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GLUCOSURIA / GLYCOSURIA IN PREGNANCY
Glucosuria, also known as glycosuria, is defined as the presence of glucose (sugar) in the urine with a dipstick reading + to ++++ .
If one urine dipstick reading of + to ++++, with no symptoms or family history occurs, the midwife should evaluate diet and repeat urine dipstick.
Nutritional Therapy is very important with a diet very high in protein and complex carbohydrates, with ample calories and limited sugars is usually recommended. Chromium picolinate supplements may be helpful. Regular, moderate aerobic exercise is encouraged.
Blood glucose testing can be done using a hand-held glucose monitoring system used by diabetics. There are many on the market and these can be purchased over-the-counter at a local drug store along with the blood-glucose testing strips. They are very similar to the urine dipsticks and can be read with an electronic device, which is more accurate, or by sight and comparing the color of the strip with the colors shown on the strip bottle. Instructions should be carefully read and followed for accurate results. Fasting (no food for at least 12 hours) levels should be under 90 mg/dL for normal whole blood. The glucose levels will depend upon the foods she has eaten, the time lapse since her last meal, whether she has exercised after her last meal and whether or not she is smoking cigarettes.
GLUCOSE SCREEN / 1 HOUR GLUCOSE TOLERANCE TEST: The most common test for gestational diabetes is called a glucose screen. With this test the mother ingests 50 grams of liquid glucose and her blood is drawn an hour later. This test gives a great deal of false positives. However, if the blood glucose level is above 140 mg/dL she is usually given further testing with an OGTT.
OGTT - ORAL GLUCOSE TOLERANCE TEST: The mother must fast without food for at least 12 hours before testing. The blood is drawn to establish a baseline glucose level. She is then given 100 grams glucose syrup orally. In the commonly used OGTT, she has her blood drawn at one, two and three hours. During the this time she is not allowed to eat or smoke. The test should use whole blood, not plasma for this test. If two of the following levels are met or exceeded, a diagnosis is made as gestational diabetes.1. Fasting, above 90 mg/dL
2. One hour, above 165 mg/dL
3. Two hour, above 145 mg/dL
4. Three hour, above 125 mg/dL
Caution should be taken when using liquid oral glucose for testing. This substance often causes nausea, vomiting, headaches, profuse sweating or bloating.
1 HOUR GLUCOSE CHALLENGE TEST PROTOCOL
This test is usually performed by giving 50 grams liquid glucose after a 3 hour fast. The blood is then checked 1 hour after drinking the glucose. An alternative to liquid glucose would be to use the "Jelly Bean Test", with 18 regular size jelly beans substituted for the 50 grams of glucola. Most pregnant women are able to consume and keep the jelly beans down without the side effects often experienced using the liquid oral glucose.
JELLY BEAN TEST: Fasting with no food should be performed for 3 hours prior to testing. If she smokes cigarettes, these must also be eliminated prior to testing. Cigarettes can interfere with the accuracy of the test. After a 3 hour fast, 18 regular sized Jelly Beans (Brach's Original Jelly Beans seemed to be the preferred choice) or 28 small Jelly Beans are given and eaten quickly by the woman being tested. The blood is checked for glucose levels 1 hour after taking the Jelly Beans. It is a much more palatable choice preferred by women being tested than the 50 grams of liquid glucose.
Normal results should below 140 mg/dL. However, many providers will order further testing in the 130-140 range as well, and a few will order further testing when results fall in the 120-130 mg/dL range.
2-HOUR POST PRANDIAL TEST: This is possibly the most reliable test at this time. A fasting blood sample is desired for a baseline level after a 12 hour fast. The mother is then given a full meal high in calories and complex carbohydrates. She has her blood drawn two hours later. Readings will be more accurate if she has done some exercising lightly after eating. Normal levels are 120 to 140 mg/dL.
BRACH'S ORIGINAL JELLY BEANS FOR "JELLY BEAN TEST"
JELLY BEAN ALTERNATIVES FOR GLUCOSE TESTING
Study using Jelly Beans as an alternative to a cola beverage containing fifty grams of glucose.
Author: Boyd KL; Ross EK; Sherman SJ
Address: Department of Obstetrics & Gynecology, St. John Hospital & Medical Center, Detroit, Michigan, USA.
Source: Am J Obstet Gynecol, 1995 Dec, 173:6, 1889-92
Abstract:
OBJECTIVE: Our purpose was to test the diagnostic value and patient tolerance of jelly beans as an alternative to a 50 gm glucose solution.
STUDY DESIGN: Pregnant women between 26 to 30 weeks of gestation confirmed by early ultrasonography were recruited to participate in the study. Each participant was given a cola beverage containing 50 grams of glucose. The plasma glucose level was determined 1 hour later. Within 2 weeks of the 50 gram glucose test, each patient ate 18 jelly beans and had her plasma glucose levels tested after 1 hour. Finally, within 2 weeks of the jelly bean test a 100 gram, 3-hour glucose tolerance test was performed on each subject. The results of the 3-hour test were used to define the presence or absence of gestational diabetes and carbohydrate intolerance by the criteria of The American College of Obstetricians and Gynecologists. Patient tolerance was rated by responses to questions regarding side effects.
RESULTS: One hundred fifty-seven women completed the study. The mean maternal age, gravidity, parity, and number of abortions were 26.06 years, 2.66, 0.96, and 0.69. By use of a 140 mg/dL threshold, the sensitivity, specificity, and positive predictive value of the cola beverage was 46%, 81%, and 18%. These values at a 120 mg/dL threshold for jelly beans were 54%, 81%, and 20%, respectively. The patient tolerance was greater for the jelly beans compared with the 50 gm cola beverage.
CONCLUSION: Jelly beans may serve as an alternative to a cola beverage containing 50 gm of glucose.
For more information about glucose testing during pregnancy see Plus-Size Pregnancy: GD Testing.
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MoonDragon's ObGyn Information: Gestational Diabetes (GD)
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