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Re: Impaired Glucose Tolerance vs Gestational Diabetes - treatment?From: Natalie Melanson Martin (nmelanson@personainternet.com)Sat Nov 12 08:58:39 2005
Thanks everyone for all your info. Here is an interesting case I had recently. 35 yo G2P1, average weight, no family hx diabetes. During her 1st pregnancy, she had Impaired Glucose Intolerance, and was referred to the Diabetes Centre for diet counselling and was monitoring her blood sugars. Baby was around 7-8lbs. For the current pregnancy, she started testing her blood sugars around 22 weeks as she still had the glucose monitor, and she also works in a hospital with nurses who were urging her to test her blood sugars! Because of the history, she was sent for a GTT around 27 weeks. Before the results came in, she called me to report she had had values of 12-15 several evenings in a row! She insisted the glucose monitor had been calibrated properly. I immediately referred her to the Diabetes Centre again, with GTT results pending, sure it would come back abnormal. Well, it actually came back with all normal values!! I talked to the Diabetes Centre's endocrinologist, who recommended continuing to monitor her because of the high values and then repeating the test in a few weeks as those are pretty high values. She has had diet counselling and reports her blood sugars have been normal ever since. She also admitted that the high values she had had followed some very rich meals. So what I am wondering is, how valuable is the GTT, and how valuable is daily blood sugar monitoring? If she hadn't been taking her blood sugars daily, and we had just done the GTT as planned, we wouldn't be concerned, but now I feel we can't really ignore those high values and need to monitor her for at least a bit longer. Another question I have is: if you do a 50g OGCT which is high and then do a 75g or 100g GTT which has all normal values, do you still treat the woman as having impaired glucose tolerance? My understanding is that the OGCT is highly sensitive which is why it's only a screen, but if it's abnormal even with a normal GTT should you still intervene with diet counseling and daily glucose monitoring, which is what we tend to do with IGT? thanks, Natalie Melanson, RM Sudbury Community Midwifery Practice
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