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Discussion Starter · #1 ·
I apologize in advance for how long my post is, but I've tried to cover all my bases before posting here.

I am 30 years old and was diagnosed with gestational diabetes at 23 weeks in pregnancy. An earlier than normal glucose test was ordered due to my PCOS. The gestational diabetes was controlled throughout the pregnancy with exercise and diet. (The goals were a fasting reading of 95 or under and a post meal reading of 120 or less 2 hours after eating. I was over these values only a handful of times and never by more than 10%.) I gave birth to a full-term, healthy girl about 6 weeks ago with no complications.

I recently had my 75 gram OGTT to verify that the gestational diabetes did resolve. I had been randomly testing my blood sugars through the weeks following the pregnancy and did not expect to pass the test. My fasting numbers had been ok, with none over 95 and most at or under 85. My post meal numbers, however, were not as good, with many reaching the 150’s even while continuing to follow a controlled carbohydrate diet.

Much to my surprise, I passed the OGTT. I had been taking my own blood sugar through the test and my meter indicated I had failed, with a fasting reading of 85, a 1 hour reading of 156, and a 2 hour of 134. Not diagnostically diabetic numbers, but definitely much higher than an ideal normal reading and high enough that I would have been diagnosed as prediabetic by my clinics standards. The official results came back significantly different, with a fasting of 65, a 1 hour of 112, and a 2 hour of 116. (The one and two hour numbers still aren’t good, but that’s another matter.) Three hours after the start of the test, I began to feel low (nausea, shaking, cold sweat) and my meter showed a reading of 54.

I mentioned the difference in readings to the nurse who called with my results, and she thought it was likely my meter was off. I checked my readings against another meter that had recently been verified with a clinic meter and every reading (from between 74 to 152) has been within 5 mg/dl of my meter. I also picked up some control solution and checked my meter. Everything checked out. Now I am left wondering what has caused the difference and questioning if the gestational diabetes has indeed resolved.

I fasted before the test as directed and my hands were clean at the time of the testing. My fingertip blood samples were taken within 2 minutes of each of the samples from the veins. Strips are current, stored properly, etc. and I have taken samples of a high reading with strips from 2 lots just to check. I understand that the fingertip samples tend to return higher values that the samples taken from the vein, but the differences seem excessive, especially considering that my meter has shown continued high results ever since delivery. In addition, the research I have read shows that this large difference applies primarily to the post meal readings and that the fasting readings are generally much closer. Therefore, I would have expected at least the fasting number to be closer.

Does anyone have any reasons that may explain the large differences (40% in the worst case)? Without a valid explanation I am left to think that the diabetes did not resolve. I would hate to leave the potential high blood sugar unaddressed. However, until I am relatively sure that there is not a valid reason for the discrepancy, I am hesitant to go back to my doctor contending that the lab results may be incorrect, or at least not telling the whole story. I tend to over think things so any input would be appreciated.
 

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I too would be so confused!
I would say at this point I would continue eating as I have been to control BG and still have enough milk for baby, put the Met back in the mix for your PCOS and continue readings with your meter.
Guess my gut feel is I’d trust my meter. Always a chance the lab messed up? But meanwhile I wouldn’t want another OGTT! Maybe just another fasting to check your meter against the lab and a regular post-meal reading as well to double check?
Although really with a new baby in the mix I might let this go a couple more months and do the fasting/new BG checks at that time (although again I’d skip the OGTT). You have a baby to take care of, and your post meal numbers being a tiny bit high according to
your meter for a few more months should be OK.
Anyway my 2cnt
 

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I'm sorry bkek but I have a very sad view of a situation where post meal numbers go over 140 fairly regularly regardless of the results of an OGTT.

Generally it's the post meal figures that first signal that your pancreas isn't delivering full value and fasting figures are the last to go wrong. I tend to view it as an early warning system and you effectively have two choices.

You can ignore it but it won't go away. Slowly your insulin response will become less and less effective and finally you will see the impact in fasting figures. However by that stage damage to your organs could well already have begun.

The other option is to decide that, ignoring the official "non diabetic" diagnosis you start to think like a diabetic and do manually what your pancreas is no longer doing automatically. In other words manage your own blood sugar much as you did during your pregnacy. And the figures you should aim for are exactly the ones you used. The important ones are that you are ideally never over 140 one hour after a meal and never over 120 two hours after the meal. Do that and your fasting numbers will take care of themselves.

The bad news? This is a lifetime job. Diabetes won't go away. Sure, it won't bother you for years but the insideous damage is mounting over time unless you prevent it. Do have a look at Blood Sugar 101 This is a site written by a lady who has been diabetic since the 1990s and she covers a lot of ground. One item I think you might find interesting is this.

However diabetes is not something that need spoil your enjoyment of life and if it is managed properly, as it will be in your case, you need never let it inconvenience you.

Come see us on the forum whenever you have any questions - there is bound to be someone around to help.
 

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Discussion Starter · #4 ·
Thanks for your replies.

donnaB - I agree that an additional OGTT would be a bad idea. The two I already did (50 for GD diagnosis and the 75 for the OGTT at the end of pregnancy) were miserable enough. I see them doing nothing but harm at this point and time.

John.in.France - I completely agree with you on the mentality that high blood sugars above 140 (and in my opinion even ones that are lower) are a clear indication that there is a problem that needs to be addressed now and not later. My issue is that the values I'm getting from the official test and those I'm getting from my meter are so different that I'm not sure which ones to trust. Questioning the accuracy of my meter doesn't make me feel any better, but as of yet, I can't find any reason to think the meter actually is off. However, while an error in the lab is possible, that also isn't highly likely. This leaves me searching for some sort of explanation as to the discrepancy.

My OB is more open to this issue than my GP, so I would prefer to attempt to get an answer on this and address it with her before I am completely handed off to the GP. I am just hesitant to go back to them without having fully explored the reasons for the discrepancy. My knowledge of the reasons for the difference in readings is not very broad and pretty much limited to the basics (bad strips, dirty hands, etc.).

I was so sure that I would have failed the test that it has really thrown me for a loop that it was a pass. I'm not trying to avoid a diagnosis of higher than normal blood sugar; rather I'm concerned that one may have been missed. Passing the glucose test now makes it more difficult to address these issues with health care providers, as many of the forum members are aware of.

Due to the PCOS diagnosis, I had already committed to a change in lifestyle before my numbers even began to become irregular. I had classic case of PCOS that was undiagnosed for 15 years. I refuse to let the same issue happen and have a diabetes diagnosis go missed, but I am still new to all of this and trying to determine if there is a logical explanation for the difference.

From the beginning, I had planned to continue with this lifestyle, even if all of my readings, lab and meter, come back normal. PCOS is often associated with insulin resistance, so even without a GD diagnosis or identified high blood sugar readings, I would have been at significant risk of developing full blown diabetes.
 

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As far as the diagnosis goes, you wouldn't be labelled as diabetic even with your own figures of 156 & 134 on a OGTT of 75 gms glucose. But you did have GD and that is why you need to be careful. You are already doing that.

As far as the meters v/s labs are concerned, BG meters are like the home BP monitors. They are just meant to give you a general idea. I've had 5 meters and tested them all against several labs. never could predict what scores my lab/s would come up with. Finally I've settled with one which is consistently 15-25 % higher. Knowing that my meter reads higher, I've still settled down to taking it at face value. This keeps me in a safer range.

I agree with donna, you could go in for another OGTT, at a different lab, maybe 6 months down the line. In the meantime keep a close watch at your BG especially the PP numbers.
 

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I agree that relying on your meter to continue to monitor your blood sugar is a wise course. But, if you are still uneasy about the discrepancy, set a little time aside (maybe that is impossible with a newborn?) and see about seeing a diabetes specialist. I know the University of Missouri has several and probably the University of Kansas does also. I know the tigers and jayhawks usually don't get along too well on the playing field but ....this is different. Really, the blood sugar readings are all relative to a standard and as long as you keep using the same standard, your results will make sense. I personally wouldn't rule out a mistake at the lab.
 
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