What Is An OGTT or a 3 Hour Glucose Tolerance Test?

What Is An OGTT or a 3 Hour Glucose Tolerance Test?

English: Photograph of abdomen of a pregnant woman

English: Photograph of abdomen of a pregnant woman (Photo credit: Wikipedia)

3 Hour Glucose Tolerance Test Is the Gold Standard

OGTT is an oral glucose tolerance test.  For most women, around week 24-28, they do a 1 hour glucose test in the doctor’s office.  Now, if you had gestational diabetes with an earlier pregnancy or your risk factors are high, you might get tested earlier in your pregnancy, and your doctor might go straight to the 3 hour glucose tolerance test.

The doctor is doing a quick check to see if you need to take the 3 hour glucose tolerance test.  So, if you fail the 1 hour test, they send you for an OGTT.  OGTT is the standard to measure and diagnose you with gestational diabetes.  This test also tells your doctor how “bad” your gestational diabetes is.  So, he/she will know if you are going way high or just a little over.  That information may or may not affect their decision about medication and diet.

So, you arrive at the lab for your 3 hour glucose tolerance test.  You will sit in the lab waiting area for a little over 3 hours so bring something to read or write to keep you busy.  It’s a lonely place and the only thing on the TV’s is the news or Jerry Springer.  Not much fun.  Trust me, you will need something in addition to the 3 year old magazines they have in the lobby.

You come in fasting, not having eaten anything after midnight the night before.  You may or may not be able to drink water.  If you can, drink water so that your blood is easier to draw.  The last thing you want is to be dehydrated and not be able to get blood or take forever.  They take your blood sugar level first as a fasting level for the baseline of the 3 hour glucose tolerance test, then you drink a “glucola” which is a concentrated sugary drink.  (I would say it tastes like coke, but it doesn’t.) It’s pretty sugary, and there may or may not be flavor options.  Then in 1 hour increments they take a sample of your blood to measure.  Otherwise, you sit in the waiting area between blood draws for the 3 hour glucose tolerance test.

Then What Happens?

Once it’s over, you leave and your doctor gets the results fairly quickly.  Then you find out if your body has done a good job of removing the sugar from your blood stream or not.  Some women view it initially as a judgement and feel that they have done something wrong.  You should know that it’s just the hormones and your body is not handling the amount of hormones well, but that does not make you a good or a bad person.

Either way, you will be fine and so will your baby.  Gestational diabetes is very treatable with diet, exercise and sometimes medication.  Read about gestational diabetes meal planning in my recently published book on amazon, and find out how to plan your day to make your pregnancy healthier and happier.

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I Have Gestational Diabetes, When Will The Doctor Put Me On Insulin?

You May Be Wondering If You Will Need Insulin

One question that routinely pops up if an expectant mother has gestational diabetes, is at which stage of the pregnancy should insulin become a part of the medication prescribed. Most doctors prefer to treat patients the ‘natural’ way that is by altering the patient’s diet and encouraging a stricter exercise regime which could be beneficial in keeping excess weight off in addition to stabilizing sugar levels in the blood. If you face a similar problem of high blood sugar levels, it is quite possible that your doctor will conduct routine blood tests every few weeks or so, to test the effectiveness of the diet and exercise combination. In most cases, sugar levels can be brought under control and extra insulin shots are not necessary, but if your doctor advises it, just remember that it is these shots which can help to prevent further pregnancy complications.  This usually happens after 1-2 months of trying diet and exercise, but it depends on your doctor’s practice.

What Is Insulin Used For In Gestational Diabetes?

Insulin is an important hormone that is secreted by the pancreas and which enables the conversion of glucose absorbed from food into energy. Sometimes, a pregnant mother may not even be aware that she has untreated gestational diabetes and in such cases, the pancreas works even harder to meet the body’s insulin requirement. However in such circumstances, there is also a chance that existing glucose levels in the mother’s blood can reach the baby through the placenta, which in turn forces the baby’s pancreas to product extra insulin for faster energy conversion. Extra glucose is then stored as fat and in many cases, such babies are later born with health problems including trouble in breathing properly.

What are insulin shots for gestational diabetes?

After conducting a thorough analysis of your blood test and sugar levels, your doctor will suggest the right type of insulin and the dosage to take. Insulin shots can either be rapid acting insulin or long acting insulin and usually U-100 is prescribed unless a patient requires a higher concentrated dose. You’ll find that insulin is packed in small glass bottles sealed with a rubber lid or in pen like cartridges which are stored in pharmacies at cooler temperatures. Insulin can be administered as an injection in the arm or thigh, given through a pump or by a jet indicator which sprays the insulin directly on the skin. Oral insulin medication is usually not advised for pregnant women.

Insulin pen needle

Insulin pen needle (Photo credit: Aki Hänninen)

Self-administration of insulin may take plenty of practice but it is important to follow your doctor’s instructions properly. And it doesn’t hurt to let your doctor know if you have a fear of needles either! Hundreds of women all over the world take insulin shots to prevent the possibility of complications in the baby and also to reduce weight gain in the baby and the mother from continually high blood sugars. But remember- even if you are advised to take insulin shots, it’s still important to take care of yourself by following a healthy diet and getting your daily dose of exercise. Although you may find self-injection uncomfortable and even painful, it will all be worth it in the end when you hold your healthy newborn in your arms!

Let me know if you have been told you will need insulin shots, and how you feel about it!  You will get some training from the nurse and doctors about the best way to administer a shot but you will have to get over the poking yourself issue.  You may already be over that with the 4 times daily blood sugar checks, though, and your insulin needle is very small – many women state it doesn’t hurt much at all.

Speaking of being on a gestational diabetic diet to control your blood sugars in conjunction with exercise and other medications – click here to get our book with meal plans and other great information about gestational diabetes.  The book is on amazon, and it’s a great resource with meal patterns and recipes for you.

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Gestational Diabetes Meal Plan: What Does That Mean?

Gestational Diabetes Meal Plan: What Does That Mean?

How do I manage gestational diabetes?

Women who have been diagnosed with gestational diabetes may be need guidelines or help about what this means and how to eat to keep their blood sugar stable. It is important to get the right types of carbohydrates and plenty of protein as well as vitamins and minerals. This involves careful planning and your doctor will help you choose the plan that is right for you and your lifestyle.

Why is your doctor checking your blood sugar for gestational diabetes?

Gestational diabetes is a condition that may develop during pregnancy characterized by high blood sugar levels. That is why your doctor monitors your blood sugar levels throughout your pregnancy. The woman who is diagnosed with it will check her blood sugar often during the day to help determine how her gestational diabetes diet plan is working. This may be as often as four or five times daily. She must choose the right foods prepared the right way for the baby and herself.

How will you know what to eat for gestational diabetes?

Your doctor may give you some simple instructions on a gestational diabetic diet or he may send you to a nutritionist. Either way you will find yourself shopping carefully, and possibly weighing and measuring your food. Your doctor may also tell you about products on the market that are complete gestational diabetes diet plans or you may ask about them. All of these methods have their advantages, but some are less complicated than others. The complete diet plans take a lot of the work away, and assure the right balance for every meal and snack.

Who becomes diabetic during pregnancy?

Most pregnancies have no risk factors of gestational diabetes, but weight issues and sugar processing issues are risk factors that can be controlled by diet. Following a gestational diabetes diet plan helps address them, with little effort on your part. With the right plan you will be confident that you are eating healthfully but not so much as to cause excessive weight. When thinking about the cost in time, and possible birth defects and birth complications it is well worth the expectant mother’s time to do her best for her unborn child. A gestational diabetes meal plan may be just the answer for your pregnancy needs.

What are the advantages of a gestational diabetes meal plan?

A gestational diabetes meal plan eliminates the work of counting and measuring and looking up values of foods. It gives you time for other healthy things, like physical activity, working and caring for your family. A gestational diabetes meal plan takes the guesswork out of your daily routine.  You can find our plans and more information about gestational diabetes meal planning on our page – Click Here.

Gestational Diabetes – How Often Should I Check My Blood Sugars?

Gestational Diabetes – How Often Should I Check My Blood Sugars?

fingerstick diabetesYou know you have to check them, right?  I read a Facebook post yesterday where a woman wrote that she was afraid to check them.

Let’s think about that, shall we?  I mean, I am afraid of a lot of things.  Data is not one of them.  And, that is what you are gathering.

It might feel like a judgement against you, especially if you have not been following a healthy gestational diabetes meal plan.  If you have been snacking too much, or eating too big of portions.  But the damage is already done and you are already making it worse by ignoring it.  Sticking your head in the sand doesn’t make it any better.  Face up to it.

Ok, now that I have that off my chest, I want to talk about how often to check your blood sugars.

First of all, make sure you know what your doctor or dietitian wants you to do.  Best practice in the beginning when you are still learning – and if you have to take insulin – is 4 times a day.

When you wake up

One hour after you start eating breakfast

One hour after you start eating lunch

One hour after you start eating supper

*Any time you feel “funny” or different.

You need to check your blood sugar at least once a day after you are past the early stages and are well balanced.  If your doctor wants more – do it.  If you end up checking it once per day, vary the time that you check it so you get a good idea of where it’s at throughout the day.  Our bodies handle sugar and insulin different depending on a lot of things.  Best that you understand your body, because it’s different than other pregnant and gestational diabetic women.

In the morning, you may have what is called a “dawn phenomenon“.

Basically,it’s that your blood sugar is higher than normal because your body (in the middle of the night) gets a little low on blood sugar so it reacts by making more blood sugar.  Add that to the fact that you may be low on insulin, and it’s going to be a little elevated.  Many women counter this by eating a little larger evening snack and making sure it has a combination of protein and carbohydrate.  That way it takes longer to digest, and gives your body carbohydrate throughout the night.  It’s not a good idea to counter the higher blood sugars by skipping a bedtime snack.

Most women are taught to measure their blood sugars about one hour after they start eating, also known as “post prandial”.  This is the time when your blood sugar is likely to have peaked and should be below 140 mg/dl.  If it’s higher than that, look at the meal and see where the carbohydrate is lurking.  Earlier this week I wrote about a gestational diabetes meal plan for a week, and I know it’s hard to understand that a lot of foods have carbohydrate in them.

Ask your doctor how you should treat your blood sugar numbers – the answer may be that it depends…  Either way, you have to check them.  Not checking them is putting your baby at higher risk, and you as well.  It’s just information that you can use to make a decision about how to treat your blood sugar levels.  That’s it, that’s all, and you need to track them throughout the day.

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Gestational Diabetes Meal: Shape Up Your Plate

When you are planning out your gestational diabetes meal, creating a healthy yet well balanced meal is one of the most important parts of your process.

I am blogging about a gestational diabetes meal as part of National Nutrition Month, you can learn more at the Academy Of Nutrition and Dietetics website – http://www.eatright.org/nnm/ 

Gestational diabetes is a short term issue but can lead to long term problems because many women who have gestational diabetes will go on to develop type 2 diabetes.  Keeping your meals in check throughout your pregnancy will lower your stress as well as improve your long term health if you keep eating the healthy way you learn during pregnancy.

One of the priorities for you, your unborn child and your doctor is to manage your blood sugars through what you eat at a gestational diabetes meal, medication and exercise.  Many women find that part of that management means some foods are limited based on their bodies and hormones.  Every woman’s body is unique and may react differently to the same foods.  But the foods that we are talking about when it comes to controlling your blood sugars are mainly carbohydrates.

What are carbohydrates and how do they affect your gestational diabetes meal?

Carbohydrates are the component of food that breaks down into glucose in your digestive system (stomach) and is absorbed into your blood stream as glucose.  They are part of a lot of foods, and can be composed of simple to complex molecules.  It is not that you should avoid carbohydrate – you need some of it!  But certain types of carbohydrate are going to cause your blood sugar to increase quickly while some are absorbed more slowly and lead to a lower peak in your glucose level.

Take for example, simple sugar.  The white stuff.  Or honey, which is concentrated sugar.  This will be absorbed quickly by your body and cause a spike in your blood sugar.  Because your body, as a gestational diabetic, does not handle the increase as well as someone who does not have diabetes, you will find that your sugar may stay high.  I know that many women avoid sweeteners during pregnancy, and that is your choice.  But consider that you really should avoid simple sugar unless it is part of a combined gestational diabetes meal that has protein and fat.

Better carbohydrate choices are going to be multi-grain foods and items that have a lot of fiber and are less processed.  Fruits instead of fruit juice.  The fiber slows the absorption of the food and allows your body to respond a little slower, which is good.  Eating whole grain pasta or wild rice instead of plain white rice is a good choice.  Whole grain wheat breads (make sure it has 2-3 gm of fiber per slice) make a much better choice than a slice of white bread.  Your body can usually break down white bread almost as quickly as simple sugar, and should be exchanged for whole grains in a gestational diabetes meal.

Portion sizes of the carbohydrate foods are very important, and most of us can underestimate our portion sizes when creating a gestational diabetes meal plate.  I recommend that you use a scale and weigh your food until you have a better awareness of how much is supposed to be a portion.  Usually – it’s about 1/3 cup on rice, and that is cooked rice – but it’s not very much!  Weigh out your cereal – a whole grain or bran type cereal – and see how big the bowl looks compared to the serving!  Add milk to it and you are adding more carbohydrate so watch the portion on that as well.

Shaping Up Your Gestational Diabetes Meal As a Complete Plan

So, controlling the amount of carbohydrate is tantamount to good blood sugar control for all of the gestational diabetes meal plans that you use.  I want to state again that complete avoidance of carbohydrate is not the answer.  You can eat a low carbohydrate diet, and by that I mean even as low as 30 gm of carbohydrate at meals, but you still have to eat some.  You and your baby need it, and not eating it at a gestational diabetes meal would be detrimental.

But you can help your body to process that carbohydrate more slowly by eating combined meals.  A “shaped up plate” would be one that has protein and fat foods on it as well.  So, you may find that you can eat 1/2 a sandwich with a good helping of meat and some mayonnaise for lunch and your blood sugar is under 130 at your 1 hour check.  Add some vegetables to that meal, maybe raw vegetables with a light ranch dip, and you have a good meal to start with.  You would probably not want to add chips to the gestational diabetes meal, but you could add another ounce of meat to your sandwich or create a nice side salad and have a full meal.  Some women even find that they can tolerate peanut butter and crackers for their evening snack and have a good blood sugar in the morning.

I think it’s important to realize that there are foods that will raise your blood sugars, and you need to eat some amounts of them at most of your gestational diabetes meal.  But combining them with protein and fat foods make them absorb slower and allow your body the chance to respond at it’s adjusted pace of insulin production.  For a gestational diabetic meal, you can have a healthy plate with a good portion of vegetables (green, orange or yellow) and some protein that will make a well rounded meal and keep you under control.

Other things affect your blood sugars, and you should be aware of them so you can note them in your blood sugar logs.  If you have a lot of stress, hormones that are released in your body can increase your blood sugar levels.  While you will never get your stress to zero, finding a way to reduce the amount of stress that you have is a priority.  The time of day can also play a big part in your blood sugars, as fasting blood sugars can be hard to control (but manageable with the adjustments of night time snacks) and hormones from your placenta may be released and cause an increase as well.  This is a big part of why every woman is going to be a little different when it comes to controlling your blood sugars.

Finally, exercise will help you keep your blood sugars down!  Something as simple as a walk right after you eat for 20 minutes will bring down your blood sugar levels because your body uses the sugar for energy.  It’s like a shot of insulin without the shot!

Consider your weight gain and the baby’s growth as two other important factors to determine if you are meeting your needs with what you eat at a gestational diabetes meal.  If you are in need of more information about how to follow a gestational diabetes diet meal plan, you can check out our meal plans – go there now.

I Have Gestational Diabetes – Where Do I Start?

“I have gestational diabetes” can be a tremendously terrifying thought.  You want to cry, scream, yell and yet you don’t know what else to do.

Some common things you can do to help you get started on the right track with managing your gestational diabetes are great to start with, especially when you don’t know much to say past the initial “I have gestational diabetes“.

When you first learn that you have gestational diabetes, it’s very important to understand that it can be controlled well and you can deliver a healthy baby.  I have gestational diabetes does not have to be something said with trembling in your voice.  Let’s talk about the steps involved in managing and controlling gestational diabetes.

I have gestational diabetes” step one for control is to look at the types of sugar that you are eating.  You may drink a glass of juice or drink regular soda or even have a candy bar sometimes because of cravings.  Now that you have gestational diabetes that has to stop being a random thing, and it needs to be part of the total calories that you’re allowed to eat for the day as well as the amount of carbohydrate that you’re allowed to eat for the day.  Simple sugars easily go into your bloodstream and increase your blood sugar, and depending on how high the blood sugar goes it can transfer extra sugar to your baby through your placenta.  The amount of simple sugar in a food can be found by reading the label, under the area labeled carbohydrate.  There is a section called sugars that indicates the grams of simple sugars that are in the food.  Until you have the control of your gestational diabetes, you want to eat a minimal amount of simple sugars.

“I have gestational diabetes” step 2 for control is that you can make your diet better in many ways.  You should replace the sugary foods with healthier foods that are whole grain instead – higher fiber helps you feel full longer without increasing your blood sugars.  Whole-grain foods provide the amount of carbohydrate that you need without giving you extra simple sugars.  High-fiber foods break down more slowly in your digestive system, allowing your body to absorb the carbohydrate in them at a slower pace and therefore deal with the increase in blood sugar over time.  Initially, you want to avoid more of the white foods that, although they are complex carbohydrates, tend to break down quickly and increase your blood sugar as much as a candy bar.  Start eating whole fruits and vegetables as well as whole-wheat bread instead of juices and plain white bread.

“I have gestational diabetes” step 3 for control starts with distributing your calories throughout the day by eating 3 small meals and 3 snacks if you can.  This helps your body to use insulin properly and manage your hunger and your blood sugar.  Most women need to balance their calories out to a 40-50% carbohydrate diet, 30% fat and the rest as protein.  At breakfast, you may want to eat a protein and a complex carbohydrate.  This might be something like a piece of ham and whole-wheat toast.  For snacks, you should try to combine a carbohydrate and protein food as well. Lunch and dinner meals may be a little larger and need to have a combination of fat, protein and carbohydrate to make you feel full and get your needed calories.

You may not realize it, but while you’re pregnant, you probably need to consume around 2000 calories a day.  Using these steps to control your gestational diabetes will help you start off in the right direction to controlling your blood sugars and having a healthy pregnancy.

“I have gestational diabetes” may be the first thought you have, but you can get more help with a gestational diabetes meal plan that includes all the needed steps and ways to manage your diet to have a safe and healthy pregnancy.  Click here to find out more about our gestational diabetes meal plans.

I Had Gestational Diabetes, Just Like You

I had gestational diabetes with each of my two pregnancies.  I was older when I became pregnant, my first child at the age of 32.  Fairly well established at my job, and not necessarily sure when I wanted to have a child.  Therefore, my husband and I were somewhat surprised to have a baby coming, but very happy about it.

I have a family history of diabetes, with my mother and grandmothers having Type 2 diabetes.  So, when I got tested at 24 weeks for gestational diabetes in my first pregnancy, I was aware that there was a strong chance I would have gestational diabetes.

Even though I knew it, at first I was kind of mad that I had gestational diabetes, because I felt that I was working so hard to manage my eating and weight gain because I was already a little overweight.  I even thought to myself that I was somewhat mad at my genes that made it more likely.  I was sure that if I just ate right, gestational diabetes would not happen to me, that I could somehow prevent it.

Gestational Diabetes Made Me Feel Like I Had No Control Sometimes

Then I felt guilty for being mad, and for maybe not ALWAYS eating perfectly.  This is something that I think a lot of us feel about everything we do during pregnancy that could affect the baby – as if I should always be perfect and somehow “one” incident of bad behavior is going to be punished.  After all, I have a huge responsibility to take care of the life inside me, and I am somehow failing miserably by having gestational diabetes.  It doesn’t matter that I knew better than to think it was punishment or something I could change.

I was hungry all the time with my first child, and although I was fortunate to not have morning sickness, I did get a stomach ache if I didn’t eat every 3 hours.  I felt like I would throw up, and all I had to do was have a small snack and it would go away.  So, I never skipped meals or snacks!  I sometimes felt like I was in denial because I just didn’t feel like anything changed.  I had to test my blood sugar 4 or 5 times a day and write it down to track, and I was doing really well with my numbers so I usually felt ok even though I had gestational diabetes.  I was scared for a while that I might do something that would harm the baby or cause him to have a problem.  I thought about everything I had done since the pregnancy started, and tried to figure out what I could have done differently.

But I finally accepted it, and moved on to management.  I was lucky enough to take medication and not have to do insulin shots, although sometimes I wish I had because the medication caused me to have kidney problems.  I did walk more and thought about how much I was eating all the time.  My husband was as worried as I was about the control of my gestational diabetes and how it would affect the baby.  Sometimes we forget that we are not the only ones with concerns about our health and the health of our baby.

I managed to gain only a little weight and did deliver a little early due to the kidney problems, but the baby was fine.  He had jaundice and had to stay in the NICU for a couple of weeks but left with no complications from the gestational diabetes.

My 2nd pregnancy was more complicated and the symptoms came on much sooner.  I got tested a lot earlier and started on the gestational diabetes management process much earlier in the pregnancy.  I did feel a lot of guilt about having gestational diabetes again with this child, but I think I accepted it much more quickly than before.  I did not have the hunger that I did with the first child, and actually lost weight but the baby continued to grow at a healthy rate and develop normally.  I managed my blood sugars more carefully, but did end up delivering much earlier and my premature baby was hospitalized for 9 ½ weeks in the NICU (neonatal intensive care unit).  My problems that I had with the first pregnancy came back in a fierce way with the 2nd pregnancy from the gestational diabetes.

Learning More About How To Manage Gestational Diabetes

Even though I am a dietitian, I had never actually been through the process of taking a blood sugar.  I had no idea where to start.  I had to go and see a diabetes nurse just to learn the process of checking my blood sugar and what to do.  My fingers were poked so much that they hurt, and sometimes it was hard to get blood from my fingers at the end of the pregnancy because I had a lot of swelling.

The thing I did have control over was the food, and how much I ate, and how it affected my blood sugar level which in turn affected the baby.  That is what I always remembered when I would be having a hard time, and trying to figure out what to eat and what to buy at the grocery store to meet my gestational diabetes diet.  The mom or wife or other jobs that I had never stopped, they continued to have the same expectations of me.  I still was the one to go to the grocery store, I still had a job, I still had to manage multiple things (including going to get my MBA at night) to fulfill my obligations.  So planning ahead became a huge part of every week so I would not have to run to the grocery store in the middle of the week or eat what I should not eat at work for my gestational diabetes!

And now, I have young children who are healthy and well despite being born a little (or a lot) early.  While the complications can still happen regardless of the care you take, I know it’s important to manage the eating and blood sugars to have the best possible outcomes.  We can’t control everything, but we can manage things better in a pregnancy complicated with gestational diabetes.

I developed a program for moms in a situation like myself, who need guidance and help getting control of our gestational diabetes.  Understanding that not all of the things that I knew as a dietitian will be something that other women know.  I made a daily pattern, daily options for breakfast and lunch (because we usually eat very similar things for breakfast and lunch so you don’t need a complicated schedule or recipes for that).  And it has recipes for dinner meals that you can feed to the entire family without a problem – no one has to know they are managed for your gestational diabetes.  Click and go to our information page to learn more about our gestational diabetes meal plans and patterns.