gestational diabetes while low carb--Is the test wrong if I don't carb-load for days before?

[plope132]

I am on a low-carb diet and have been for years (about 50-100 g/day). I was tested for gestational diabetes using the following protocol:

on March 7: about 2 hours after eating 2 hard boiled eggs and an espresso with cream:

HBA1C 4.9% or 30.1 mmol/L

Blood sugar in Serum: 70 mg/dL

on March 10: After black coffee and then 2 hours later 50 g of glucose and then 1 hour later a blood draw:

blood sugar: 144 mg/dL

The results on March 10 imply that I may have gestational diabetes. However, I think the protocol for the test was not followed because (as I read through the literature) it seems I should have been eating at least 150g of carbs/day for 3 days before the test.

Does anyone have any knowledge about this? Can you point me to any scientific literature on how low carb influences the result of such glucose tests? My OBGYNs office is also not sure how to interpret these results or if I should have been carb-loading.

Edit: I think I wasn't clear enough about why I am concerned... The World Health Organization, LabCorp, Mayo Clinic, Mass Gen and so many other labs, hospitals, medical foundations and peer reviewed literature state something to the effect:

Patient Preparation

Patient should be active and eat a regular diet that includes at least 150 grams of carbohydrate daily for three days prior to the test. Patient should be instructed not to eat or drink anything except water for at least eight hours and not more than 14 hours before the test. Patients should also be advised to discontinue, whenever possible, all nonessential medication that can affect glucose metabolism at least three days before testing.

I did not do this. I am not really trying to convince myself I don't have the results I have--you cannot argue with a number--but I am trying to understand what not following the protocol means for that number. I am also concerned because no doctors in my area (diabetes specialists included) follow this for any of the stress tests (any number of grams of glucose). If you don't do the test right, the results cannot be right and this is a super serious diagnosis!

 

[katrina2017]

@plope132 I was given no special instructions about what to eat and my understanding is that it doesn’t matter.

GD is not a failure. It’s a function of the placenta and pregnancy hormones.

Ignoring/fighting the diagnosis can only hurt you or your baby. Whereas taking it seriously will do zero harm and likely help. There are marathoners and D1 athletes who get GD. It’s not a failure on your part. It just happens sometimes.

I just got diagnosed last week. 4th pregnancy and first time I ever had it. I’m learning a lot and so far my sugars have been excellent. But I’m glad I’m checking just to ensure baby and I are healthy.

 

[drita]

@katrina2017

GD is not a failure. It’s a function of the placenta and pregnancy hormones.

Ignoring/fighting the diagnosis can only hurt you or your baby.

I can't stress this enough. I had GD with my first pregnancy and I saw a lot of posts online of women getting the diagnosis and insisting it must be wrong for some reason.

The truth is: If you fail the test there is something going on. It might never become relevant during your pregnancy (in my case my levels remained normal throughout pregnancy, despite a completely normal diet, donuts and all), but since the health (both short term and long term) of your baby might be at stake it's better to err on the side of caution and to keep an eye on the blood sugar levels.

 

[swissmade]

@drita This!!! I went through the same cycle of thoughts but really it’s all the dang placenta. Coworkers and friends were surprised at the diagnosis being I workout often, meal prep, skip the break room sweets, etc. so I found myself explaining it to them that it’s not my fault and can happen to anyone. I only failed my 1 hour test by 1 point so I was shocked when I failed the 3 and got diagnosed

 

[jcthesword]

@swissmade Hard same. I'm considered low risk by nearly every metric - healthy weight, varied balanced diet, regular exercise - and I still got a rager of a case. I failed the 1 hour by 4 points, but failed the 3 hour miserably. We hypothesized that, because I'm hypoglycemic when I'm not pregnant, the added stressor of the placenta was enough to push me the other way into diabetic territory.

Feel free to join us over on r/GestationalDiabetes!

 

[swissmade]

@jcthesword I was a regular but baby is now 2.5 months! She was born under 7 pounds and had normal sugars from birth. Only complication I had was borderline high amniotic fluid at 39 weeks but it didn’t change anything for me (was on the waiting list for an induction but never made it….). I went into labor naturally at 40 weeks on the dot! My 6 week PP A1C was normal too

 

[jandolphrohnson]

@plope132 Are you taking the 3 hour test? If not, so that, or ask to monitor blood sugar from home for a week.

/r/gestationaldiabetes is a great resource too.

I was low to moderate on carbs, and failed both tests. I tried to blame the carbs, but home testing proved the tests were accurate. I actually needed more carbs to stabilize my blood sugar, but not all carbs led to the same results for me.

Please do NOT just treat this like type 1 or type 2 diabetes. As my endocrinologist explained, gestational diabetes is it’s own thing, with its own treatment and management practices.

And I know this sucks, but it’s not the end of the world. I was diet controlled until I needed steroids and then ended up on insulin since steroids mess up your blood sugar, but it it’s a short term issue, and I’m now back to my normal diet with two happy, healthy babies.

 

[basilstaghare]

@jandolphrohnson Yes as a t1diabetic, GD is it's own thing. So many just act like it's t2 while pregnant. And YES to the needing more carbs frequently to stabilize. That's absolutely true, even for t1diabetic pregnancies.

 

[jandolphrohnson]

@plope132 You can also buy the glucose monitor and blood strips/needles yourself, and test yourself at home for a few weeks, but please note that what works/is stable now, may not be the same in a few weeks.

With that in mind, I think you just need to take the test, and stop focusing on the protocol. Can you just up your carbs for a few days beforehand if you're really concerned? I know it's not your normal diet, but maybe that will make you more confident in the result.

And yes, they can treat you, because they will work with you if you have gestational diabetes to log food, carbs, etc, to determine what spikes you, or leads to too low fasting numbers. Originally being on a low carb diet isn't going to change treatment. Once you're diagnosed it's all about logging your blood sugar levels to see what causes spikes, and what leads to healthy numbers. You will likely have to switch your diet up regardless of whatever diet you started with.

And side note--GD, if well controlled, will not automatically lead to an early induction, or other issues. The only added testing I had was that they tested my blood sugar post-partum a few times, and I was fine. So long as I went to my normal OB appointments showing a log of appropriate post-meal and fasting blood sugar levels, they considered it something to know about, but not a concern. They didn't even count the eventual insulin as an issue since they knew the cause of my spikes and the insulin did the trick to keep me stable.

 

[ripe4harvest]

@plope132 This is the instructions for the 3hr test, not the 1hr test as you described it, at least based on the instructions from my local lab. The 1hr test, no specific diet needs to be followed before.

 

[ripe4harvest]

@plope132 As others have said, the 1hr test is a screening test. They are trying to identify EVERYONE who may have gestational diabetes. It could be a false positive based on your diet, or not, but the only way to find out for sure is to do the 3hr test.

The 3hr test is actually diagnostic. Just make sure you follow the diet recommendations perfectly to increase the chances that your test is accurate. From what I am reading the 150g/day for 3 days before is for thr 3hr test, NOT the 1hr test.

 

[teddy8765]

@plope132 According to my provider you can’t fool the test, regardless of what you eat before.

Eta: anecdotally, before my first 3hr one, I had M&Ms for breakfast without thinking. It was still normal.

 

[unequallibidio]

@teddy8765 in regards to your anecdote, I went as low carb as possible for the several days leading up to my 3-hour test and I still failed. GD is an issue with your placenta being a dumb dumb and not knowing wtf to do with insulin, nothing more, nothing less.

OP - I hope you've asked this question in r/gestationaldiabetes - That sub was invaluable to me during my pregnancy!

 

[callousedhands]

@plope132 No, your diet prior to test should not have influenced your test results. The test is showing how you process those 50 grams of sugar you ate. Next they will do 3 hour test and then you can continue with low carb diet to manage your blood sugar.

 

[bellahouz]

@plope132 If you’re already having a low carb diet, then you shouldn’t have any issue following a diet appropriate for those with GD.

I was never given specific instructions on how to eat or what to eat. You should be eating as you normally would for the diagnosis to be accurate.

A GD diagnosis doesn’t mean you did something wrong. Like many things in pregnancy, it’s out of your control and has to do with your placenta. My family has a history of diabetes, and I was fully prepared to get a GD diagnosis even though I was eating relatively healthy (which many people assume can help avoid a GD diagnoses - it can’t).

 

[kitteh]

@bellahouz But having a wrongly flagged diagnosis can be bad. I was in that boat, even though my morning fasting were consistently around 78, I peaked post meal at 100 to 120... as soon as labor approached, it was as though it wasn't. And I was treated like any other GD mom.

"I don't want you going past 41 weeks". Big baby. Uh, Scans don't suggest that. "Scans can be wrong". If my baby was scanning large, they wouldn't say that. Pure confirmation bias.

So we induce waaay before I'm ready. Awful 36 hr experience. Misery beyond misery. Worse than an unmedicated birth (i know from experiencing both). I gave birth to a 6 lb 12 oz baby at 41 weeks. She is SMALL

They won't release from hospital for baby glucose checks. Perfectly fine. I actually had to sign a bunch of against medical advise forms to get the hell out of there. Before even looking at my baby, the pediatrician on hospital staff was vehemently against me leaving. Then he turned around and saw her. Suddenly his demeanor flipped. "Oh wow. She does not look like a GD baby at all".... yes, please look at my baby before lecturing me for 20 minutes. They see that label and that's all they know.

I ask about newborn tremors. Nurse says "Oh that's what happens with GD because your insulin wasn't controlled"... lady, with a morning readings under 80 and never one spike, this isn't due to wild insulin. The glucose checks confirm that. Please get your head out of your ass. Every damn question I had for the nurse was "oh gd baby". No no no no. All wrong.

 

[rylt]

@plope132 The safest approach would be to assume it was correct and also start testing your levels at home.

My experiences are mostly with type 2 diabetes with my family members, but I've also had two friends who had GD. This is what my experience would suggest.

Your diet sounds like it's already diabetes friendly, (low carb has worked well for my family members with diabetes). If you are consistently getting high readings at home, then you'll likely need to start with insulin since you're already on a low carbohydrate diet, so that would probably mean it's going to be hard for you to manage it with diet alone. One of my friends had this happen. Even when she was eating perfectly her levels were all over the place bc of her hormones.

But, if your readings at home are already all within the expected range, then you know either you don't have GD, or you do and your diet is controlling it already.

Just remember, GD is very specifically tied to your body's reaction to the hormones triggered by the placenta. Even if you do need insulin until you give birth it should resolve as soon as the placenta is delivered.

 

[cgi2099]

@plope132 Thats not how you test for gestational diabetes on my country.

-+- -+-

"The test for gestational diabetes is called an ‘oral glucose tolerance test’ (OGTT). You need to fast for 10 hours (generally overnight, missing breakfast). A blood test is taken, followed by a 75g glucose drink and further blood tests at 1 and 2 hours later. You will be required to remain at the laboratory for the 2-hour test."

This is how they can test for both glucose load and insulin response in your body. And with the glucose drink being the only "food" and a known quantity in you that day it keeps the test consistent so its valid.

https://www.google.com/amp/s/www.healthdirect.gov.au/amp/article/gestational-diabetes

-+- -+-

I dont get why you were allowed to eat beforehand or had both done so close. Did they just jab you snd do the regular glucose strip to check you sugar instead??

 

[jwilder9]

@cgi2099 OP described the one hour test, you described the 3 hour. In my experience if you failed the one hour test they used the three hour to diagnose.

I had gestational diabetes in my second pregnancy and did the one hour tolerance test 3 times in my second pregnancy as they kept "checking".

I know it can be different in different places.

 

[cgi2099]

@jwilder9 A 1h test without fasting is just not a thing for GD over here. You get the long one straight away, everyone does.

I did specify in the first line that thats not how its done in my country not in general. Im in Australia.