I had my routine screening for gestational diabetes last week and came back with high levels so I have to go sit at the clinic for THREE DAMN HOURS tomorrow to find out if I’m really diabetic or not. It wouldn’t surprise me a bit since I have crazy family history of diabetes, including gestational diabetes (not me, but my sister had it twice), but still…
My dad is diabetic so I’ve stopped by a few times to check my blood sugar. An hour after I ate lunch today (whole wheat spaghetti tossed with chicken, bell peppers, and a little oil) I went by to check and was at 113. Maybe a half hour, forty minutes later I was down to 103.
This is totally normal for a non-diabetic, right? So my question is, as a diabetic is it possible to appear “non-diabetic” like this one day but have high BS the next?
Sorry, I’m panicky. This pregnancy has been rough enough already and this is just like One More Thing that I don’t need and I really hope I managed to jack up the first test somehow and that I’m really totally fine.
Yes, what you describe is possible. There are a lot of variables that can affect your blood sugar. Just to name one, vigorous exercise can cause a spike in insulin many hours later. I no longer work out after 7 p.m. because it tends to cause me to go low in the middle of the night–and then go HIGH the next morning because my liver releases extra glucose to handle the drop in blood sugar, while my slacker pancreas is sitting around doing nothing.
I’m not diabetic, but I also failed the 1 hour GTT and had to do the 3-hour. I don’t know why I failed the first one, my diet was normal and I don’t have a history of high blood sugar or family history of diabetes, GD or otherwise. I was pretty surprised I failed.
I did pass the 3-hour test. It’s actually pretty common to fail the first then pass the second one. Only about 15% of women who fail the 1-hour are actually diagnosed with GD. I don’t know what my numbers were for the 3-hour, but my doctor said they were “great”.
It wasn’t so bad, the worst part for me was that it’s boring waiting around, so bring things to do. I got a bit nauseous in the first hour, and at the end - plan to eat something right after you’re done, I didn’t right away since it was almost lunch anyway by that time, and regretted it.
What kind of screen did they do to make them think you might have GD?
As far as whether or not what you’re seeing is normal or not, well, it’s hard to tell from just a couple tests. Different foods affect different people differently. I’d just keep testing if I were you and see if you ever see spikes. Actually, what I’d probably do is really try to raise my glucose and see what happens - like go drink a full-sugar soda or glass of juice and test 30 minutes later.
I know for me that I’d see a spike - heh, a big one, if I didn’t dose for it - but it’s pretty well established that my pancreas has bit the dust.
They sent me home from my last OB with a 50 gram glucose beverage which I had to drink in five minutes one hour prior to a blood draw. They expect numbers <140 and I think mine was 186. I didn’t finish it in the five minutes though and it was not a full hour from me drinking the last 1/4th of it to the draw. I’m not sure if that screwed it up or not.
I’m still at my parents’ house. I did have a KitKat and came up with 127 about a half hour later. That test was like 15 minutes ago and it’s down to 101 now. Oh, and I pigged out on fair food the other day (corn dog, mini doughnuts, the sweetest lemonade in the land, etc.) and still only came out in the mid-120s.
I haven’t. My dad has two meters and is sending me home with one. I should have gotten it a week ago so I could have been reassuring myself this whole time, but I’ll check it in the AM. I can’t eat breakfast tomorrow anyway.
My main question was why, if I’ve had decent numbers since, would the original number at the clinic have been so high, but I don’t think that’s answerable. I guess mostly I just want some reassurance because, honestly, while gestational diabetes isn’t the end of the world, it really is just One More Thing.
Athena is right that you also need to be looking at your morning fasting sugars to have a better idea of your status. Most diabetics have their highest numbers in the morning before eating.
That doesn’t make any sense - morning numbers, after you’ve been fasting all night, are usually low. My highest numbers are after I eat anything carby. Morning numbers are nice & low, because if they’re not, it’s almost certainly because of something I did or didn’t do.
Of course, before diagnosis & treatment, your morning numbers will run high. But they get higher after you eat even in that situation.
I am talking about highest tested blood sugar numbers. Blood sugars probably are highest immediately after eating, but no doctor asks you to test sugars immediately after eating. (At least I’ve never heard of that.) You test 1-2 hours after, depending on doctor’s orders, and Type 2 diabetics often have enough insulin response that those numbers are lower than morning fasting numbers.
I am a Type 2 diabetic, and so my information is probably specific to that type. I should have said that. I don’t know a lot about Type 1. My understanding is that gestational diabetes is a lot like Type 2, but I could be wrong about that. IIRC, you have Type 1.
That said…
Just because you’re not eating overnight, doesn’t mean that sugars aren’t being dumped into your bloodstream. Fasting sugars are often the highest that Type 2 diabetics will see on a blood glucose test because of the hormonal “jolt” that the body gets in preparation for waking. One of the things that happens in response is for sugars to be released from the liver.
So, for example, I was told to test fasting morning numbers and 2 hours after each meal. Prior to treatment, my morning fasting number was around 300, but my 2 hour post-meal numbers were closer to 200. I have been told by multiple endocrinologists that this is a typical pattern for Type 2 diabetics.
Okay, 300?? Like I said, I haven’t done the overnight fasting, first thing in the morning test yet (I definitely will tomorrow though), but I tested this AM like 1.5 hours after eating a blueberry muffin and I was at 107. So even without the fasting numbers, I like the way this looks for me.
Still sucks about the 3 hour clinic visit tomorrow though.
I have white coat hypertension*, I wonder if you can have white coat hyperglycemia, too?
*Seriously, apparently it’s very rare. Every time I go in for OB check ups I have at least two, sometimes three people check my BP and it’s always something outrageous, like last week when it was 158/82. With concerns about pregnancy-induced hypertension and everything, and my insistence that I do not have high blood pressure, I finally told my doc I’d monitor it a couple times a week on my own time using my medically trained mother. My BP is consistently in the 120s/60s (122/64 this evening) which seemed to satisfy him at my last appointment.
This is what I mean when I say that this is just one more thing. We’ve had concerns about Down Syndrome (based on “artifacts” on the ultrasound that apparently only the radiologist could see; after a blood test and the most agonizing week ever, that turned out fine) and concerns about PIH and concerns about my anatomy and whether I can physically handle a birth or if I’ll need to have a cesarean (maybe not but the doctor still isn’t sure), and now this whole diabetes thing and blahblahblah.
Sigh. Everything else has turned out fine so far, but it’s very tiring.
End tangent.
Oh, and re: AM testing. Is this something I should do BEFORE I do anything else or does that not matter? Should I keep the meter and everything on my nightstand and do it literally first thing in the morning?
Before you put any food in your mouth for the day. It doesn’t have to be the instant you leap out of bed. I tend to find it is easier to remember if I leave the monitor on the nightstand and do it first thing, but it’s not a requirement.
I hope it turns out to be nothing. It is possible to occasionally have a high or low blood sugar level and not have diabetes. Maybe it was a one-off.
Did they tell you that “white coat hypertension” is rare? It’s not. I come from a family of doctors, and it’s a well-known and rather common phenomenon. A lot of people get anxious in the doctor’s office. And anxiety causes high blood pressure. Sometimes to a surprising degree. It happens to me, too.
I was diagnosed with gestational diabetes with my first baby, although it turned out to likely be an undiagnosed case of pre-existing type 2 diabetes, or maybe just pre-diabetes. My diagnostic levels when not pregnant have always been kind of borderline. Anyway, I’m very familiar with these issues.
A 186 on the 1-hour GTT is kind of high, although with that high of a number, you’re right, I’d be expecting to see higher numbers when you are checking after meals and so forth. That said, one thing that happens during pregnancy is that starting sometime in the 2nd trimester, you start to produce hormones that increase your insulin resistance, sometimes quite dramatically. So a problem that can be minor to borderline at week 28 can sometimes turn into a more major problem by week 34 or whatever. But again, the numbers you are seeing after meals are just not problematic at all. They are perfect, non-diabetic numbers.
The other good news here is that if your blood sugar is really in the normal range most or all of the time, you’re not doing any harm to your baby whatsoever. Zip. Zero. Nada. If you fail the 3-hour GTT (which seems unlikely, although anything is possible) then you just start monitoring your diet closely and it’s overall a good thing, not a really big deal in the grand scheme of things. I had to go on insulin during my pregnancies, but just for a point of reference here, prior to starting insulin administration, I was seeing post-meal numbers in the 200 to 250 range. Not cool.
OK, and then to address this tangential note of people having trouble with high fasting numbers; Athena, I’m surprised you’re not familiar with this, because I know you’re pretty knowledgeable on the topic of diabetes. For some people, going long periods without eating (such as overnight) can lead to your liver dumping glucose into your bloodstream, which is a normal thing that happens to everybody if they haven’t eaten for a while. Except that diabetics can’t process that glucose, so it just hangs out making your blood sugar run high, so you wake up in the morning and blam, you’ve got a super high fasting number. For some people, eating breakfast will shoot that number even higher, but for some people (like me!) morning activity and lord only knows what other internal process tend to bring the number down a bit, even figuring in the carb count from breakfast, so yeah, my fasting number does tend to be the highest one I see all day. It’s not a terribly uncommon phenomenon.
Anyway, good luck OP with the GTT! Keep us updated!
Yes, that screws it up. There is a specific “profile” for blood sugar concentration starting from time of intake, and the levels of glucose that are defined as “normal 1h after intake” are different from those “normal 45min after intake” or “30min after intake”. If it was a little less than 1h it didn’t matter, but make it 15 min to drink instead of 5, and 30min to the blood draw instead of 60min and the test is simply not valid because its experimental conditions haven’t been met.
Yeah. But good to know it’s not and, actually, looking it up, he might have confused his stats with masked hypertension. What I wonder about: Why does this not apply to hospital settings? I wound up in the ER in my first trimester with severe abdominal pain. So I’m in pain, first of all, and stressed out to the freaking max because on top of being in pain and worrying about that, the nurse couldn’t find heart tones. All this, and the highest BP reading (that I saw; I was on morphine after that) was 124/68. So, that seems a little confusing.
Thanks, MsWhatsit, good post.
Nava, I think that seems likely. They asked for my start time, not my end time, when I checked in but I did offer that I hadn’t finished in the allotted time. I drank the last bit all at once like seven or eight minutes after I finished the first part. So, from opening the bottle, it probably took 12-13 minutes so, since they went an hour from my start time (and even assuming that everybody’s clocks match up), it would have only been 45 minutes between intake and draw. Nobody seemed to bother about that too much though.
FBS this AM is 90. I’m starving. I don’t have to be there for another hour and a half. SIIIIIIIGH.
My wife’s number was one over the limit on the one-hour test, so they made her do the three-hour test. She was fine. We found out later that the limit varies from place to place, and a lot of places would have considered her one-hour result normal. Ah, well.
Oh, I’m definitely aware of that - trust me, I spent a good amount of time with my basal rates to beat down the morning glucose dump. Even so, what I personally wake up with even when it’s higher than I’d like doesn’t even compare to what happens when I eat.
From the very first, when I was diagnosed as Type 2 (yup, I spent a good six months as a Type 2 :-)) I was told that my morning numbers should be less than 110, and right away was put on meds/insulin with that as a goal. This was LONG before any doc wanted to deal with post-meal numbers. So yeah, I’ve never heard the whole thing of morning numbers being the highest of the day unless we’re talking uncontrolled diabetes. I guess for whatever reasons, my docs at the time didn’t like high fasting numbers.
That said, now that you mention it, I remember when I was at Joslin talking to Types 2s who talked about having high numbers in the morning no matter what they did, but as the day progressed they got lower.
I also have to think that Q. N. Jones statement about it being the highest TESTED number must come into play. I’ve heard too many Type 2s talk about their sugars going crazy after eating very few carbs - much fewer than I can handle, for example - and I’ve never heard them say that their post-meal numbers were lower than their fasting numbers. But that’s very obviously anecdotal evidence, and I’m hardly a researcher.
Because anxiety causes dramatic but brief bouts of hypertension. If you’re in the hospital, you’ve gotten past the big anxiety rush and your blood pressure goes back down.
Well, now that I’m highly medicated, my fasting numbers in the morning are still a problem, even though my post-meal numbers are under control. I’ve been told (and read) that fasting numbers are frequently the hardest to control, particularly because some of the medications for Type 2 diabetes aren’t as good for controlling them.
For example, I take Byetta, and it’s great for bringing down the post-meal sugars, but does basically nothing for fasting numbers. Some meds can work against you in controlling fasting sugars. Some people find that metformin pulls sugars out of your liver overnight and can even make your fasting numbers worse! It’s not a universal phenomenon, but not rare either. I have that problem. I actually have to eat a candy bar before bed if I want my morning fasting sugars to be below 140.
So it’s definitely a recognized phenomenon that fasting sugars can be the hardest to control. But it doesn’t happen to every diabetic.
I’m not a researcher, and I don’t know why this (fasting numbers being highest) is a phenomenon for some Type 2 diabetics. And from what I’ve read, the researchers don’t know why some diabetics have different patterns with their blood sugar numbers than others do. They just know that there are a few common variations, this being one of them. Another variation I’ve heard of is the one that you mention–crazy high post-meal numbers in response to carbs.
The theory (I think) is that after eating, the pancreas is better at producing insulin, and/or insulin resistance is lower for some reason. Whereas the beta cells of the pancreas may not be stimulated as well to produce insulin to deal with fasting sugars. Again, I’m not 100% sure about this, and I don’t think doctors are either.
If only diabetes were exactly the same for everyone, it would be so much easier to treat!
P.S.–Athena, I want to start a thread on insulin pumps, because I’m considering getting one, and if you would pop in and talk about yours, I would appreciate it.
This is partly because researchers are finding that the old standards for blood sugar numbers are just not low enough to achieve the best patient outcomes in the long term. For example, currently the ADA says that 2 hour post-meal sugars should be 140 or lower. But research is finding that patients who have 2 hour post-meal sugars at 125 or lower have better long-term outcomes.
But it’s taking awhile for physicians and the ADA to revise their standards in response to the new research. Some doctors are really aware of the new studies, and others just look at ADA guidelines. This is why I insist on seeing an endocrinologist instead of being managed by my GP–they are generally better informed on the latest research.
