My baby is a little large on ultrasound for the gestational age. My one-hour glucola test came back elevated. Could these factors be an indication of diabetes?
Certainly LGA (large for gestational age) babies are a concern and make us think of gestational diabetes. The one-hour glucola test (the O'Sullivan test) is the screen for it. Because it's just a screen, it's only considered valid (and reassuring) if it comes back normal. If it's elevated, we chuck out the results and move up to a better diagnostic test -- the full-blown Glucose Tolerance Test (GTT), where you have a fasting sugar drawn, then you consume a sugar load (possibly more glucola), then have blood sugars drawn at one, two and three-hour intervals.
There are blood sugar levels appropriate for each blood sample in this test, and if you are too high in two of them, you will be considered a gestational diabetic (up to 10 percent of pregnant women can be).
Even if this happens, don't panic. Gestational diabetes is usually controlled with a diabetic diet -- a diet offering lots of food varieties, but which involves a shift in the types of things you eat. Rarely do we need to prescribe insulin.
Gestational diabetes is not a real diabetes, because it's not that you don't make enough insulin, it's just that the insulin you make is not as good. We call this "insulin resistance." But don't underestimate gestational diabetes -- it can cause bad effects on the baby and you just like the real thing! For example, you may find yourself bearing a humongous baby that would be at a higher risk for complications at delivery, such as shoulder dystocia, and a higher likelihood of you needing a C-section.
If you were to have gestational diabetes and faithfully follow your diet, you will likely avoid these complications. Your doctor will watch for these concerns. But we're getting ahead of ourselves. You only flunked the one-hour test. You may very well pass the GTT with flying colors, in which case you're off the hook.
By the way, Dr. O'Sullivan, the woman who instituted the glucola test (a test that has probably saved thousands of lives by making often-silent gestational diabetes another aspect of pregnancy to be treated), was one of my examiners on my board exams. And she didn't ask me one single question about diabetes!