Written by: Robert
My pregnant paleo-wife ran into the bathroom crying. The phone call from the doctor’s office informed her she failed the glucose-tolerance test, looks like gestational diabetes. Second test will confirm this. If she can’t control her blood sugar through dietary changes or insulin injections, baby will be so big she will need a C-Section. Scarring. Subsequent pregnancies all requiring C-Sections. More scarring. On the bright side, they said there’s a chance her gestational diabetes might not turn into type-II diabetes after she gives birth. . .
I’m thinking of a 6-letter word that starts with ‘S’ and ends with ‘D’. I grab a dictionary. Second definition: ‘Tending to make poor decisions or careless mistakes’. I opt for uninformed (‘Not having, showing, or making use of information’) instead, and dial the doctor’s office. I explain what my wife eats, how there must be a mistake. “If she eats that well and still failed, then she probably has Type I diabetes that was undiagnosed before her pregnancy. We are learning how Type I can develop later in life now.” You have got to be S—–uninformed.
I guess we should have seen this coming. After all, she only gets two hours of brisk walking in daily, could only do 100 full sit-ups and 30 pushups before her belly got too big. At a height of 5 feet, 126 pounds (26 weeks pregnant), the thinspo body-mass index rates her as grossly obese. And did I mention she was living on an organic farm when we met, eating vegetables straight from the field? That couldn’t have been good for her. All that sunshine and fresh air, yikes. Do we really know the side-effects of an over-dose of health? Maybe the fact she doesn’t have a cavity in her mouth should have tipped me off something just isn’t right here. Is that even normal? We can’t rule out the possibility that running marathons as a teenager couldn’t have helped. Why didn’t her parents encourage more resting in front of the television. We can only wonder. We will ask her parent’s when we see them for her twenty-second birthday.
I need answers. Searching the net I find other paleo-mom’s failed the glucose-tolerance test. And failed the second, longer, glucose-tolerance test. At least now my wife doesn’t think her body is defective or that she wasn’t a good mom. Maybe we can avoid that C-Section, just maybe. Then I hit gold: Robb Wolf’s article. Answers. I’m singing “H-B-A-1-C, that’s-the-test-for-me” as I pick up the phone and dial the doctor. They are not pleased. Definition of White Coat: “No questions. Just obey.” I’m getting a lecture: “Why isn’t she eating bread? Is this by choice? Wheat is natural.” My mouth hops ahead of my brain: “So if she’s walking through a wheat field she can pick it and eat it?” They are not pleased. I take a big breath and adopt a more servile tone: “Um, please would it be okay if we tested her glucose at home for several weeks? She just isn’t used to all that sugar at once. We are just so concerned, we want to make sure we see how bad it is. We really appreciate your concern. We know this is serious.” They agree to a fasting glucose test.
Test time. Drew two-vials. What was that about, I wonder. Takes all day to get the results. Waiting and praying. Then, the call. That second vial was the HbA1c test. I’m watching her face as she gets the news. . .
My pregnant-paleo wife is bouncing up and down laughing. She passed both tests with flying colors. God Bless you Robb Wolf.
My wife also failed both of the glucose tests and was told she had gestational diabetes. My wife and I have been following a paleo-template for over year prior to her becoming pregnant. When my wife got the news, she was also crushed. We had the same questions, “how can someone who eats like us, and does as much walking as my wife, have gestational diabetes?”
The doctor sent my wife to some diabetes “class” and had her meet with a “diabetes coach”. They both explained how insulin’s role and how it worked. When they started asking my wife what she ate and how much she exercised, the “coach” was starting to become agitated. The “coach” must have thought we were being dishonest. My wife was walking our dog 2-3 miles a day throughout her pregnancy. I almost lost it when the “coach” said to avoid fat because it will clog the insulin receptors. Before I could open my mouth, my wife and already kicked me and gave me THE LOOK. I left his meeting upset. It amazed me how much bad information was given to us in such a short period of time.
“clog the insulin receptors” … You are a better man than I. I would have lost it. Hell, I’m kinda mad now and I don’t even know you.
Just goes to show… Always good to question the establishment and take charge of your own health.
outrageous — what a great thing YOU TWO aren’t S…D! gawd only knows how many babies and mothers are damaged by the bad advice. 🙁
So, so, so dismaying! You have my sympathy SO much! I can imagine with horror you trying to find another doc after this one fired you, if your wife had not passed the second time! Congrats on squeaking through. I still suggest y’all start looking NOW for a back-up doc to — at the very least! — support you with your OB-GYN, if, god (and insurance companies) forbid, they test your wife again later (“cause she was nearly diabetic early on” {eye roll}) — you will need to have already lined up your medical troops to support and protect you later! Or, at the very-very least — gather up the medical documentation that supports your position, so you can …. not-argue …. with the fool you’re dealing with now, but perhaps convince him to go along with your wise and healthy decisions!\
You won a battle — the WAR is not over!
(And congrats soon-to-be mom and dad!)
Eating low-carb tends to induce Insulin resistance. This isn’t the bad kind of Insulin resistance though. Your body has sensed that there is less Glucose coming into the system & makes your peripheral tissues (ie, fat & muscle) resistant to absorbing it so that it is spared for your brain. I wonder if increasing daily carb intake for a period of time before the test would change the results.
Good googly moogly!!! When your only tool is a hammer the whole world (including your wife) is a nail. This makes me embarrassed for the entire medical profession.
I bet someone that drinks a 6 pack of beer per day would pass the alcohol tolerance test, but someone who doesn’t drink, or drinks a beer once every 2 weeks might have trouble clearing alcohol under the conditions of the alcohol tolerance test.
Medical school is like drinking from a fire hose. An entire semester of biochemistry gets memorized for the test, but alas, never learned.
Great job looking out for yourself!
Good!
I’m a mom of three kids, my first one was a c section, rest were natural births. I was always borderline pass fail on the diabetes test with all three. I am 4’11 (beginnng weight of 110-115) and fully active during all pregnancies, back then I was sad, but prone to eating more raw veggies and meat than breads and pasta anyways (just a taste thing for me). I can look back and say I was easily gestational diabetic but yet ignored because of of the borderline numbers they knew (those numbers have changed). My babies were ; first one born 2 1/2 weeks past her due date at 9 lbs and 23 1/2 inches. She didn’t even come close to the birth canal, partly was still policy to lie down (old school hospital) and partly because being so big and late. I look back and as a doula ow I might have still ended up the same. Second baby was 3 weeks ahead of schedule and 8 lbs 22 1/2 inches. I had her natural, back then they were ok, today policy less so, but many can push for that and succeed. (friend just did a month ago but they do ask for more stress tests etc…plus she was 45 having her fourth, her second was a c section. ) My third baby was 2 weeks ahead of the due date at 9lbs and 22 1/4 inches. you can see a trend of large babies despite my tiny size. I breast fed all my babies.. Now that the whole family is paleo I can see where I was GD being smaller etc those standard numbers didn’t apply. I’d say get a glucose tester and watch…sometimes despite everything we can still have issues that we can’t control, you are likely in control, but glucose testers will give you more info…may find temporarily unable to allow potatoes, or certain fruit for a time.. My kids now teenagers quite sensitive to foods, one easily hypoglycemic until we went paleo. Preganancy is hard work for a moms body, and gestational diabetes is a real concern, but failing doesn’t mean your going to be diabetic for life (I’m not still and according to my a1c never yet got there) my husband did and so also my kids show early hedging towards diabetes, even though no doctor said anything, looking at those numbers for standards I notice when anything is on high side of a ‘normal’ and start making changes then, cause waiting for doctors to say anythng was already a problem…i work with many moms mostly as a doula, sometimes just a sounding board for alternatives while stuck n traditional doctors etc. (small towns have this issue). Eat drink stay active and glucose test often.. Likely will have a healthy bouncing baby and a healthier parents to keep up with it! trust me a c section isn’t the end of the world, and minimal scarring even my stretch marks not all that bad, and healthy eating will reduce them faster also.
My midwife allowed me to pass on the glucose tolerance test and just measure via bloodwork a 2 hr post priandial glucose measure. Was perfect at 82:) If you normally don’t consume 50+ grams of pure glucose at a “meal” without other macronutrients to buffer the bloodsugar blow, what do they expect is going to happen? When I qwas pregnant w/ my twins I did not know any better– glucose tolerance tested at 67!!!! Yep, I passed – no mention of the hypoglycemic response ’til I paged thru my records 5 yrs later. Glad you managed to bypass the mess!
I am sooooo glad I’m going to see a D.O. tomorrow who 1) works in the same office as my OB-GYN and 2) works with and follows herself the Paleo/Primal diet. I can get those two to talk to each other avoid this mess should I be blessed enough to get pregnant!
I hate to break in with bad news here, but I was diabetic with good HbA1c and fasting scores, so it’s certainly possible.
After I failed the 1 hour test, I went nuts with disbelief. I had been Paleo for years, had been at a healthy weight, did everything right — there was no way I could possibly be diabetic. Well, I measured my postprandial blood sugar for weeks and I had to admit that I was glucose intolerant. I’ve done a ton of research on diabetes since then, and here’s what I’ve found:
1. HbA1c is not a great predictor of gestational diabetes because it measures your average blood sugar over the last 2 or 3 months. Well, most GD cases don’t begin until after 20 weeks, and typically you’re taking your GD test at around 26 weeks. That means you can have good HbA1c scores and still be spiking after meals.
2. Fasting blood sugar doesn’t predict fetal outcomes as well as postprandial blood sugar.
3. 2 hour postprandial blood sugars aren’t as useful as 1 hour.
I very sorry to burst the happy bubble, but I wanted to share this because what you don’t know here could very possibly hurt you.
As for me, I maneuvered my way out of the ob/gyn healthcare system, watched my diet like a hawk for the rest of the pregnancy, and ended up having a lovely home birth. So that’s possible too! 🙂
Here’s a helpful article to start. In fact, read everything on Blood Sugar 101. 🙂
http://diabetesupdate.blogspot.com/2011/10/normal-blood-sugars-in-pregnancy.html
And if you have better information, please chime in. I’m no expert, and I’m always looking to learn more.
I was CW before being diagnosed with gestational diabetes and, subsequently, permanent type 2. Your comments reassure me that I didn’t necessarily do it to myself.
Keep in mind that gestational diabetes is caused by the placenta inducing glucose intolerance in the mother – possibly in order to shunt glucose to the fetus. (This could be a useful thing in times of food scarity. Not so useful in modern times.) This is why I do not believe it can be prevented. Be sure to keep an eye on your post prandial blood sugars for the rest of your life. Once this mechanism is set in motion, in 50% of GD women it persists and can show up later on as type 2 diabetes.
This was my story as well. I had been eating Paleo for 2 years before becoming pregnant in March 2011. This was our first child so I didn’t even question the glucose test, although I could hit myself because i question everything else. I failed the first one and then went on to fail the 3hr. I was threatened by the nurse at my practice that if i didnt see the health coach they’d drop me from the practice and I could have a still birth if I didnt take this seriously. I kept telling her and the doctor that tests are not One size fits all and I dont follow a western style diet. For someone who eats less than 100 gram of carbs a day and low to zero sugar intake, how do they expect my body to react to a pure sugar drink. Robb talked me off my hysterical ledge and assured me everything was fine.
So, againt my will I went and saw the nutritionist and started taking my sugar levels as required. Note, those strips are EXPENSIVE. She was shocked as I was the first person she ever had to tell to eat more carbs. her words, Dont the doctors know you have to eat at least 250 grams of carbs/day for this test to test properly? well, no because the medical community is operating now on CYA policies. So I played around with the glucometer: testing different fingers, testing after drinking OJ, eating high fats before cards to blunt the response, etc. As I told everyone, I did not have GD. Infact the doctor took one look at my numbers and said he wasnt sure why I was there. Since I was paying for the freaking useless visit, I made him sit there and answer 30-45 minutes worth of questions. 🙂
my sweet baby was born 9 days late, natural and healthy as can be. She is a Paleo baby and functioning extremely well. My baby eats avocado, broccoli, fish, yams, fruits, chicken….AMAZING
In the end, doctors need to treat patients as INDIVIDUALS. If my diet and lifestyle are outside the realm of what you normally see then talk to me about OPTIONS. Dont assume I fall into the sick and unhealthy mold that you think is normal.
Lesson learned.
I am grateful that I read a book about evidence-based pregnancy procedures during my first pregnancy. There is actually no *evidence* that this test affects outcomes in ANY way – good or bad. What a waste of money, even for women who eat SAD.
Hi Robb (and anyone who will be reading this post),
Thanks a lot for this precious information. I’m 27 week pregnant and I’m supposed to have the glucose tolerance test sometime in the coming weeks. I think I don’t want to do the test because:
i) The probability that I’m currently having Gestational Diabete might be 0; I’m following the paleo diet (relatively low-carb), I’m extremely fit and active, I’m not overweighted at all (rather the opposite); this is my second pregnancy and all well smoothly with the first one (small and nice baby at birth, etc.).
ii) In the event I have GD, then I gather that what I should do is precisely what I’m doing now: eat well, be very active, don’t be overweighted, etc. So what’s the purpose of investigating GD in the first instance?
iii) I did the test for my first pregnancy and I thought it was awful for my body; I was surprised I did not get a false positive because my body —like the one of any paleo folk— is not used at all to receive raw glucose like in the test. Cf. what happened to your wife. My guess is that it did not occur to me the first time possibly because my diet was/is somewhat less paleo than your wife’s.
I just wanted your advice on this (of course I’ll also ask my obstetrician and this is my decision eventually so you won’t have any responsibility in my decision, no worries 😉 ). In other words, my question is: What would you tell me to do if I were your wife 😉 ?
Many thanks in advance for your feedback!
Folks who eat we’ll just have problems with the ogtt. Have you read my pieces on gestational diabetes?
Yes I did. Based on it and Chris Kessler’s piece on the topic I had in mind skipping the OGTT altogether and just doing a post-meal glucose test at home with a glucometer.
Robb,
Thank you for this post. I’ve been living a greater than 80% Paleo lifestyle for more than 3 years and just received the news I failed my 1-hour and 3-hour glucose tolerance tests:
1-hour=198 mg/dL
3-hour:
Fasting=96
1-hour=209
2-hour=226
3-hour=165
I’m an avid CrossFitter and been a top level athlete my entire life, but according to just my BMI (I’m 5’4, 155#s, 26% body fat) the doctors are calling me borderline obese (hey, I’m not saying I couldn’t afford to lose a pound or two, bot obese, really?). I’m 32 soon to be 33 years old and 12.5 weeks pregnant. They are saying I have type II diabetes because it is too early to be gestational diabetes.
Here’s the kicker–I passed my HBA1C with flying colors.
What does this all mean?!?! Does this mean I have type II diabetes and because of my lifestyle I’ve been managing it successfully or could it be my body isn’t used to consuming large quantities of sugar at one time and thus failed the glucose tolerance tests? I am soo confused and upset right now because I feel, like many of the folks who have posted on here, that I’ve done everything right…eaten a healthy diet, am physically fit, and in general take care of my body.
Help…
So I talked with my doctor about measuring the blood sugars in another way. He told me no. He told me to eat a high protein breakfast before coming for the rest. I am not changing doctors at this point, although I am ticked off. But what is my best bet for passing. I have some people say to eat high carb for three days before. I will do this. I don’t avoid carbs all together just sugar anyhow. Is this the best way to pass, and not his advice of just protein that morning? Help?!
I failed my glucose tolerance test with my curent pregnancy baby #2. I passed with my son, when I was eating tons of junk! We are eating a lot healthier now. Not paleo, more of a primal/WAPF diet. My ob never caught that I failed the test. I switched providers at 34 weeks and it was them who actually caught it, 10 weeks after I took the test. Thankfully my midwife isn’t making me do the 3 hr test. Instead I am checking my sugars 4 times a day (first thing and and hour after each meal) until my next appointment. I am also keeping a food diary. For me, this is a better way of testing than doing the 3 hr glucola test! Yuck!!!! http://firsttimefulltimemamma.com/2015/08/14/i-failed-the-one-hour-glucose-tolerance-test-and-the-doctor-never-caught-it-what/
I just got a call that I failed by glucose screening. My hospital says 130 is the level it should be under. I was at 138 after 1 hour. Most places set the level at 140 which would make me below the threshold for GD. So now they want me to come in a do the 3 hour glucose tolerance test because I “failed” the screening. All while I eat about 85% paleo and do moderate workouts 5+ times per week. I’m 6’1 and currently weight 180. I’m 25 weeks pregnant. Any suggestions?