Sunday, August 26, 2007

Medical madness

On Friday evening after 6pm I got a phone call from my obstetrician to tell me the results of the GTT were positive. She gave me three numbers and told me I needed to call the endocrinologist that night on her mobile. She mentioned it was only just positive, but the numbers meant nothing to me.

The endo told me the results would "normally be regarded as absolutely abnormal" but that she had had a woman in the last few weeks who had similar results that turned into completely normal on repeat of the test. So would I please do the test again on Tuesday? !!!!

So I agree (what else do you do when presented with virtually no information on a Friday evening?) and I go hit Google.

Turns out that if I lived in the US or UK, the result would not be considered positive, nor is it positive according to the WHO standards. The baseline and 2 hour result were well within normal. Only the one hour result was above the cutoff - 10.4 rather than less than 10. No-one else in the world considers the one hour result diagnostic. They don't even collect it in the UK.

It also turns out GTT's are regarded as having poor reproducibility and the one hour result is particularly prone to changes in such things as the dilution of the glucose.

It gets better, even gestational diabetes, what they are testing for, hasn't achieved a consensus in definition, although I only found multiple references to the controversy, and didn't go looking for the details of the controversy.

So apparently gd is different here than in the UK and the US. Treatment is different too.

You gotta love the medical profession. I understand that they have to work with the limited information that they have, I just don't understand why they present it, and expect me to treat it, as gospel.

And I have to admit, she is at least repeating the test, and not just treating me for diabetes I am pretty convinced I don't have. No drinking right before the test this time, dilution increases the 1 hour blood glucose level. And unless the new test looks a lot more convincing, I'm not going with any treatment unless they can point to an independent symptom. In the UK the recommendation is not to treat unless the baby is looking big (ie over 95th percentile) - apparently unnecessary treatment results in poorer outcomes - geez, whoda thought having to test your blood sugar and inject insulin for no good reason would result in poorer outcomes?

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