Saturday, March 12, 2011

glucose tolerance test--refusal of 3 hr. test

on wednesday i received a voicemail from my nurse stating that my 1 hr. glucose test score was a little high and giving me the phone number to schedule a 3 hr. test with a local lab.  i was in meetings for most of the day, so when i called back at 4:35pm the doctor's office was already closed for the day.

i felt a little frustrated...mainly in myself that i "failed" the test, but also in the fact that i could not get a hold of the doctor's office to ask my score.  naturally i googled "glucose test pregnant normal score" and saw many message boards about the subject.  most people said that anything over 130 or 140 required a retest.

finally when i was able to talk to the nurse the next day, our conversation went something like this...

me: yes i was just calling back about my glucose test results
nurse: what is your name?
me: silvy
nurse: was your result normal or abnormal?
me: um, the voicemail i got said abnormal...
nurse: did you get the phone number for the local lab?
me: yes. 
nurse: well what else do you need?
me: i was just wondering if you could tell me my score
nurse: oh, well i'd have to pull your chart to do that
me: okay
*awkward pause*
nurse: well i'll have to call you back since i have to pull your chart
me: okay thank you

several hours later i still had not heard back, so i called again and found out my score: 135.

after a few hours of thinking about and researching it some more, i decided not to retest.  main reasons:
1. i don't think i have gestational diabetes.
2. even if i did have gestational diabetes, the treatment would likely be to regulate with diet.
3. i can regulate my own diet.
4. i don't think it is ideal to fast for long periods of time while pregnant or drink large amounts of sugar water on an empty stomach.
5. i often feel lightheaded when getting my blood drawn.
6. i don't want to take a whole morning off of work for the test.
7. i read many doctors have tightened the "passing window" for the glucose test, thus retesting many more people and producing many more false positives.
8. my score, 135, is not often retested.
9. as much as i love and respect doctors, i think know their own liability plays into extra unnecessary tests and procedures (i.e. why the c-section rate has gone up so much recently), this test included.
9. my pregnancy is not high risk and i passed the glucose test with parker.
10. the nurse did not call me about my results for 5 days after the glucose test (when she had the results in 1 day) and also indicated there was no rush in scheduling my 3 hr. is it really necessary?

i think it is slightly humorous to read all of the posts on message boards of women who cannot believe others would refuse a test their doctor recommended.  comments like "that is so selfish, foolish, etc." and "don't you want to do what is best for the baby?" appear often.  however, i think it is really important for women to educate themselves about all topics related to pregnancy and not just blindly listen to a doctor's suggestion for everything (see the business of being born...yes it is rikki lake but still good, haha).  imo, refusing the 3 hr test is the best thing for my baby.

i received a message from one of my high school friends who is pregnant (and was a national merit scholar, ha, but i do respect that) encouraging me to refuse the test and find alternative ways to check glucose (which i plan on discussing with my doctor on my next visit).  i appreciated her support and wisdom on the subject.  i feel good about the decision to not retest (and so does james), so i'll focus on eating less refined sugar and making sure i exercise at least 30 minutes/day. 

and i can't end the post without a photo, so here is a sweet shot of baby boy kehrli at 20 weeks.  can't wait to meet you little guy!  (less than 3 months to go!!!)


Katie said...

When I was pregnant with Naomi, I had several friends who were pregnant at the same time (I can count at least six). EVERY SINGLE ONE OF THEM FAILED the first glucose test, BUT they passed the second (I passed the first, but I'm a bit hypoglycemic). What's crazy is that the girls who were in their second pregnancies had all passed the first test with their first pregnancy. Craziness! You're right--the standards have changed.

Good for you for making an informed decision. I like that you're balancing your own knowledge and research, the opinions and experience of others, and then discussing it with your doctor. Very wise, friend. Good luck!

Krista said...

I think you are making the right decision and I completely agree with you. The system has gotten a little bit ridiculous if you ask me.

alicia said...

i did have a 131 turn out to have gestational diabetes. but like i said on facebook, you're healthy so i wouldn't have tested you. i don't blame your decision.

Erin said...

I am so glad that you posted this. People rarely consider the "costs" of medical tests, and IMO this is actually the biggest problem with health care in the US. 

I think people don't like to discuss costs, because they think "cost" = money, and it makes people uncomfortable to place $ values on life (even though they do it subconsciously everyday - but that's another story). My father-in-law, who is now the assistant director of the NIH for the Obama Administration, wrote a book on the subject called "Disease, Diagnoses, and Dollars: Facing the Ever-Expanding Market for Medical Care."

I post the following article for all my students to read.
The point is that many tests do not improve health outcomes and can create unnecessary pain, stress, and even surgery. More testing/medication is not ALWAYS better, and now at least some health guidelines are being reexamined. For example it is now recommended that low risk women (one sexual partner and previously normal pap-smears) receive a pap-smear biannually instead of annually. The guidelines at my health center are still - no pap-smear = no birth control. I had to contact my physician and talk her into giving me a birth control prescription without an exam. It was well worth the hassle. :) 

Ok, just one more example. The medical "rule of thumb" is that every pregnant woman over 35 be tested to see if the baby has down's syndrome. Since the test has a very small risk of causing a miscarriage, it is not preformed on everyone. When one of my colleagues asked his wife's doctor about the reasoning behind the age 35 cut-off, the doctor explained that if you graph the probability of causing a miscarriage and the probability of finding down's syndrome over mother's age, the two lines cross at about 35 years old. No value on information, no value on risk of miscarriage, just the probabilities. Horrifying. 

Anyway, I don't have a medical degree, and these decisions should always be made in consultation with a doctor. Every patient is entitled to know why they are undergoing a test and what the risks and potential benefits are. And for heaven's sake, please vaccinate your children! 

kristina said...

silvy, i completely agree with you decision. after being pregnant/birthing a child in another country, it is easy to feel that some things done in america are, well, a bit unnecessary. Making an educated and informed decision that suits your family is the best way to go. All the best with number 2! cant wait to see them both when we move back!!

Hannah said...

If it makes you feel better, I didn't take a glucose test at all when I was pregnant.

Don't feel bad for trusting your gut. Mothers often know better than care providers in those instances anyway.

Best of luck in your pregnancy.


Erin said...

Did you delete my comment? :(

Diet DP Loving Mom said...

I was a borderline fail in the one hr and the three hour. I was glad I retested and tested my blood sugars 4x a day for 10 weeks. It wasn't as bad as I thought it would be and B was 8 days early and over 8 lbs. She would've been closer to 9 lbs if she had gone all the way to 40 weeks. The doctors were good at monitoring her weight during my pregnancy and would not allow me to go one day past my due date.

As you know gestational diabetes causes moms to make bigger babies and not the good kind of fat. It can also lead to trouble giving birth.

I don't say this because I think you are making a bad decision. I just made the other choice and while diet and exercise helped, testing my blood sugars really helped me stay on track. I knew how bad/good they were and could adjust my diet meal to meal and snack to snack.

Good luck.

Michelle said...

I just found your blog as I was trying to research passing glucose test results. I am pregnant with baby #4, and for the 4th time I've failed my one hour glucose test. I dutifully went in and took the 3 hour test for the others. This time around I decided to not take the 3 hour test. I always get around the same # (137-140)for the one hour, and I ALWAYS pass the 3 hour. I decided that rather than waste 4 hours (with drive time) of my day to take a test I am 99.9% sure I'm going to pass I'm just going to start cutting out refined sugars and exercise every day (which I should be doing anyways.) I'm glad I read this, because I was starting to second guess my decision, just because of some of the responses I get from people. lol. My husband is a Dr. and says he supports me either way but thinks I should take it just to be on the safe side, but I just think it's pointless. You've strengthened my resolve. :-D Thanks.

Anonymous said...

Nice blog, very helpful,

I want to know approximate cost of the 3 hour Glucose test.
Want to keep a tab on my finance.
Help Appreciated.


Anonymous said...

Thanks for this - I know this post is old but it made me feel better about my decision. I'm hypoglycemic and have refused to do the three hour test (I failed the 1 hour). The nurse told me that if I fainted due to lack of nutrients to my brain, that it would be fine for the baby - FINE?!?!? Really? I doubt it, I told her that I wasn't going to take it until I talked to my doctor, she was quite angry with me and said I had to do it and I just flat out refused. So, I'm very glad that others are making similar decisions. I plan on refining my diet a bit and adding more exercise just to be on the safe side.

Anonymous said...

Thank you for this. I am refusing the 3hour test as well. My score was 6 points over the limit. I had been eating lots and lots of fruit so I've tamed that down & I make sure I walk at least 30 min a day. I feel great & don't see the need for the test. Also drinking tons of water.

Sew What said...

I am so happy I found this. I also want to refuse the 3 hour test and have but Im not being treated fairly for doing so. I am currently looking into alternatives. Anyone who is reading this and is afraid to refuse will cause problems with your Doctor ask for the HbA1c test, mo fasting and one blood draw. I plan on putting my request in writing and faxing it over just in case the Doctor tries to drop me for being an uncooperative patient. Which is not the case. Like you I know my body and I think the test which includes 4 blood draws and 12 hour fasting(this equals at least 15 hours of going hungry not good for a pregnant woman IMO) is not fair or healthy. I have other children who cannot sit in an office for about 4 hours. It was hard enough taking the 1 hour test. Good luck to anyone out there in the same situation.

Helen said...

Can you share your doctors reaction?

I had gd with my 1st baby. I am pregnant again and my doc has already tested me for gd with this pregnancy...I'm only 13 weeks!!! I feel she is a little test happy.

I have declined to take the 3 hour test and to just check my sugars 4 times a day and chart everything I eat and have my doc review them every week. Just because I used the word "refuse" when I declined to take the test I feel like I am being looked down upon by my doctor. She is not happy with my decision and is very relcutant in my personal decision. I have a family history of diabetes and had gd with my 1st baby. Statistically, I will have it again.

I feel this has created an uncomfortablness between my doctor and myself and I am on the hunt for a new doctor.

I have read many women who do not agree with this decision but I feel they are not informed that the mother will monitor her diet and blood sugar.....she's not just saying no to the test and going on with her life.

I am searching and searching for conclusions and outcomes to these stories!! Thanks so much : )