Gestational Diabetes

(Note: I'm posting this story because someone requested it in the comments of my last post. I apologize if it gets long.)

I failed my gestational diabetes screen by two points.

For those of you not familiar with the screen, it’s a test during pregnancy where you drink this horrible, sugar drink and then come in an hour later to get your blood glucose tested. Considering I was seven months pregnant, not showing, and weighed only 116 pounds, I didn’t think there was any chance of my failing the test. I was so overconfident that I had some crackers right before I had the drink, to make it go down easier. (This was allowed, but probably stupid and likely pushed me over the cutoff.)

The cutoff my practice used was 135 and I had a blood sugar of 137. In some practices, a cutoff of 140 is used. And when I looked this up in research studies, in a woman of my age, race, and BMI, it is appropriate to use a cutoff of 140. Or actually, some say the screen isn’t even necessary in the first place in someone like me.

Now if you fail the screen, the next step is a three hour glucose tolerance test. You come in for a fingerstick and if that’s normal, they give you a huge amount of sugar, do a venous draw for blood glucose, then repeat that every hour for three hours. I did not want to do this test.

You are probably thinking to yourself, “Why is she being such a baby? It’s just four blood draws.” That’s exactly what I’d be thinking if someone told me that story, believe me. I’ve had like a billion blood draws in my life and I’ve always thought of it as no big deal… needles don’t bother me.

Except for some unknown reason, my ob/gyn practice gave the most painful blood draws known to man. Now I can deal with short-term pain, no problem, but on two separate occasions of having my blood drawn at this practice, my arm was basically incapacitated. The pain in my biceps was so bad that I was actually awakened during the night due to pain. I could barely move my arm to drive and I had bruises going all the way up to my deltoids. And the pain persisted for over a week. Both times! Their phlebotomist was obviously not the greatest.

So I wasn’t thrilled by the idea of having four of these blood draws in a row at that practice. (The only other place they’d do them was at a hospital a million miles from my office.) My job involves a lot of writing and I was terrified by the idea of my arm being taken out of commission. I was literally in tears at the thought of being unable to function or sleep due to these blood draws--blood draws that I felt were basically unwarranted given the fact that it was so unlikely that I had GD. If I felt the baby were in danger, I’d have done anything, but it seemed more like this test was being done so they could cover their ass.

Anyway, I did try to keep a somewhat open mind. I felt if they had a convincing argument, I’d do the test. I went to my appointment for the 3 hour test at 8:30AM. I did the fasting fingerstick, which was 90. I asked if it would be possible to briefly speak to any OB at the practice about the test before doing it. Immediately the phlebotomy tech looked really put out, and acted like this was a ridiculous request that would take hours to fulfill.

About five minutes later, they miraculously located an OB that was between patients and she came over to talk to me. Except before I even opened my mouth, the doctor’s arms were crossed and she looked really angry at me for taking up 2 minutes of her precious time.

I explained that I was a doctor, that I researched the test myself and that I knew I was extremely low risk. I explained that research showed that with someone my age, race, and weight, testing wasn't indicated at all, or at the very least, a cut-off of 140 was warranted.

Doctor: [snippily] "OUR cut-off is 135."

I then tried to explain to her about how painful the blood draw had been at that office. They clearly went through the vein both times due to the pattern of bruising. I had been awake all night in pain. And then continued to have pain for a week after both times.

Doctor: [snippily] "That's impossible."

So I guess I was lying?

At this point, all I wanted to do was run home crying. Finally, I said I would do the test in fingersticks on my left hand.

Doctor: [snippily] "Fine, so I'm documenting your refusal to do venous draws!"

The phlebotomist was kind of cold to me after that too, possibly since she was the one who gave me the two painful draws. She started ranting about how she didn't know how to document my results. I felt like I had to apologize with every single hourly fingerstick.

I don’t know exactly what the doctor could have done differently. I would have preferred if she gave me an actual explanation of why it was so important for me to have the test, aside from just reiterating the cutoff. Or if she did agree with me the test was unnecessary, she could have nicely explained to me that she had to document a refusal, but admitted that I was very unlikely to get a positive result.

Anyway, three of the four fingersticks weren't even close to the cut-off. The fourth was below the cut-off, but only slightly. I was terrified the entire night that the mean doctor would call me and try to bully me into repeating the test and threaten to kick me out of the practice.

What did end up happening was that I had to call the next day (originally, they promised they’d call me, but apparently they wrote me off) and they got a different OB to speak to me. It wasn't my usual doctor, but it was one I had seen before and liked. He told me that the test was definitively negative. He didn't know what to make of the one borderline number, but said their glucometer tends to run high, and one abnormal value wasn't enough to diagnose GD anyway. He said to me, “I kind of remember from seeing you and from looking at your weight here… you’re pretty tiny, aren’t you? I really don’t think you could have diabetes. That test was probably overkill. Just, you know, eat healthy.”

(I then proceeded to not gain any weight for the next month because I was so nervous about eating carbs, and meat made me ill.)

Even though I guess it worked out in the end, the whole thing left me with a negative feeling about the practice. I felt uncomfortable coming to my visits and I imagined everyone was angry at me. Moreover, guess which OB in the practice was on call the night I went into labor?

So now that it’s all over and I’ve given birth to an average sized baby, you can go ahead and feel free to judge me and tell me that I sacrificed my baby’s health for the sake of avoiding discomfort.