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March 3, 2003

Gestational Diabetes

Question from Stanley, North Carolina, USA:

I am 20 weeks pregnant and was diagnosed with gestational diabetes this week. I had it with my last pregnancy but it was easily managed by diet, I kept track of my own blood sugar levels at home (all of which were normal), and I really never had any special tests toward the end of my pregnancy. However, I am being seen by a different OB/GYN practice this time, and they are handling the whole thing very differently. As soon as I failed my one-hour test, they said I needed to take the three-hour test, immediately which was impossible for me to do within the week as they wanted me to do, and I finally had the test two weeks later (at 20 weeks). I am supposed to have a dietitian appointment next week and then come in weekly for blood testing, no tests at home. I believe the nurse said that I will fast, give blood (not sure whether it is drawn from my arm or by a finger stick), eat, and then wait an hour or two for another blood test. I asked why they don't allow patients to monitor themselves at home and got the answer that patients do not keep reliable records. I explained that, if possible, I would prefer to do it another way (due to having three other children at home and the cost of gas, the inconvenience, etc.), but she said this is protocol, and there is no exception. To me, this seems a bit excessive, particularly since do not have terribly high levels. I called another major OB practice, and they said that they would handle it the same way. I plan to call another doctor and see how they would handle it, but I am concerned. The nurse I talked to also said there was no guarantee that I could avoid all of the interventions they might want to do, such as amniocentesis, scheduled induction, C-section, etc. Do I have any rights whatsoever?

Answer:

In my practice, I usually have patients checking their own blood sugar values. I have no problems with reliability since the glucose meters have memory, and the numbers can be easily reviewed. I think you should shop around a bit to find a practice that fits your needs. The nurse with whom you spoke is giving you the worse case scenario. With good management, I would expect you to go to near term and hopefully have a successful vaginal delivery.

OWJ

[Editor’s comment: The ADA’s Position Statement about Gestational Diabetes Mellitus states that “Daily self-monitoring of blood glucose (SMBG) appears to be superior to intermittent office monitoring of plasma glucose.” [Emphasis in the original.]

WWQ]