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Re: Impaired Glucose Tolerance vs Gestational Diabetes - treatment?From: Robert J. Carpenter, Jr. MD (zygote@icsi.net)Sat Nov 12 16:17:42 2005
<?xml version="1.0" ?><html> <head> <title></title> </head> <body> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > The screen is exactly that - a screen. It has false positives and</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > theorectically false negatives</span></font><font face="Arial" size="5"><span style="font-size:18pt"> </span></font><font face="Arial" color="#7f0000"><span style="font-size:10pt">The false positives (</span></font><font face="Arial" size="5"><span style="font-size:18pt">negatives </span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt">XXXX- wrong word typed- excuse stupidity). are at least 20%</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > so a number of folks will have completely normal 3h Dx tests. </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > The other question has been covered in recent posts with use og</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Diabetic type of diet for all abn patients. </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > On 12 Nov 2005 at 10:00, Natalie Melanson Martin wrote:</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Thanks everyone for all your info.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Here is an interesting case I had recently. 35 yo G2P1, average</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > weight, no family hx diabetes. During her 1st pregnancy, she had</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Impaired Glucose Intolerance, and was referred to the Diabetes</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Centre for diet counselling and was monitoring her blood sugars.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Baby was around 7-8lbs. For the current pregnancy, she started</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > testing her blood sugars around 22 weeks as she still had the</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > glucose monitor, and she also works in a hospital with nurses who</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > were urging her to test her blood sugars! Because of the history,</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > she was sent for a GTT around 27 weeks. Before the results came</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > in, she called me to report she had had values of 12-15 several</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > evenings in a row! She insisted the glucose monitor had been</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > calibrated properly. I immediately referred her to the Diabetes</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Centre again, with GTT results pending, sure it would come back</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > abnormal. Well, it actually came back with all normal values!! I</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > talked to the Diabetes Centre's endocrinologist, who recommended</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > continuing to monitor her because of the high values and then</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > repeating the test in a few weeks as those are pretty high values.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > She has had diet counselling and reports her blood sugars have</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > been normal ever since. She also admitted that the high values she</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > had had followed some very rich meals. So what I am wondering is,</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > how valuable is the GTT, and how valuable is daily blood sugar</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > monitoring? If she hadn't been taking her blood sugars daily, and</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > we had just done the GTT as planned, we wouldn't be concerned, but</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > now I feel we can't really ignore those high values and need to</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > monitor her for at least a bit longer.</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Another question I have is: if you do a 50g OGCT which is high and</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > then do a 75g or 100g GTT which has all normal values, do you</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > still treat the woman as having impaired glucose tolerance? My</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > understanding is that the OGCT is highly sensitive which is why</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > it's only a screen, but if it's abnormal even with a normal GTT</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > should you still intervene with diet counseling and daily glucose</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > monitoring, which is what we tend to do with IGT?</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > thanks,</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Natalie Melanson, RM</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > Sudbury Community Midwifery Practice </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Robert J. Carpenter, Jr. MD</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > 6624 Fannin, #2720</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > St. Luke's Medical Tower</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > Houston,TX 77030-2339</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > 713-795-4600</span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> > </span></font></div> <div align="left"><font face="Arial" color="#7f0000"><span style="font-size:10pt">> </span></font></div> <div align="left"><br/> </div> <div align="left"><font face="Arial"><span style="font-size:10pt">Robert J. Carpenter, Jr. MD</span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt">6624 Fannin, #2720</span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt">St. Luke's Medical Tower</span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt">Houston,TX 77030-2339</span></font></div> <div align="left"><font face="Arial"><span style="font-size:10pt">713-795-4600</span></font></div> <div align="left"></div> </body> |