them were eight – yes EIGHT – sugar-derived ingredients (such as lauryl glucoside, sucrose laurate, and even straight-up GLUCOSE).
You’d think as a certified diabetes educator, I’d know better. Hell, I DO!
I’m just glad I realized on day 1 of testing NOT to use that soap before checking my blood sugar!
So that reading of 129 was really just telling me that my hands were covered in sugar. Great.
(I should have thought to wash my hands again and re-test, but in my post-glucola stupor, that didn’t even cross my mind.)
I knew I needed more data. A few blood sugar readings don’t reveal much.
To see if I truly had gestational diabetes or not, I would need at least 1 week’s worth of blood sugar readings (preferably more, in my opinion).
I was very curious to check my fasting blood sugar – the reading taken first thing in the morning – because that often gives a sneak peek into your baseline blood sugar levels.
The next morning I got a 73.
In all my years working with women with gestational diabetes, I’ve had one GD client who had fasting blood sugars in the 70’s. Myself and the perinatologist agreed she had been misdiagnosed (she, like me, had eaten a low-carb diet prior to her GTT).
Nonetheless – and for the sake of science – I have continued to test my blood sugar (nearing 2 weeks now) – both fasting and after meals – to see where I’m at.
Eating my usual, real food diet has given me perfectly normal blood sugar readings.
I’ve also purposefully had some high-carb meals to see my tolerance to a similar amount of carbohydrate as the glucola, but in the form of a mixed meal.
My doctor had requested post-meal blood sugar #s be taken 2-hours after meals, but I’ve checked at both 1 and 2 hours out of curiosity for some meals (some women spike at 1 hour, others at 2 hours, so I wanted a more complete picture of what was going on in my body).
The highest carbohydrate meal I tried was 50g total carbs (45g net carbs): gluten-free butternut squash ravioli (intentionally overcooked to further raise the glycemic index) with sausage, kale, mushrooms, and butter.
1 hour later: 114
2 hours later: 86
This was a larger portion than I normally serve myself and I was full before I cleared my plate, but since I had already calculated out the nutrient content, I wanted to finish it… again, for science!
I repeated the same meal a few days later with similar results:
1 hour later: 104
2 hours later: 89
My usual meals vary in carb content, but I rarely reach 45g carbs per meal, so it was reassuring to get “normal” readings.
(In case you’re wondering, I have been tracking my macronutrients during this time. I know from experience that most people, myself included, underestimate how many carbohydrates they eat – sometimes by quite a bit! So I wanted to have a more accurate idea of where I fall on the carb spectrum. While it’s been helpful for the purpose of collecting data, I fully recognize the downsides of tracking macronutrients and will be quitting at the end of this experiment. It really does make it challenging to remain a mindful eater with all these numbers getting in the way!)
I’m nearing the end of the 2-week experiment and have not had a single reading out of range.
My post-meal readings have only gone beyond 100 a few times – all from high-carbohydrate meals. (The 114 I mentioned above was, by far, my highest reading.)
My fasting blood sugar numbers remained steady as well (and I didn’t employ the advanced tips & tricks for naturally lowering fasting blood sugar that I teach in the Real Food for Gestational Diabetes Course).
My average fasting blood sugar is 75.
My average blood sugar after meals is 87.
For those of you familiar with conventional gestational diabetes target blood sugar levels (or especially non-pregnancy blood sugar targets), you might think my readings are too low.
I assure you, they are not.
As covered in my book, Real Food for Gestational Diabetes, average blood sugar levels in healthy pregnant women are as follows: (Diabetes Care, 2011)
- Fasting: 70.9 +/- 7.8mg/dl
- 1 hour post-meal: 108.9 +/- 12.9mg/dl
- 2 hours post-meal: 99.3 +/- 10.2mg/dl
It’s safe to say, I do not have gestational diabetes.
But with or without the official diagnosis, I would not eat any differently.
One side benefit of eating a nutrient-dense, real food diet is maintaining normal blood sugar numbers. And given that even mildly elevated blood sugar in pregnancy (below diagnostic thresholds for GD) has been linked to health problems in baby, including the risk of congenital heart defects, I have no intention to eat more refined carbohydrates just because I can “get away with it.” (JAMA Pediatrics, 2015)
The way I eat is delicious, full of nutrition for me and baby, keeps me satisfied, and has helped me stay pretty much craving-free. It’s also kept my weight gain, blood sugar, blood pressure, iron levels (and more) completely normal.
But this experience has reminded me how important it is for our screening methods for gestational diabetes to improve.
If you’re going to bother with drinking the glucola, you’d hope that the results are accurate!
It’s certainly weird to go from working alongside one of the world’s top gestational diabetes perinatologists whose passion is evidence-based care (and in an office that trains UCLA’s medical residents) to a teeny office with family practice doctors who only do prenatal care part-time.
Sadly, routine care is not necessarily evidence-based.
The two-step screening method for gestational diabetes is outdated (that’s the 1-hour, 50g screening followed by the 3-hour, 100g glucose tolerance test). A fairly high percentage of healthy women “fail” the first test while some women with excessive insulin production “pass” it and are never formally diagnosed. For those who go on to take the 3-hour test, diagnosis is delayed for weeks when awaiting the results of the second test. Finally, diagnostic criteria (the cut-off of what’s “normal”) arbitrarily varies doctor-to-doctor.
That’s why the International Association of Diabetes and Pregnancy Study Group (IADPSG), the World Health Organization (WHO), and nearly all countries aside from the United States recommend the more reliable and specific 2-hour, 75g glucose tolerance test, which is done fasting and includes more rigid cut-offs for diagnosis.
This method more accurately identifies women at risk for “adverse pregnancy outcomes” associated with gestational diabetes. (Journal of Perinatology, 2014) Plus, it’s just one test. The primary opposition to it is that, due to stringent diagnostic thresholds, more women would be diagnosed with GD and that may increase healthcare costs. (Though I argue, with low-cost interventions like my real food approach and the long-term health benefits to both mom and baby, these would be negligible or may even result in cost savings.)
I would have rather done that test, but that’s not protocol in my doctor’s office.
(Sidenote: To say that I know more about gestational diabetes than my doctor is the understatement of the century.)
In an ideal world, this glucose tolerance test would also measure insulin levels, as I discussed in my interview with Robb Wolf.
In lieu of a glucose tolerance test, the following are options:
1) A fasting blood sugar (venous blood sample, not a fingerstick), can accurately screen for GD. (Int J Endocrin Metab, 2007) However, it can leave some women undiagnosed – those who have normal fasting levels, but have an impaired post-meal insulin response.
2) First trimester hemoglobin A1c is highly predictive of gestational diabetes, so much so that the California Diabetes and Pregnancy Program: Sweet Success recommends it as a way to diagnose GD (and therefore many women would not need to undergo a glucose tolerance test at all). However, if you do, you’d have a pretty good chance of guessing your results. If your A1c is 5.9% or greater in the first trimester, your chances of “failing” the glucose tolerance test are 98.4%. (Diabetes Care, 2014) But keep in mind, it is NOT an accurate option for screening later in pregnancy, as I discussed in this interview.
3) Home blood sugar monitoring remains the most controversial way to diagnose gestational diabetes. Even though I opted for this option (in addition to first trimester A1c + the 1-hour glucola) and I believe it’s a great one for low-risk women who eat a lower-carbohydrate diet, it has some major drawbacks.
a) For one, it’s time consuming. You need to really be motivated to keep up with checking your blood sugar 4x per day. It’s annoying to set alarms, to carry testing supplies with you, to track what you’re eating, and poke your finger so often. I personally felt the annoyance was worth it and provided more useful, real-life information to me, but for others, it’s easier to just drink the glucola and move on.
b) Your diet impacts the results. This is both a good thing and a bad thing. You get a clear idea of how food affects your blood sugar, but I’ve had women who will purposefully starve themselves or temporarily switch to a very low-carb diet to “pass” the test, then go back to their usual diet that includes oatmeal/cereal for breakfast, fruit smoothies, and large portions of starchy foods or sweets. So, unless you continue to eat the way you normally do, you’re only hurting yourself and your baby.
c) Some women cheat. I’ve had women test other people’s blood sugar (like their husband), just so they can avoid the diagnosis. (When you work in this field long enough, you see just about everything!) Of course, if the diet for managing gestational diabetes actually worked (meaning prevented most women from requiring medication) and tasted good, I think this would be less of an issue… (hence why my real food approach is now being taught in at least one medical school and is being employed in several research studies).
d) The criteria for how many out-of-range blood sugar readings (or how high those #s need to be) to trigger a positive diagnosis is wishy-washy at best. In my situation, all of my numbers were well-below the goal range, so it was pretty cut and dry. But for many women, blood sugar readings hover in the grey zone. In that case, it’s unclear what to do. Personally, if I had questionable numbers, I would continue home blood sugar monitoring as if I had gestational diabetes, but for others that’s just too much work and they want a definitive diagnosis.
How do I feel about my decision to drink the glucola?
At the end of this experiment, I’m glad I drank the glucola. I learned that drinking a bunch of pure sugar spikes my blood sugar more than I’d expect (and been reminded that it makes me feel like crap). I’m also glad I didn’t carb-load just to “cheat the test.” By monitoring my blood sugar at home, I’ve confirmed that the way I eat is indeed right for my body.
Given my response, I probably wouldn’t opt for a glucose tolerance test in the future (unless it also included measurements of my insulin response – for science!), but the experiment – at this point in time – was worth it.
Knowing that blood sugar & insulin levels can shift week-to-week (especially in the 3rd trimester), I will continue checking my blood sugar at home – maybe not after every meal, but occasionally so I can be proactive if my numbers start going up.
Going through this has helped me feel, first-hand, the panic that hits my clients when they “fail” the glucola. I’m just glad I can offer them the support they need to make sense of all the information and get a game plan to manage this with as much ease as possible – both for my private clients and members of the Real Food for Gestational Diabetes Course.
Now I’d love to hear from you:
What are your thoughts on the way gestational diabetes is diagnosed?
Did you fail the glucola, like me? Did you go through the same “Do I have gestational diabetes” panic?
If you were officially diagnosed with gestational diabetes, how do you feel about it now?
Tell me in the comments below.
Until next week,