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Is there another test, such as a urine test, to screen for diabetes?
Afraid not. The only definitive screening and diagnostic test is a blood test. A urine test is very unreliable as a screening tool and is most certainly not diagnostic.
How is the diagnostic test for diabetes conducted?
You will hear the term Glucose Tolerance Test or, more often, GTT.
It simply involves the person fasting for several hours overnight and taking a measured sugary drink in the morning. A series of blood samples are taken, normally every thirty minutes for the next two hours. Levels of sugar in each sample are analyzed.
What does the GTT tell the doctor?
It will tell the doctor whether the mother's body is processing sugars (and other carbohydrates) efficiently. If this is the case, it will mean she is not diabetic.
It could, on the other hand, show that the control of blood sugars is not optimal - which will be termed "impaired glucose tolerance".
It could show that blood sugar level control has been completely lost. This will mean she has gestational diabetes.
What are the implications of impaired glucose tolerance?
Well, she does not have diabetes, so things are not too bad.
The standard control of this is purely dietary. Her doctors and midwife will give her advice on the kind of changes she needs to make in her diet. In most cases, a dietician is involved, to give personalized specialist dietary advice.
Regular blood sugar tests will be done for the remainder of the pregnancy.
Can the baby be affected by impaired glucose tolerance?
When this diagnosis is made, the mother is bound to have a closer follow-up of her pregnancy. Sometimes impaired glucose tolerance progresses into gestational diabetes, which may call for changes in the management strategy.
If impaired glucose tolerance is well controlled, there is no evidence of any adverse effects to the growing fetus in the womb.
What if she has gestational diabetes?
A careful assessment of her condition is made. The decision will then be taken whether to stick to dietary control of her condition or to start her on insulin. If her obstetrician opts for the former, she will be asked to have frequent timed blood-sugar tests. It is of absolute importance that she sticks to the monitoring regime. If the dietary management alone does not seem to give good control, then insulin needs to be used. The aim is to achieve blood-sugar levels that stay within the normal range.
Is there a role for exercise in gestational diabetes?
Yes. Strenuous exercise is out, as it can cause a dangerous fall in the blood sugar level. On the other hand, a complete lack of exercise does make blood sugar control that little bit more difficult. The midwife and doctors will advise the mother on the recommended type and extent of exercise. However, it is never necessary to go to the gym.
How is insulin administered?
The mother will, be taught how to self-administer insulin injections. Most people find this quite easy to learn. The injection causes very little pain and is relatively superficial.
Metformin and other drugs
Some diabetics use tablets for their condition. Can't these be used for gestational diabetes?
Traditionally, tablets such as Metformin, glyburide, pioglitazone and other similar anti-diabetic oral drugs were not used in pregnancy. There were concerns that these could potentially harm the baby by creating a low blood sugar environment. Extensive animal and laboratory studies have, in the last few years, shown that the use of these oral medications in pregnancy is, in fact, safe and in selected patients beneficial in optimising blood sugar control. They have therefore been increasingly deployed for this purpose, either in isolation or together with insulin. However, it is very important that any woman who conceives whilst on Metformin or any other oral hypoglycaemic agent informs her doctor straight away so as to allow the earliest possible expert input in her diabetes management during pregnancy.