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December 23, 2000

Diagnosis and Symptoms

Question from Front Royal, Virginia, USA:

I am 37 years old and 18 weeks pregnant with my fifth child. My mother has type�2 diabetes and is clinically obese. I am technically "overweight", but I work out regularly (cardiovascular and with weights) and recently had a body-fat index measurement at my health club which indicated my body fat is 24%. My diet is high in whole grains (we make our own bread, so the whole wheat is really whole wheat), fresh fruits and veggies, with very little refined sugar and limited meat. With my first two pregnancies, the one-hour test levels were 137 mg/dl [7.6 mmol/L] and 140 mg/dl [7.8 mmol/L], and I passed the three-hour test. With my third pregnancy, the one-hour value was 139 mg/dl [7.7 mmol/L], and my midwife agreed to forego the three-hour test if I followed a special diet (which turned out to be no different from my "normal" diet, except I had to reduce my fresh fruit intake). During my fourth pregnancy, the obstetrician allowed me to forgo all glucose tolerance testing after I suggested taking my blood sugar at home (fasting and one-hour post-meal) for several days when my mother was visiting. (My fasting values were all under 80 mg/dl [4.4 mmol/L], and, after meals, the highest was 120 mg/dl [6.7 mmol/L]). My babies have weighed 5 pounds 11 ounces (36 weeks), 7 pounds 9 ounces, 8 pounds 3 ounces, and 7 pounds 11 ounces (the last three were full-term). We have moved and the prenatal care options in our area are extremely limited. I have proposed checking my sugar at home in a "normal" environment as I did before, and/or going on the diet, but I am still being pressured to do the glucose test, which they want to do early and then repeat because of my family history. I object to the artificial conditions of the test and to the consumption of refined sugar involved. I learned when I was about six years old that sugar on an empty stomach made me nauseated, and I see no reason to undergo that and consume something foreign to my diet in order to create an artificial situation, when the whole point is to maintain healthy blood sugar levels on a regular, everyday basis. I feel taking this test is like forcing a vegan to submit to a lactose intolerance test. I'm considering home-birth if I can't get the current care-givers to agree to an alternate and more normal method of testing blood sugar. Their only alternate so far is that I eat jelly beans instead of drinking Glucola -- yuck! Any advice or other alternative testing procedures that I could present?

Answer:

I think it would be reasonable to follow your blood sugars at home, fasting and one hour after meals. The fasting should be 80-90 mg/dl [4.4-5 mmol/L] and the post meal less than 130 mg/dl [7.2 mmol/L]. This is a lot of testing to avoid a single glucose screening test, but is an option.

OWJ