How to Test for Gestational Diabetes

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Gestational diabetes is a common condition experienced by approximately 2-5% of women during pregnancy. During the digestion process, the food breaks down to a type of sugar known as glucose. The glucose will then enter the bloodstream and be utilized as a source of energy through the pancreatic hormone called insulin. When the body doesn’t produce enough insulin to convert glucose into energy, glucose will remain in the blood in high levels causing hyperglycemia. When a woman gets pregnant, her body experiences various physical and biochemical changes including hormonal changes which may largely affect the responsiveness of insulin in the interstitial cells. To test for this type of gestational diabetes, first you'll need a screening test – then, possibly, a tolerance test – both of which we'll discuss below.

Part 1
Part 1 of 3:

Getting a Screening Test

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  1. In this test, you have to fast for six hours beforehand – in other words, don't eat breakfast before your appointment and just fast while you're asleep. That way, you can avoid being hungry.
    • Don't eat anything after around midnight if your test is early the next morning. This ensures that your sample will be true to your natural blood sugar levels and no food or drink will elicit abnormal results.
  2. Make sure you get a good, balanced, healthy diet for the few days before the test to make sure your blood sugar levels are looking good. In other words, avoid excessive sugar and simple carbs. That means no cookies, cakes, chocolate, candy, or sweet breads.
    • Drink plenty of water, too. The more water you drink, the easier it will be for the technician to draw your blood. It will lead to fewer pricks and therefore less pain.
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  3. The testing of gestational diabetes can be done using a screening test for glucose at your first prenatal visit and if you're between 24 and 28 weeks. [1] It's the first of the two tests you may be required to take.
    • The glucose screening test is not a definitive test for gestational diabetes, rather it is a tool designed to determine whether or not you, the expectant mother, have abnormal blood sugar levels requiring several tests to confirm the diagnosis of diabetes. If the result is too high, the physician will request for further diagnostic work-up – the glucose tolerance test, which we'll discuss in the next section.
    • Wear a short-sleeved top, like a t-shirt or blouse. This makes it easier to have blood drawn by the laboratory technician.
  4. This test is done to measure the processing of sugar by your body. You will be given a solution of sugar where 50 grams of glucose is mixed with water and instructed to drink the solution in five minutes.
    • This glucose mixture usually comes in different flavors that include lime, orange or cola; you will be given your preferred flavor.
  5. A blood sample will be taken from your arm and measured for blood sugar levels. That's it! Then you can go home – you'll be told when to come back in for your results.
    • In case you vomit after taking the solution (not unheard of), you will be encouraged to go home and come back on another day for a repeat of the test. Most people usually feel sick after taking the solution and this is because of the sugar that is contained in the solution.
    • Rest for an hour so that the sugar can be allowed into your bloodstream. Read a book or magazine to pass the time. Then you can go about your day as normal.
  6. Usually the analysis of the blood takes approximately 2-3 days. Your doctor will likely only call you if the results are normal; if they are abnormal (which doesn't necessarily mean gestational diabetes), you'll likely be called in.
    • When the level of sugar is between 140-200 mg/dl, you will have to take a glucose tolerance test to pinpoint the issue. [1]
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Part 2
Part 2 of 3:

Getting a Glucose Tolerance Test

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  1. To avoid being hungry, just like in the screening test, schedule your appointment for the morning. This way, you can avoid actually fasting and get the fast over with in your sleep.
    • When you schedule your appointment, discuss what medication you are on. This can help your doctor know how to move forward; he or she may have specific instructions you need to follow to ensure the test works. This is especially important for those on hypertensive and antiretroviral drugs.
  2. You may take a late dinner the day before the test is done, but you should only drink water the day of the test. This is why scheduling the test early in the morning is best.
    • This is a necessary step to take – if you do eat the day of the test, you will have abnormal sugar levels that could lead your doctor to the wrong conclusions. If you accidentally eat, you'll have to reschedule your appointment.
  3. It's a good idea to carry a snack to eat for when the procedure is finished. Some people feel a little dizzy or fatigued after giving blood and having a snack handy will get your metabolism back in no time. Try not to bring something too sugary, as you've just ingested glucose. Bring some carrots, cheese, or plain granola to munch on.
    • You'll want something to do, like a book to read, too – you'll be at the doctor's office for at least three hours. To fight the boredom, make sure you come prepared.
  4. In this test, you'll have to give a blood sample once every hour for three hours. Your blood will be taken once initially upon "fasting," and then you'll receive another glucose solution to take. Then, two more blood samples will be taken to see how your blood responds over time.
    • Sugar is absorbed by the body very fast. The test shows how the glucose metabolism takes place in the body and how quickly it responds.
    • The laboratory technician should alternate the arms to reduce pain and inflammation on one arm.
  5. When one of the results is abnormal, you'll be advised to see your doctor later in the pregnancy for the test to be repeated. In the case where two of the readings are abnormal, the diagnosis of gestational diabetes is done. You'll be given medicines to help control your blood sugar levels.
    • In the case where the fasting glucose level is 95mg/dl or above the reading is considered abnormal.
    • When the level of sugar is above 180mg/dl after 1 hour, the reading is considered abnormal.
    • When the blood sugar is above 155mg/ dl after 2 hours, the reading is abnormal.
    • When the blood sugar is above 140mg/dl after 3 hours, the reading is abnormal.
  6. This is very important especially in the last stages of the pregnancy. The doctor will monitor your blood sugar levels to ensure that they are within a normal range and may adjust the medicines you're taking depending on the results. The doctor will also monitor the progress of the baby to ensure that it is growing well.
    • The risks that are associated with gestational diabetes include giving birth to a very big baby. These babies are at risk of injuries during delivery and they may develop diabetes later as they grow up. Because of this, it's incredibly important to go for regular checkups.
    • Most mothers who are diagnosed with gestational diabetes do not present with any symptoms and that is why it is important to test. The early diagnosis of gestational diabetes will help in control of blood sugar throughout the pregnancy and therefore help to prevent complications of the disease.
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Part 3
Part 3 of 3:

Managing Gestational Diabetes

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  1. Your dietician (or doctor) will compute your daily caloric requirement based on your height, weight and level of activity. The diabetic diet should have balanced proportions of protein, fats and carbohydrates to ensure that your body gets the proper amount of vitamins, minerals and calories to sustain daily routine activities and keep your baby healthy.
    • The recommended dietary protein requirement is around 100 to 150 grams (4 to 5 oz) a day. Otherwise, don’t take more than 20 percent of calories from protein if you have kidney problem other than gestational diabetes. Choose lean meat, skinless chicken, fish and low-fat milk and dairy products.
    • To get sufficient amount of carbohydrates per day, include 5 to 6 servings of fruits or vegetables every day. Legumes, brown rice, oats and barley are good sources of carbohydrates.
  2. To keep your blood sugar levels normal, it’s important to eat complete meals. Do not skip meals and snack between (with healthy snacks) when possible. This will help keep your blood sugar in the right place and help you maintain a healthy weight.
    • Avoid foods very high in sugar like candies, cookies, cakes and soft drinks. These do the opposite to your blood sugar – it will spike and be difficult for your body to handle.
  3. Research has shown a very positive relationship between exercise and the body’s ability to process blood sugar. It’s recommended to engage in 30-minute cardio and aerobic exercises like walking, jogging, or swimming, every day. [2]
    • As obesity is a risk for those with diabetes, regular exercise will help keep you fit and at an ideal weight, too.
  4. In cases where diet and exercise is not enough, your physician will likely prescribe anti-diabetes medications. Possible medicines are metformin and glibenclamide tablets or insulin injections. Pregnant women reaching above their blood sugar goals on oral medicine should be given insulin shots.
    • Metformin is given in titrated (controlled) doses. First it is given at 500 mg ½ tablet orally once a day for 7 days. Then, 500mg 1 tablet orally once a day for another 7 days, and then a 500 mg tablet orally twice a day.
    • The initial dose of glibenclamide is 2.5 to 5.0 mg per day then eventually adjusted to 2.5 mg once a day to 7.5 mg twice a day.
      • Doctors will consider medicine titration more quickly if the patient does not experience gastrointestinal issues.
  5. Most physicians recommend taking self-tests at home by using a glucometer to keep track of blood sugar levels. In addition, regular blood tests may be required as part of the pre-natal schedule.
    • Your doctor will likely request for another blood sugar test 6 to 12 weeks after delivery to ensure that blood sugar levels have returned to normal.
  6. There are a variety of risk factors that can increase your chance of developing gestational diabetes. These include:
    • Obesity or body mass index (BMI) over 30
    • History of gestational diabetes in previous pregnancy
    • Genetic factors or a family history of the condition
    • Sugar in urine during early pregnancy
    • High blood pressure
    • Over 35 years old
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      Tips

      • Carry the doctor’s request form that shows the procedure that the doctor has ordered. This is very important especially in cases where the test is not being done in the doctor’s office. In addition, carry all the documents that you may need for the test to be done. This includes insurance cards and ID.
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      References

      1. ↑ 1.0 1.1 Beckmann, C. R. B., & American College of Obstetricians and Gynecologists. (2010). Obstetrics and gynecology. Baltimore, MD: Lippincott Williams & Wilkins.
      2. ↑ http://www.diabetes.org/food-and-fitness/fitness/
      3. Metzger BE, Coustan DR (Eds.): Proceedings of the Fourth International Work-shop-Conference on Gestational Diabetes Mellitus. Diabetes Care
      4. Major CA, Henry MJ, De Veciana M, Morgan MA: The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes.
      5. Franz MJ, Horton ES, Bantle JP, Beebe CA, Brunzell JD, Coulston AM, Henry RR, Hoogwerf BJ, Stacpoole PW: Nutrition principles for the management of diabetes and related complications
      6. Poretsky, L. (2009). Principles of diabetes mellitus. New York: Springer.

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