- My failing score was 165 mg/dL. The American Diabetic Association cutoff is 180 mg/dL* to diagnose gestational diabetes. Therefore, the national authority on diabetes says I passed.
- A baseline glucose was not drawn, only after 1 hr post-orange drink. So we don't know if the oatmeal I had for lunch prior to my 1PM appointment might have already spiked my glucose level. It might be a baseline issue more than a metabolism issue. (I was told to eat normally.)
- Even if blood sugars are lowered -- through testing, diet, exercise, even with insulin or oral antidiabetic medications -- the risk of having a larger birth weight baby remains if I do, in fact, have gestational diabetes. So the intervention is useless for the biggest concern to the baby.
- The major risk factors for me are poorly supported by research: increased risk of preeclampsia (conflicting data) and increased 5-year incidence of type 2 diabetes (even experts concede that the gestational diabetes diagnosed for this subset of women likely just uncovered latent undiagnosed type 2 diabetes, and pre- and post-pregnancy obesity is a strong correlate).
- Some experts think that gestational diabetes, considering it's estimated to occur in up to 10% of pregnant women depending on the source, may actually be a normal condition of pregnancy that simply bears routine monitoring as with blood pressure (for preeclampsia), fundal measurements (for intrauterine growth restriction), etc.
- My blood pressure remains perfect, my urine shows no spilled protein or glucose or ketones, and my weight gain and fundal measurements are on track (exactly the same as with Jackson).
Fuckity-fuck-fuck. Just when I thought I was in the home stretch (3rd trimester!) with single-digit weeks until full-term, and then this bullshit. They are mailing the info to me with the diet (which I'll do my best to follow) and a lab order to schedule the 3-hr test. I might just not do it and then talk it over at my next monthly appointment in 3.5 weeks. And if they call in the mean time, I'll explain my reasons and see what they have to say. I'm not psyched about the prospect of being flagged as noncompliant, so I want to be sure to lay out a clear case for them. I also don't want for the compromise to come down to frequent non-stress tests or whatever, because that's just more intervention of another kind. I feel like the level and nature of monitoring already built in to the OB practice is sufficient to look out for me and the baby. I hope they agree. They are generally a low-intervention practice (which is partly why I chose them) so perhaps I will prevail. Dare to dream.
Of course, none of this can stop the paranoia that I should just give in to the testing and intervention for the sake of safety. I might pass the 3-hr test anyway. I just don't know. I'm not inherently high risk, so I want to proceed like a normal pregnant person. Anyone here know how the hell that even works?
*So I looked into it more and the test should have been done fasting per ADA recommendations, and the 180 mg/dL cutoff is for a fasting test. So maybe I will suggest we simply repeat following the ADA guidelines and then go from there.**
**Okay, after looking into it even further, the routine OB test is non-ADA and is a "challenge" versus a tolerance test, and I roundly failed. So I appear to be screwed and should probably take the 3-hr test and cross my fingers. Fuck me.