Thursday, March 14, 2013

Paleo Pregnancy - Refusing the Oral Glucose Tolerance Test for Gestational Diabetes

Let me start off by saying that gestational diabetes is a condition that should be taken seriously. If there had not been a viable alternative, I would have sucked it up and drank that nasty, orange glucose drink for the sake of my health and my baby's. But the good news is there are alternatives and if you wouldn't usually willingly gulp down a large, sugary beverage and are worried about the effects a clean-eating diet could have on the test results, talk with your healthcare provider about your options (Read: I am not a doctor and only your healthcare provider can advise you on your risk and your options).

I am happy to announce that I now offer preconception and pregnancy nutrition and health coaching programs! If you are diagnosed with gestational diabetes and need some nutritional guidance, or just need support to live a healthy lifestyle to optimize fertility, pregnancy and the health of your baby, click here to learn more about my coaching packages.

You can also learn more about managing your diet during and after pregnancy in my book, The Everything Paleo Pregnancy Book.

  • What is gestational diabetes? 

According to babycenter.com, gestational diabetes is a form of diabetes that between 2 and 10 percent of expectant mothers develop during pregnancy. Because of the hormonal changes to your digestive system during pregnancy, it is possible for your cells to become less responsive to insulin. If your pancreas can't produce enough insulin to keep up with your body's demand, you can have too much glucose in your bloodstream and develop gestational diabetes.

There are certain factors that may put you at a higher risk for developing gestational diabetes, such as body mass index, a diagnosis of gestational diabetes in previous pregnancies, the presence of sugar in your urine or a family history of diabetes. Excessive first trimester weight gain has also been linked with a higher occurrence of gestational diabetes.

It is possible to develop gestational diabetes without the presence of any of these risk factors, which is why most practitioners screen all of their patients between 24 and 28 weeks of pregnancy. With so many unknowns, I felt it was important to address the issue of gestational diabetes with my midwife, even if I wasn't on board with the traditional testing methods.

  • How does it affect your baby?
If you have gestational diabetes and your blood sugar levels are too high, your baby's blood sugar levels will be too high, as well, which will cause the baby's pancreas to produce more insulin. The additional glucose and insulin can cause your baby to gain too much weight in utero, to the point that the baby may be too large to fit through your birth canal or to become injured during delivery. On top of that, babies who are born with a higher than normal birthweight because of gestational diabetes often go on to be overweight in childhood and adulthood.

  • How can you manage gestational diabetes?
In most cases, gestational diabetes can be easily managed through diet and exercise. Eating a balanced, whole foods diet and avoiding processed foods like candy, cake, fast food and pretty much anything in a box, and getting some form of exercise most days of the week should keep gestational diabetes under control and decrease any potential risks to you or your baby. Medication may be prescribed if diet and exercise alone don't help to lower your glucose levels, but this is rare.

Sorry. No more donuts...

Let's see.......plenty of exercise, lots of fruits, vegetables and healthy protein and little or no processed foods. Sounds a lot like what I was already doing! Another reason I felt confident I was not at risk, but I still didn't want to leave my baby's health to chance.

I've got the exercise part down cold!

  • How do practitioners test for gestational diabetes?
Gestational diabetes is typically tested using the oral glucose tolerance test (OGTT). When you arrive at your practitioner's office, you will be given a drink that contains 50 grams of glucose and told to consume it in five minutes. This is usually a standard beverage provided by a drug manufacturer, but some practitioners will allow you to drink a regular soda or even eat jelly beans.

It would have been hard to resist the test if I could have eaten these yummy jelly beans :)

What else is in this drink? I had a hard time finding an ingredient list, but a kind reader who had a bottle of the orange flavor (because she also refused the test and never drank it) shared the ingredients of this  artificially sweetened, artificially flavored drink with me:

Ingredients: purified water, 50g Dextrose (D-glucose derived from corn), Citric Acid, Natural and Artificial Flavors, Sodium Benzoate, 0.1%, FD&C Yellow #6. It also labeled as "Gluten Free & Dairy Free".

An hour after consuming 50 grams of glucose, your blood will be drawn. Typically, a blood glucose level of 140 mg/dl or above means further testing to more accurately diagnose gestational diabetes in the form of a three hour OGTT. You get to consume the fake, sugary beverage again and this time you get to sit around and have your blood drawn once an hour for three hours and you aren't allowed to eat or drink anything for the duration of the exam.

I had a couple of concerns as I learned more about the OGTT. 

First, how would my body react to ingesting such a high dose of sugar in one sitting? Would I get dizzy, throw up or maybe even pass out? It has been a long time since I have had that much sugar and on the few occasions where I have had too much sugar in the past year, it affected how I felt for the whole day.  

Second, would the results be accurate? Most days, my sugar consumption is limited to fresh fruit, dried fruit and maybe some natural sweeteners such as honey or molasses. I was concerned that this could affect my results and I would end up with a false positive. 


  • What's a pregnant mama to do?
At my twenty week appointment, my midwife brought up the topic of gestational diabetes and let me know that my test would be given at my next appointment at 24 weeks. I have been open with my her about my diet since the beginning of my pregnancy and let her in on my concerns. She did say it was possible that my diet could produce inaccurate results, which backed up the research I had done online of other pregnant women following a Paleo diet who failed the OGTT. I asked if there were any alternatives and, luckily, there was.

She told me that they could call in a prescription for diabetes testing supplies and I could keep a food diary and test my blood sugar after each meal for a two week period. This didn't exactly sound like my idea of a good time, but it did sound manageable. The results would be much more accurate and I could learn more about how my body processes certain foods.

This went everywhere with me for two weeks. Maybe they should make a cute purse to hold it.

I thought it over for a few days, but what finally clenched it was when I learned that my health insurance covers diabetic testing supplies and I would pay almost nothing ($10 to be exact) for the glucose monitor, lancets and test strips. I was in! My midwife called in the prescription and I proceeded to test my blood sugar four times a day for two weeks. I bought a little notebook to record my meals and glucose levels and named it "The Blood Sugar Diaries".  My first finger prick of the day came right after waking up, while my body was still in a state of fasting. I then tested my blood sugar level two hours after the start of each meal. I actually had to get Kevin to prick my finger the first time because I was too scared. Once I realized that it barely hurt at all, I took over for the rest of the two weeks. 

I was shocked, but it really didn't hurt. 
At first, it was kind of fun. I liked seeing that my levels were normal and my body seemed to be processing everything as it should. After the first week, when I was fairly well convinced that I did not have gestational diabetes, it got to be a little less fun and became more of a chore. But I kept at it because I knew it was the only way I could avoid that nasty drink. 

My next appointment was only a few days after I completed my testing so I prettied up my food diary and blood sugar results into a word document (my midwife was very impressed). She looked it over for a few minutes and said that my numbers looked great and no further testing was required. My fasting blood sugar was usually in the 80's or 90's and my average after meals was about 110 mg/dl. If you are super nerdy and into that sort of thing, you can see my full two week diary at the end of this post. Note: I only recorded my meals, not the many snacks that I eat in between meals.

In the end, I was relieved to learn that both myself and my baby were healthy and I was glad that I didn't just accept the standard test without further questioning. But, really, if I had failed the OGTT, the diet that would have been prescribed would be eerily similar to the diet that I already follow. That is the funny thing about it. The very diet that could cause my results to be inaccurate is the one that I would be told to follow if I had failed the test.  Things that make you go hmmmm....


This post is linked to Party Wave Wednesday at HolisticSquid.com!


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2/16/13
7:40am Fasting 83 mg/dl
10:50am Breakfast Eggs, sausage, pepper, onion
Smoothie with banana, coffee, cocoa, coconut milk
12:50pm 99 mg/dl
3:15pm Lunch Romaine, apples, dried cherries, carrots, oil and vinegar, pepitas
5:15pm 107 mg/dl
7:05pm Dinner Burger patty, mustard, pickle
9:05pm 89 mg/dl


2/17/13
7:45am Fasting 112 mg/dl
8:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
10:30am 94 mg/dl
1:30pm Lunch Grapes, nuts, raisins, turkey
3:30pm 83 mg/dl
7:00pm Dinner Chicken, spaghetti squash, olives, basil, onion, coconut milk
9:00pm 90 mg/dl


2/18/13
6:45am Fasting 82 mg/dl
7:15am Breakfast Sausage, brussels sprouts, onion, dried cherry, avocado, egg
Smoothie with banana, cocoa, coconut milk
9:15am 113 mg/dl
11:30am Lunch Chicken, spaghetti squash, olives, basil, onion, coconut milk
Dried apricots
1:30pm 115 mg/dl
7:30pm Dinner Tilapia, broccoli, cherries, walnuts, dark chocolate soufflé w/ raspberries
9:30pm 106 mg/dl

2/19/13
8:00am Fasting 93 mg/dl
7:30am Breakfast Sausage, pepper, onion, cabbage, egg
9:30am 86 mg/dl
12:30pm Lunch Sausage, pepper, onion, cabbage, egg, grapes
2:30pm 134 mg/dl
8:00pm Dinner Ground beef, onion, lettuce, apple, coconut
10:00pm 107 mg/dl

2/20/13
7:50am Fasting 92 mg/dl
8:15am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
10:15am 96 mg/dl
12:15pm Lunch Salad w/ blueberries, avocado, romaine, turkey, oil and vinegar, pepitas
2:15pm 88 mg/dl
6:15pm Dinner Roast beef, salad
8:15pm 82 mg/dl

2/21/13
7:30am Fasting 90 mg/dl
7:30am Breakfast Egg, pepper, bacon, avocado, onion, sweet potato
Smoothie with banana, coconut milk, cocoa, almond butter
9:30am 102 mg/dl
12:15pm Lunch Egg, pepper, bacon, avocado, onion, sweet potato
Apple, dried apricots
2:15pm 110 mg/dl
6:00pm Dinner Roast beef, salad
8:00pm 98 mg/dl

2/22/13
5:30am Fasting 86 mg/dl
7:45 am Breakfast Pepper, onion, egg, avocado, spinach, bacon
10:00am 93 mg/dl
1:00pm Lunch Qdoba salad and soup, dried apricots, dark chocolate
3:00pm 114 mg/dl
8:00pm Dinner Turkey, mushrooms, tomatoes, broccoli, mustard, fruit
10:00pm 103 mg/dl

2/23/13
7:35am Fasting 88 mg/dl
10:30am Breakfast Sweet potato, onion, pork, eggs, salsa, avocado
Smoothie with banana, coconut milk, cocoa, strawberries
12:30am 85 mg/dl
8:30pm Dinner Turkey, bok choy, carrots, grain free muffin, banana
10:30pm 119 mg/dl

2/24/13
7:30am Fasting 82 mg/dl
8:00am Breakfast Sweet potato, onion, pork, eggs, salsa, avocado 
Smoothie
10:00am 99 mg/dl
12:45pm Lunch Grain free muffin, turkey burger
2:45pm 119 mg/dl
6:15pm Dinner Salad, pumpkin chili
8:15pm 90 mg/dl

2/25/13
7:15am Fasting 83 mg/dl
7:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
Smoothie with banana, pumpkin, coconut milk
9:30am 103 mg/dl
1:45pm Lunch Pumpkin chili, apple, dried apricots
3:45pm 109 mg/dl
8:00pm Dinner Tilapia, asparagus, grain free brownie, almond butter, blueberries
10:00pm 102 mg/dl

2/26/13
6:00am Fasting 90 mg/dl
7:30am Breakfast Brussels sprouts, onion, eggs, avocado, sausage 
Smoothie
9:30am 106 mg/dl
12:45pm Lunch Grain free muffin, turkey burger
2:45pm 119 mg/dl
6:15pm Dinner Salad, pumpkin chili
8:15pm 90 mg/dl

2/27/13
7:15am Fasting 83 mg/dl
7:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
Smoothie with banana, pumpkin, coconut milk
9:30am 103 mg/dl
1:45pm Lunch Pumpkin chili, apple, dried apricots
3:45pm 109 mg/dl
8:00pm Dinner Tilapia, asparagus, grain free brownie, almond butter, blueberries
10:00pm 102 mg/dl