Why Do I Need A Gtt
During pregnancy some women develop gestational diabetes, which usually resolves after your baby is born, and a further blood test with your GP surgery will be taken six weeks after delivery to ensure this. It is important that this is recognised in order for the appropriate advice and treatment to be accessed, for the wellbeing of you and your baby.
Some people are more likely to develop gestational diabetes if they have:
- A family history of diabetes
- A body mass index of greater than 30
- Delivered a larger than average weight baby
- Had gestational diabetes in a previous pregnancy
- Have a family origin with a higher prevalence to diabetes, such as being of South Asian, Afro-Caribbean or Middle Eastern decent.
What should I do before coming for the GTT?
As your midwife has identified a risk factor for gestational diabetes you will have been given an appointment for an oral Glucose Tolerance Test, usually at around 26/28 weeks of pregnancy.
You will need to have two blood tests taken. The second blood test will be taken two hours after the first. You will need to remain within the clinic until the test is completed. If you walk around or go home the test will become invalid as you will be burning off the sugar you have been given.
What Is A Prenatal Glucose Screening
Glucose screening checks for gestational diabetes, a short-term form of diabetes that some women develop during pregnancy. It’s becoming more common in the United States, affecting about 6% to 7% of pregnancies.
The test is usually done at 24 to 28 weeks, but sometimes earlier if a woman is at higher risk for gestational diabetes.
Your Diabetes Treatment In Pregnancy
Your doctors may recommend changing your treatment regime during pregnancy.
If you usually take tablets to control your diabetes, you’ll normally be advised to switch to insulin injections, either with or without a medicine called metformin.
If you already use insulin injections to control your diabetes, you may need to switch to a different type of insulin.
If you take medicines for conditions related to your diabetes, such as high blood pressure, these may have to be changed.
It’s very important to attend any appointments made for you so that your care team can monitor your condition and react to any changes that could affect your or your baby’s health.
You will need to monitor your blood glucose levels more frequently during pregnancy, especially since nausea and vomiting in pregnancy can affect them. Your GP or midwife will be able to advise you on this.
Keeping your blood glucose levels low may mean you have more low-blood-sugar attacks . These are harmless for your baby, but you and your partner need to know how to cope with them. Talk to your doctor or diabetes specialist.
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What To Expect From Gestational Diabetes Testing
Brian Levine, MD, MS, is board-certified in obstetrics and gynecology as well as in reproductive endocrinology and infertility.
If you are pregnant, your obstetrician has probably told you that you will need gestational diabetes testing. Don’t worrygestational diabetes testing is an important part of routine prenatal care. Most women are tested during weeks 24 through 28 of pregnancy. If you have any risk factors for diabetes, your doctor may consider testing your blood sugar as early as your first prenatal visit.
Extra Tests You May Be Offered
A Glucose tolerance test is a way of examining how your body handles glucose. If a GTT is deemed necessary it is routinely performed at 26-28 weeks of pregnancy .
If the result is not as expected you will be referred to Southmead Hospital Antenatal Clinic Diabetes Obstetric Team if you are booked to birth there. If you are booked at RUH or UHB, then a referral will be made to their endocrine service.
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Gestational Diabetes And Wellbeing
Some women can feel vulnerable and anxious when theyre pregnant. And finding out you have gestational diabetes might make these feelings worse.
“Theres a lot of shame and misconceptions attached to being a diabetic. I was really upset and in denial for a while. I was worried about the baby. I was also worried if I would be diabetic in future. I was encouraged by my diabetes team to stay active. I made time to do it for myself, for my mental sanity at this difficult time.” Rei
If youre feeling anxious, talk to your care team and ask for support. This support might come from healthcare professionals, voluntary organisations or other services. You can find out more on the NHS website.
Pregnancy can also cause depression in some women. Symptoms may include not wanting to do anything or see anyone, feeling down for long periods of time, not sleeping well or sleeping too much, overeating or not eating enough and feeling bad about yourself.
During pregnancy, your midwife and care team should ask if youve ever had problems with your mental health and whether youre having any now. Dont be afraid to be open and ask for support. Its a hard thing to do, but asking for help and talking about how youre feeling can be really helpful.
Id really recommend newly diagnosed mums speak to other mums with, or whove had, gestational diabetes, if they can. The moral support really helps. Vicky, a journalist from London
Choose Healthy Carbohydrates Instead
Complex or unrefined carbohydrates such as whole grain breads and cereals, whole fresh fruits and even baked potatoes are absorbed more slowly into your bloodstream and are less likely to give you the large sugar jolts that can result in excess glucose filtering into your urine.
In fact, since complex carbohydrates contain more fiber, they actually slow the absorption of sugar into your bloodstream. Whats more, they provide lots of essential nutrients for pregnancy .
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What Are The Warning Signs Of Gestational Diabetes
Pregnant women have heard tales or experienced it themselves of the orange drink they have to take around 24 to 28 weeks of pregnancy. Its a story thats passed from woman to woman about the overly sweet, syrupy taste of the drink and having to sit in the doctors office for blood tests.
But this important screening is worth the inconvenience. It detects and diagnoses gestational diabetes in pregnant women. Gestational diabetes affects nearly 10 percent of pregnant women, according to the American Diabetes Association.
Gestational diabetes, left untreated and unmanaged, can pose serious health risks to your baby, including:
- Excessive birth weight
- Preterm birth and respiratory distress syndrome
- Low blood sugar at birth
- Increased risk of type 2 diabetes later in life
Fortunately, gestational diabetes is easy to diagnose and manage, says Barbara E. Simpson, M.D., a board-certified obstetrician/gynecologist. The fasting blood sugar test can make sure mom and baby stay healthy and happy.
Symptoms Of Gestational Diabetes
Gestational diabetes does not usually cause any symptoms.
Most cases are only discovered when your blood sugar levels are tested during screening for gestational diabetes.
Some women may develop symptoms if their blood sugar levels gets too high , such as:
- needing to pee more often than usual
- a dry mouth
- tiredness
But some of these symptoms are common during pregnancy and are not necessarily a sign of gestational diabetes. Speak to your midwife or doctor if you’re worried about any symptoms you’re experiencing.
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Gestational Diabetes And Type 2 Diabetes Link
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing type 2 diabetes after giving birth. And it also increase the risk of your child becoming overweight and going on to develop type 2 diabetes as an adult. But there are lots of things you can do to reduce your risk of developing type 2 diabetes including breastfeeding your baby.
Oral Glucose Tolerance Test
The OGTT measures blood glucose after you fast for at least 8 hours. First, a health care professional will draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.
High blood glucose levels at any two or more blood test timesfasting, 1 hour, 2 hours, or 3 hoursmean you have gestational diabetes. Your health care team will explain what your OGTT results mean.
Your health care professional may recommend an OGTT without first having the glucose challenge test.
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How Is Gestational Diabetes Treated
If youre diagnosed with gestational diabetes, your treatment plan will depend on your blood sugar levels throughout the day.
In most cases, your doctor will advise you to test your blood sugar before and after meals, and manage your condition by eating a nutrient-rich diet and exercising regularly.
In some cases, they may also add insulin injections if needed. If your doctor encourages you to monitor your blood sugar levels, they may supply you with a special glucose-monitoring device.
They may also prescribe insulin injections for you until you give birth. Ask your doctor about properly timing your insulin injections in relation to your meals and exercise to avoid low blood sugar.
Your doctor can also tell you what to do if your blood sugar levels fall too low or are consistently higher than they should be.
A balanced diet is key to properly managing gestational diabetes. In particular, people with gestational diabetes should pay special attention to their carbohydrate, protein, and fat intake.
Eating regularly as often as every 2 hours can also help you manage your blood sugar levels.
Why The Test Is Performed
This test checks for gestational diabetes. Most pregnant women have a glucose screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if you have a high glucose level in your urine during your routine prenatal visits, or if you have a high risk for diabetes.
Women who have a low risk for diabetes may not have the screening test. To be low-risk, all of these statements must be true:
- You have never had a test that showed your blood glucose was higher than normal.
- Your ethnic group has a low risk for diabetes.
- You do not have any first-degree relatives with diabetes.
- You are younger than 25 years old and have a normal weight.
- You have not had any bad outcomes during an earlier pregnancy.
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The Dreaded Gestational Diabetes Test: What To Expect
I remember sitting with my mom at the doctors office as a little girl. She had a big bump and was drinking some weird orange punch. When I asked if I could try it too, she told me, no, its for me and the baby. Besides, its really gross anyways. Ah the gestational diabetes test.
I watched her gulp down this syrupy drink and I remember feeling so bad for my poor mama, who had to drink it even though it was gross.
Fast forward a few years, and I was being handed the same drink- but this time for me. I wasnt sure what to expect, and all I knew was that this drink is known to be really gross. I was nervous about it and dreading having to go through this test.
But after going through it personally, I realized that its really not anything to be too worried about. Here is what to expect with your gestational diabetes test, with some tips on how to pass it!
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What It Means For Your Baby
If you have type 1 or type 2 diabetes, your baby may be at higher risk of:
- having health problems shortly after birth, such as heart and breathing problems, and needing hospital care
- developing obesity or diabetes later in life
There’s also a slightly higher chance of your baby being born with birth defects, particularly heart and nervous system abnormalities, or being stillborn or dying soon after birth.
But managing your diabetes well, before and during your pregnancy, will help to reduce these risks.
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What Happens During The Oral Glucose Tolerance Test
The oral glucose tolerance test involves quickly drinking a sweetened liquid , which contains 50g of glucose. The body absorbs this glucose rapidly, causing blood glucose levels to rise within 30 to 60 minutes. A blood sample will be taken from a vein in your arm about 60 minutes after drinking the solution. The blood test measures how the glucose solution was metabolized .
Treatments For Gestational Diabetes
If you have gestational diabetes, the chances of having problems with your pregnancy can be reduced by controlling your blood sugar levels.
You’ll be given a blood sugar testing kit so you can monitor the effects of treatment.
Blood sugar levels may be reduced by changing your diet and exercise routine. However, if these changes don’t lower your blood sugar levels enough, you will need to take medicine as well. This may be tablets or insulin injections.
You’ll also be more closely monitored during your pregnancy and birth to check for any potential problems.
If you have gestational diabetes, it’s best to give birth before 41 weeks. Induction of labour or a caesarean section may be recommended if labour does not start naturally by this time.
Earlier delivery may be recommended if there are concerns about your or your baby’s health or if your blood sugar levels have not been well controlled.
Find out more about how gestational diabetes is treated.
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Can I Test For Gestational Diabetes Early
Testing in the first trimester is possible and a great option, especially if you:
- had gestational diabetes before.
- are prediabetic.
- have multiple risk factors.
Testing in the first trimester is done differently from the OGTT. Its an HbA1c test , and its over 95% accurate in predicting a diagnosis later in pregnancy.
This type of test requires nothing extra from you. You have to ask your doctor to request an HbA1c test with your normal blood work, and the doctor simply has to check that box when ordering the blood work.
If youve already had your initial blood work done, dont worry. Bring it up at the next appointment.
The benefit of testing in the first trimester is early intervention if necessary, but testing early doesnt excuse you from testing again at 24 to 28 weeks. Remember, insulin resistance gets worse as pregnancy furthers, so its necessary to test again later in pregnancy.
The only scenario where you wouldnt have to test at 24 to 28 weeks is if you were already diagnosed with gestational diabetes from the 1st trimester HbA1c test.
Ask A Laboratory Scientist
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What Is Gestational Diabetes
Gestational diabetes is a type of diabetes that occurs during pregnancy. It happens when your body is not able to produce enough insulin to keep the amount of glucose in your blood at proper levels. Untreated GD increases the likelihood of having a large baby, and is associated with birth complications as well as health risks for the newborn . Untreated GD also increases the risk of stillbirth late in pregnancy . Women who develop GD are at higher risk of developing type 2 diabetes in the future. However, there is excellent treatment for GD, and most women diagnosed with GD have normal deliveries and healthy babies.
How The Test Is Performed
TWO-STEP TESTING
During the first step, you will have a glucose screening test:
- You do not need to prepare or change your diet in any way.
- You will be asked to drink a liquid that contains glucose.
- Your blood will be drawn 1 hour after you drink the glucose solution to check your blood glucose level.
If your blood glucose from the first step is too high, you will need to come back for a 3-hour glucose tolerance test. For this test:
- DO NOT eat or drink anything for 8 to 14 hours before your test.
- You will be asked to drink a liquid that contains glucose, 100 grams .
- You will have blood drawn before you drink the liquid, and again 3 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked.
- Allow at least 3 hours for this test.
ONE-STEP TESTING
You need to go to the lab one time for a 2-hour glucose tolerance test. For this test:
- DO NOT eat or drink anything for 8 to 14 hours before your test.
- You will be asked to drink a liquid that contains glucose .
- You will have blood drawn before you drink the liquid, and again 2 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked.
- Allow at least 2 hours for this test.
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Screening At First Antenatal Visit
At your first antenatal appointment , when you are around 12 weeks pregnant, you should be assessed for the presence of risk factors for gestational diabetes.
All women have their urine tested for sugar at the antenatal clinic. If sugar is present in your urine sample, you will have to give a blood sample, which will also be tested.
If your blood test shows that your blood glucose level is high, then you will have to have a glucose tolerance test. For this, you will have to fast overnight so that any food you eat does not affect the test result and then you will have a blood test. You will be given a sugary drink after the blood test and two hours later you will have another blood test.