I am 32 years old, I have mild PCOS, and I am 28 weeks pregnant with twins. Since my one-hour blood glucose was 149 mg/dl [8.3 mmol/L], my obstetrician wants me to do a three hour glucose tolerance test, but I don’t want to.

I want to refuse the test because I do not feel it would be accurate considering that I’m having twins, have PCOS, and giving my body sufficient time to process the glucose, which, from what I understand, due to the PCOS takes a little longer to process through. I cannot find any research on these factors and their influence on the GTT. I also feel that my newly diagnosed gallstones and paranoia with eating anything has also influenced the test.

I am willing to change my diet, test fasting and two hours after breakfast, and whatever other non-Glucola blood tests my OB feels necessary to monitor, but I do not feel the necessity to subject myself and my babies to the unreasonable amount of glucose that I would not normally consume. It is most likely that I would pass the GTT as I did in my first pregnancy.

I don’t understand how one test has uniform result numbers for every person when it’s been proven that even race can play a role in the risk of developing gestational diabetes. Also, have no tests been compared to singleton pregnancies to those of multiples? I feel my 149 mg/dl [8.3 mmol/L] result is within reasonable range considering my circumstances (fat, twins, PCOS, lack of nutrition due to gallstone attacks). I’m sick of all these “standard” tests and want to go live back in the olden days when ladies would just go and have their babies like we’re naturally made to do and not worry about all this medical stuff.

I appreciate that you do not want to perform the oral glucose tolerance test, and while it is your choice not to have the test performed, your physician has made the appropriate recommendation for diagnosing gestational diabetes. However, you are incorrect that because you passed it last time you will automatically pass it now. Later pregnancies, twin pregnancies, and Polycystic Ovary Syndrome are associated with a higher frequency of gestational diabetes. My recommendation to you is to have the test performed, for the health of your children.

JTL
Additional comments from Jane Seley, diabetes nurse specialist:

As you know, you have a number of high risk factors for the development of gestational diabetes (GDM). Those risk factors are: family history of type 1 diabetes, previous history of GDM, body mass index (BMI) greater than 25, previous baby born weighing more than 9 pounds, prior history of poor pregnancy outcome, glycosuria (spilling sugar in urine), polycystic ovarian syndrome (PCOS) and being a member of a high risk ethnic group (Native or African American, Latina, Asian or Pacific Islander). I would consider a blood glucose 135 mg/dl [7.5mmol/L] or higher to a positive screen for a 50-gram glucose challenge, and you were 149 mg/dl [8.3 mmol/L].

If you cannot agree to the confirmatory three-hour oral glucose tolerance test, then you must consider yourself positive (that you have GDM) and begin the treatment immediately. GDM, left untreated, has serious consequences for both you and your babies. Some of the risks include high blood pressure and preeclampsia for you and macrosomia (excessive growth) and respiratory distress syndrome for your babies.

The initial treatment for GDM is blood glucose testing four times per day: fasting (when you wake up in the morning) and exactly one hour after you start eating your main meals. The goals are: a fasting blood sugar less than 90 mg/dl [5mmol/L], and a one-hour postprandial 1 hour post less than 140 mg/dl [7.8 mmol/L]. Additionally, you should be testing your urine every morning when you wake up for ketones. If positive, this indicates you may not be getting enough calories for your babies to hold you throughout the night. You should see a dietitian as soon as possible and get instruction in a GDM diet: three main meals and three snacks which restricts carbohydrates throughout the day.

JS