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I Failed the Glucola

Last week, I left you hanging about the results of my glucola.

One of my readers emailed me:

“Damn cliff hanger!! I want to know your results. Lol. This is why I binge watch tv shows after the whole season is out. The suspense is killing me.”

Who knew a glucose tolerance test could be described as “suspenseful?!” (other than me, of course…)

I was certainly curious to get the results of my test. When the lab technician said they could run the analysis in office, I decided to stick around for a few extra minutes. (Plus, I just had to finish the riveting article I was reading in Alaska Sporting Magazine…)

I was sure I had passed, so when the lab tech said:

“You should have studied better.”

I knew he was joking.

But he wasn’t.

I got a 141.

Passing is <140.

I was kind of shocked.

I failed the glucola. Now what?

Now, the 1-hour, 50 gram glucola is NOT diagnostic of gestational diabetes on its own. It is a screening test to identify those at “high risk” and determine who should get further testing.

He said my next step was to come back again for the 3-hour test. Of course, since I specialize in gestational diabetes, I knew all that.

I had already discussed testing options with my doctor and had decided that regardless of the results of the 1-hour, 50g screening that I would check my blood sugar at home with a glucometer for 2 weeks just for my own knowledge. In fact, I already had my prescription for blood sugar testing supplies in hand before I drank the glucola.

Still, I walked out of the office feeling like a failure.

How could I not feel that way? The official medical terminology is “passing” or “failing.”

I cursed under my breath as I made my way to the car.

A million thoughts raced through my head:

  • Should I have opted out of the dumb test and just done home glucose monitoring?
  • Now are they going to pressure me into doing the 3-hour test (with double the sugar)?
  • What if I really do have gestational diabetes? I know how to manage it, but would my birthing options be limited? Would I be treated differently by my doctor?
  • Why didn’t I carb-load for the past week?! I knew my moderately low-carb, low-glycemic diet made it more likely for me to get a false positive. I’m such an idiot.
  • I shouldn’t have skipped my walk this morning. If I had exercised, like usual, I would have had better insulin sensitivity. Maybe I should have done squats in the bathroom?!

And then the other part of me was thinking…

  • If you had carb-loaded for a week, technically you would have been “cheating the test.” Yes, you likely would have passed, but YOU were the one who wanted to see the results based on what you usually eat and here you have ‘em. You confirmed what’s been well-documented in the literature for decades. (See NEJM, 1960)
  • If you had exercised immediately before – or during – the test, yes, you may have gotten a lower reading… But there are days when you don’t walk or exercise, and now I know how my blood sugar would respond on those days IF I ate 50g of pure sugar. (I’m sure as hell glad I DON’T eat 50g of sugar, pretty much EVER. Now I know how my body responds to it.)
  • Your first trimester A1c was low, so you definitely didn’t have prediabetes, and your weight gain is within normal, so the likelihood that you have GD is still pretty slim.
  • Numbers are simply information, not “good” or “bad.” Just like you tell your clients, you need to test at home and see where your blood sugar is at before you choose your next steps.
  • Of all people, you know what to do. No matter what you find out from testing your blood sugar at home, you’ll be able to manage it.

I’m usually a pretty rational person, but my mind was all over the place.

Maybe my erratic blood sugar was clouding my judgement.

By the time I had picked up my blood sugar testing supplies and got home, I felt like I was having reactive hypoglycemia. Hungry, moody, a little shaky… It had been a long time since I felt that.

So the first thing I did when I got home was wash my hands and test my blood sugar.

I got a 129.

This was now 2 hours after I drank the glucola.

“Holy shit. I really DO have gestational diabetes! I’m insanely insulin resistant.”

So I got myself a low-carb snack (figuring I didn’t want to spike my blood sugar any higher), then dinner a few hours later, and anxiously anticipated my blood sugar reading after my meal.

It was 87.

100% normal.

Granted, that meal was real food – not 50g of sugar – but I still didn’t understand why my insulin response 2 hours after the glucola was so dismal. Plus, I was hungry at that time. If you’re hungry, it’s usually a good sign your blood sugar is on the lower end, especially if you have normal insulin sensitivity.

My pancreas must suck.

I was stumped.

And then I got thinking… I had recently refilled my hand soap at the kitchen sink. That’s what I washed my hands with when I tested my blood sugar the first time. After dinner, I washed my hands in the bathroom with different soap.

I hunted down the original bottle for the Burt’s Bees liquid soap I had used to refill the kitchen hand soap.

And let me tell you, I laughed as I read the ingredients. Among them were eight – yes EIGHT – sugar-derived ingredients (such as lauryl glucoside, sucrose laurate, and even straight-up GLUCOSE).

You’d think as a certified diabetes educator, I’d know better. Hell, I DO!

I’m just glad I realized on day 1 of testing NOT to use that soap before checking my blood sugar!

So that reading of 129 was really just telling me that my hands were covered in sugar. Great.

(I should have thought to wash my hands again and re-test, but in my post-glucola stupor, that didn’t even cross my mind.)

I knew I needed more data. A few blood sugar readings don’t reveal much.

To see if I truly had gestational diabetes or not, I would need at least 1 week’s worth of blood sugar readings (preferably more, in my opinion).

I was very curious to check my fasting blood sugar – the reading taken first thing in the morning – because that often gives a sneak peek into your baseline blood sugar levels.

The next morning I got a 73.

In all my years working with women with gestational diabetes, I’ve had one GD client who had fasting blood sugars in the 70’s. Myself and the perinatologist agreed she had been misdiagnosed (she, like me, had eaten a low-carb diet prior to her GTT).

Nonetheless – and for the sake of science – I have continued to test my blood sugar (nearing 2 weeks now) – both fasting and after meals – to see where I’m at.

Eating my usual, real food diet has given me perfectly normal blood sugar readings.

I’ve also purposefully had some high-carb meals to see my tolerance to a similar amount of carbohydrate as the glucola, but in the form of a mixed meal.

My doctor had requested post-meal blood sugar #s be taken 2-hours after meals, but I’ve checked at both 1 and 2 hours out of curiosity for some meals (some women spike at 1 hour, others at 2 hours, so I wanted a more complete picture of what was going on in my body).

The highest carbohydrate meal I tried was 50g total carbs (45g net carbs): gluten-free butternut squash ravioli (intentionally overcooked to further raise the glycemic index) with sausage, kale, mushrooms, and butter.

My results?

1 hour later: 114
2 hours later: 86

This was a larger portion than I normally serve myself and I was full before I cleared my plate, but since I had already calculated out the nutrient content, I wanted to finish it… again, for science!

I repeated the same meal a few days later with similar results:

1 hour later: 104
2 hours later: 89

My usual meals vary in carb content, but I rarely reach 45g carbs per meal, so it was reassuring to get “normal” readings.

(In case you’re wondering, I have been tracking my macronutrients during this time. I know from experience that most people, myself included, underestimate how many carbohydrates they eat – sometimes by quite a bit! So I wanted to have a more accurate idea of where I fall on the carb spectrum. While it’s been helpful for the purpose of collecting data, I fully recognize the downsides of tracking macronutrients and will be quitting at the end of this experiment. It really does make it challenging to remain a mindful eater with all these numbers getting in the way!)

I’m nearing the end of the 2-week experiment and have not had a single reading out of range.

My post-meal readings have only gone beyond 100 a few times – all from high-carbohydrate meals. (The 114 I mentioned above was, by far, my highest reading.)

My fasting blood sugar numbers remained steady as well (and I didn’t employ the advanced tips & tricks for naturally lowering fasting blood sugar that I teach in the Real Food for Gestational Diabetes Course).

My average fasting blood sugar is 75.
My average blood sugar after meals is 87.

For those of you familiar with conventional gestational diabetes target blood sugar levels (or especially non-pregnancy blood sugar targets), you might think my readings are too low.

I assure you, they are not.

As covered in my book, Real Food for Gestational Diabetes, average blood sugar levels in healthy pregnant women are as follows: (Diabetes Care, 2011)

  • Fasting: 70.9 +/- 7.8mg/dl
  • 1 hour post-meal: 108.9 +/- 12.9mg/dl
  • 2 hours post-meal: 99.3 +/- 10.2mg/dl

It’s safe to say, I do not have gestational diabetes.

But with or without the official diagnosis, I would not eat any differently.

One side benefit of eating a nutrient-dense, real food diet is maintaining normal blood sugar numbers. And given that even mildly elevated blood sugar in pregnancy (below diagnostic thresholds for GD) has been linked to health problems in baby, including the risk of congenital heart defects, I have no intention to eat more refined carbohydrates just because I can “get away with it.” (JAMA Pediatrics, 2015)

The way I eat is delicious, full of nutrition for me and baby, keeps me satisfied, and has helped me stay pretty much craving-free. It’s also kept my weight gain, blood sugar, blood pressure, iron levels (and more) completely normal.

But this experience has reminded me how important it is for our screening methods for gestational diabetes to improve.

If you’re going to bother with drinking the glucola, you’d hope that the results are accurate!

It’s certainly weird to go from working alongside one of the world’s top gestational diabetes perinatologists whose passion is evidence-based care (and in an office that trains UCLA’s medical residents) to a teeny office with family practice doctors who only do prenatal care part-time.

Sadly, routine care is not necessarily evidence-based.

The two-step screening method for gestational diabetes is outdated (that’s the 1-hour, 50g screening followed by the 3-hour, 100g glucose tolerance test). A fairly high percentage of healthy women “fail” the first test while some women with excessive insulin production “pass” it and are never formally diagnosed. For those who go on to take the 3-hour test, diagnosis is delayed for weeks when awaiting the results of the second test. Finally, diagnostic criteria (the cut-off of what’s “normal”) arbitrarily varies doctor-to-doctor.

That’s why the International Association of Diabetes and Pregnancy Study Group (IADPSG), the World Health Organization (WHO), and nearly all countries aside from the United States recommend the more reliable and specific 2-hour, 75g glucose tolerance test, which is done fasting and includes more rigid cut-offs for diagnosis.

This method more accurately identifies women at risk for “adverse pregnancy outcomes” associated with gestational diabetes. (Journal of Perinatology, 2014) Plus, it’s just one test. The primary opposition to it is that, due to stringent diagnostic thresholds, more women would be diagnosed with GD and that may increase healthcare costs. (Though I argue, with low-cost interventions like my real food approach and the long-term health benefits to both mom and baby, these would be negligible or may even result in cost savings.)

I would have rather done that test, but that’s not protocol in my doctor’s office.

(Sidenote: To say that I know more about gestational diabetes than my doctor is the understatement of the century.)

In an ideal world, this glucose tolerance test would also measure insulin levels, as I discussed in my interview with Robb Wolf.

In lieu of a glucose tolerance test, the following are options:

1) A fasting blood sugar (venous blood sample, not a fingerstick), can accurately screen for GD. (Int J Endocrin Metab, 2007) However, it can leave some women undiagnosed – those who have normal fasting levels, but have an impaired post-meal insulin response.

2) First trimester hemoglobin A1c is highly predictive of gestational diabetes, so much so that the California Diabetes and Pregnancy Program: Sweet Success recommends it as a way to diagnose GD (and therefore many women would not need to undergo a glucose tolerance test at all). However, if you do, you’d have a pretty good chance of guessing your results. If your A1c is 5.9% or greater in the first trimester, your chances of “failing” the glucose tolerance test are 98.4%. (Diabetes Care, 2014) But keep in mind, it is NOT an accurate option for screening later in pregnancy, as I discussed in this interview.

3) Home blood sugar monitoring remains the most controversial way to diagnose gestational diabetes. Even though I opted for this option (in addition to first trimester A1c + the 1-hour glucola) and I believe it’s a great one for low-risk women who eat a lower-carbohydrate diet, it has some major drawbacks.

a) For one, it’s time consuming. You need to really be motivated to keep up with checking your blood sugar 4x per day. It’s annoying to set alarms, to carry testing supplies with you, to track what you’re eating, and poke your finger so often. I personally felt the annoyance was worth it and provided more useful, real-life information to me, but for others, it’s easier to just drink the glucola and move on.

b) Your diet impacts the results. This is both a good thing and a bad thing. You get a clear idea of how food affects your blood sugar, but I’ve had women who will purposefully starve themselves or temporarily switch to a very low-carb diet to “pass” the test, then go back to their usual diet that includes oatmeal/cereal for breakfast, fruit smoothies, and large portions of starchy foods or sweets. So, unless you continue to eat the way you normally do, you’re only hurting yourself and your baby.

c) Some women cheat. I’ve had women test other people’s blood sugar (like their husband), just so they can avoid the diagnosis. (When you work in this field long enough, you see just about everything!) Of course, if the diet for managing gestational diabetes actually worked (meaning prevented most women from requiring medication) and tasted good, I think this would be less of an issue… (hence why my real food approach is now being taught in at least one medical school and is being employed in several research studies).

d) The criteria for how many out-of-range blood sugar readings (or how high those #s need to be) to trigger a positive diagnosis is wishy-washy at best. In my situation, all of my numbers were well-below the goal range, so it was pretty cut and dry. But for many women, blood sugar readings hover in the grey zone. In that case, it’s unclear what to do. Personally, if I had questionable numbers, I would continue home blood sugar monitoring as if I had gestational diabetes, but for others that’s just too much work and they want a definitive diagnosis.

How do I feel about my decision to drink the glucola?

At the end of this experiment, I’m glad I drank the glucola. I learned that drinking a bunch of pure sugar spikes my blood sugar more than I’d expect (and been reminded that it makes me feel like crap). I’m also glad I didn’t carb-load just to “cheat the test.” By monitoring my blood sugar at home, I’ve confirmed that the way I eat is indeed right for my body.

Given my response, I probably wouldn’t opt for a glucose tolerance test in the future (unless it also included measurements of my insulin response – for science!), but the experiment – at this point in time – was worth it.

Knowing that blood sugar & insulin levels can shift week-to-week (especially in the 3rd trimester), I will continue checking my blood sugar at home – maybe not after every meal, but occasionally so I can be proactive if my numbers start going up.

Going through this has helped me feel, first-hand, the panic that hits my clients when they “fail” the glucola. I’m just glad I can offer them the support they need to make sense of all the information and get a game plan to manage this with as much ease as possible – both for my private clients and members of the Real Food for Gestational Diabetes Course.

Now I’d love to hear from you:

What are your thoughts on the way gestational diabetes is diagnosed?

Did you fail the glucola, like me? Did you go through the same “Do I have gestational diabetes” panic?

If you were officially diagnosed with gestational diabetes, how do you feel about it now?

Tell me in the comments below.

Until next week,

Manage gestational diabetes without fear.

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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes.


Leave a comment
  1. Hi Lily,
    Wow, the power of a label! I don’t know to what extent your treatment options will change, but not much might change for you because you are already living out the most effective treatment (diet). One way or another, you will come up with the right tools and information to continue to advocate for you and your child. Your clients are very fortunate to have you working with them.

    • Appreciate your kind words, Renata. However, you might want to carefully re-read the post. The 1-hour test is not diagnostic on its own. I opted for home blood sugar monitoring for 2 weeks in lieu of the 3-hour test.

      • I know this is old but I think it’s absolutely insane that a serious healthcare professional could ever recommend skipping an OGTT with a straight face after failing the one hour screen. other methods aren’t standardized for a reason. The A1C test is bogus for diagnosing this. I’m the perfect example – an A1C of 4.6 at 10 weeks pregnant and I was diagnosed with GD at 27 weeks. My one hour screen was in the 170s. I gained 8 pounds only to that point. A1C means almost nothing in this context except assuring me I didn’t have pregestational diabetes. My A1C throughout my pregnancy never went higher than 4.8 but I definitely had to watch the carbs. I always recommend your book to people but I’m really dismayed to see this post, which basically perpetuates the stigma that only overweight people need to take GD screens seriously.

        • I actively encourage ALL women to get tested for gestational diabetes – that may be via a glucola/OGTT or it may not be. As explained in this post, an OGTT is not 100% accurate in all cases, particularly if a person is eating a low-carbohydrate diet. This is why other methods of testing are options.

          For example, in clients who cannot tolerate an OGTT (such as after bariatric surgery or with hyperemesis gravidarum), and in-office fasting blood sugar (venous sample) combined with home blood sugar monitoring are used. As a certified diabetes educator who specializes in gestational diabetes, I can assure you that an OGTT is not the “only” method for diagnosing gestational diabetes.

          A detailed and evidence-based discussion of all the screening options for gestational diabetes, can be found in Real Food for Pregnancy.

  2. Wow, Lily. What an incredibly valuable experience. I personally think you made a good decision to do the test because the results (and our reactions) teach us so much about ourselves. Thank you for leading by example. Keep spreading the real food word.

    • It’s certainly been interesting, Briggite! Thanks for your support and following along. 🙂

  3. This was super helpful! I’m about to go in for my glucola test and I’m nervous about it. This pregnancy I’ve been craving more sugar than usual (even though I’m having a boy) so I’ve had to be very careful with how I eat. Before pregnancy, I ate a lot less sugar. Time will tell but now I know to watch my hand soap and do my own research. Thanks!

    • Glad it was helpful for you, Kimberly! You can read about my experience drinking the glucola & why I decided to go for it here. 🙂

  4. Oh my god – thank you for writing this post! I, too, just failed the first glucose tolerance test and wonder if I really have gestational diabetes. My test result was borderline (143) and I eat a pretty clean diet without a ton of starchy foods and very rarely eat sweets.

    I really don’t feel comfortable doing a second glucose tolerance test with a whopping 100g of sugar. That just seems crazy to me. I don’t want to expose my baby to super high amounts of sugar if I already know my blood sugar was high from half the amount.

    I’m going to talk to my doctor about getting a meter. I don’t mind testing my blood sugar for the rest of the pregnancy if that’s what he suggests. I’d rather know where I’m at and manage it than worry. I’m also going to check out your online gestational diabetes course. Sounds like something that would help me out a lot!!!

    • Hope this gives you some extra info to discuss with your doctor when you make your decision, Lucy.

  5. Interesting read! I failed the one hour at 140 and got talked into the three hour. Had I gone with testing at home, I never would have been diagnosed, or “labeled.”

    Like you, I had all those thoughts running through my head.

    I’m also really fascinated by your comment that you’ve only seen one person diagnosed with a fasting of 73. I only had fastings between 68-75, typically just at 70 every day of my third trimester. I rarely had a two hour blood sugar above 95. I of course questioned the diagnosis, which my doc didn’t appreciate — it made for a terrible third trimester — and made me resent every single office visit. She told me it was “not uncommon” to see non-GD numbers in a “GD patient,” which makes your comment very interesting!

    • That’s probably thanks in large part to the way in which we diagnosed gestational diabetes at that office (75g GTT described above), which is more accurate than the 2-step method currently used in the States.

      Regardless of an official diagnosis or not, maintaining normal blood sugar is the ultimate goal, so you did a great job. But I’m sorry to hear it caused you so much stress. :/

  6. I have read in several places that a low carb diet often causes women to be more sensitive to the gtt and so that is why some women carb up prior to the test. Why do you consider that cheating when it sounds as if the gtt just is not an accurate way for women on low carb diets to test their blood sugar?

    • I personally wanted to see how my body responded to the GTT with my usual diet (moderately low carb), not tweak what I was eating just to “pass” the test. Like I explain in the post, this was as much for my own n=1 research than for anything. You can read all the reasons why I agreed to take the (imperfect) test in the first place in this post.

  7. Hi, Lily-

    I am checking my blood sugar at home. What do you think about fasting levels between 80-91 and two hour postprandial levels 80-98? I know that the fasting levels are slightly higher than your healthy recommendations above but the postprandial levels are lower than the same recommendations. Thanks!

  8. I’m from New Zealand. We do the 75gm 2hour gtt test here. I remember feeling so sick from the drink. I only just managed to hold out for the two hours and have my blood taken, then vomited my entire stomach contents as soon as I got home. I was confused because I wondered how much I had actually absorbed given that it seemed to all come out again! Sorry I know that’s unpleasant.
    My results were borderline so I started testing my blood sugars at home and I developed GD within a few weeks. I initially tried to go paleo and not eat starch to try control my levels. But the dietician told me I needed to eat carbs. 15 grams were the unit of measurement and I needed 10 to 12 units per day as a pregnant woman. I ended up needing insulin and though overall things went well I had a week of failed inductions, an emergency c-section delivery and then my baby had a week in NICU (for suspected infection, but his blood sugar levels were fine).
    So now I’m at the beginning of pregnancy #2 and I want to see if I can do things better. My boy is a happy, healthy, breastfed toddler who amazes us every day. I hope for this next child we’ll be able to have an easier pregnancy, delivery and start to life! So far I’ve quit sugar in natural and artifical forms, except for eating whole fresh fruit. I’m really struggling with nausea though so I’m still having some starchy carbs and trying to survive the first trimester. Have ordered your book and am looking forward to learn more.

  9. Well i did the 2 hour gtt… Didnt pass the 2 hour by 1 point. Being that i had GD with my last pregnancy… I didnt bat an eye. But 1 point? Whats your take?

  10. I originally took the 1 hour glucose test on December two weeks ago. They called the next day and said that I had failed. The range at My ob is 60-139. They reported that I was 227. They said as a result of such a high level, I wouldn’t need to even take the 3 hour test as it was definitive that I had gestational diabetes. This did not sit right with me for a few factors based on my lifestyle (more of a paleo/primal diet) and the woman who did my blood draw seemed a little distracted the whole time and even had the needle out of my arm at one point in that blood was pooling on my arm rather than going into the tube. Anyway, I requested the 3 hour test (this past week) since I needed peace of mind. My results were as follows
    -Fasting range 60-92. result 102
    **I took my blood sugar (with the glucose meter) 1 hour before I left for my test and the fasting number was 88 so the number they reported didn’t make sense to me
    -1 hour range 60-179. result 145
    -2 hour range 60-153. result 114
    -3 hour range 60-139. result 76

    I guess my question is, the whole thing doesn’t make sense. What do you make of it? My conclusion was that possibly someone reported the wrong number for my initial 1 hour glucose test and maybe it was supposed to be 127 instead of 227. Wouldn’t my number be much higher on the three hour glucose test at the 1 hour reading since it was 100g of glucose rather than 50g like the 1 hour test and also be higher because glucose levels naturally rise the further on in pregnancy you are? I’ve been frustrated with my OB practice and almost didn’t go back for this second pregnancy and this is just another thing that makes me question my decision to go back this time… if you have the time to give me your thoughts on the situation, I’d appreciate if very much. Thank you!

    • I’m really not able to give personal medical advice outside of a formal dietitian-client relationship. If you’re interested in understanding your results, what this means for your pregnancy and want my input, go here.

  11. Hi! I eat really well too and lower carbs and very minimal processed foods. My 50g test came back at 144. I didn’t want to do the 100g so I opted for home monitoring so far I have been in the 80s- low 90s (couple
    Times with higher carb meals) 2 hours post meals . Fasting between 77-80. I use the relion ultima meter. Do you think this is accurate? Thanks!

    • Sounds similar to my experience.

  12. I failed the 1hr with a 191 I was sure I would fail the 3hr but I didn’t, I passsed! my fasting was 83, my 1hr was 177, my 2hr was 124, and my 3hr was 115.. can you help me understand how my results were so different from the 1hr

    • The one hour test is not a fasting test, meaning it can be affected by what you ate prior to your appointment.

  13. Hi Lily,

    Thank you again for your continued work! I’m so glad you will be teaching at some midwifery conferences! What are your thoughts on a fasting and 2 hours post prandial option with 75g dose of real food? Also what are your thoughts on the 50g test alternative with jelly beans.


    • Good questions, Jen. Fasting blood sugar is definitely helpful to measure, especially given that even very minor elevations in fasting blood sugar are linked to a higher risk of macrosomia and fetal hyperinsulinemia (see the HAPO study). The jelly bean test or 75g carb meal has never been compared to a 75g glucose tolerance test in the research. I’d be more inclined to have a woman monitor her blood sugar for two weeks and include some high-carb meals during that time. That way you get much more information and a woman can see in real time how her blood sugar responds to different meals/meal composition.

  14. Would’ve been interesting to see how you would’ve responded to the 3 hour OGTT. I had almost the same numbers as yours(1 hour, fastings and post pranial), but was labeled GD because I failed the 3 hour too.

  15. Hello Lily,
    Is it possible to fail the 50g (not fasting) test but pass the 75g test ( bloods drawn fasting and 1 & 2 hrs after nasty drink)?
    This is my second pregnancy. I had gestation diabetes (glucose intolerance controlled with diet alone) during my first pregnancy. This time around in my first trimester I decided to test my sugars 1 hr after a higher carb breakfast and got a 9.9. This prompted me to ask my midwife for early testing. So unfasting I did the 50g nasty sugar drink. Got a 9.something 1 hr later. She sent me for the 75g and I passed. I’m really confused.
    No one seems to have enough indepth knowledge to answer my questions. Thanks for any clarification you can give. Genna

  16. Hi Lily,
    I was diagnosed with GD 3 years ago during my last pregnancy. I got a 147, and I believe the cutoff was 140. I failed the three hour as well.

    My fasting blood sugar was always in the 70s. I rarely exceeded the the maximum of 140 and usually tested in the 120s 1 hour after my meal. I tested for the rest of my pregnancy and controlled my blood sugar on diet alone. Since then I’ve lost weight, about 8 pounds (I wasn’t overweight to begin with) but my current BMI is 19.7. Three years ago my BMI 21.1, when I began my pregnancy.

    Anyhow, I felt more confident going into the test this time. I ate almonds and cashews three hours before the test, I was concerned because I was hungry when I drank the drink, but figured it would be fine. Well, according to my glucose monitor I failed spectacularly with around a 250. I haven’t received the official results yet, but I would be floored if they were any different. About an hour and a half later my glucose meter read 175. I went on a walk and when I got back my 2 hour result was 70. Back to fasting.

    I’m devastated and so confused. Prior to this test I’ve had my Hemoglobin A1c tested twice. Once last year in April, it was 5.5%. And then again at the end of December, it was 5.2%. I got pregnant 4 months after this test was done, and I continued eating the same way I did in December, which was mainly vegan. I try to adhere to a mostly Vegan diet, but I’m definitely not a vegan. I eat meat maybe once or twice a week and try to keep dairy about the same. During my first pregnancy I was not trying to eat vegan and ate a lot of meat, so protein doesn’t seem to be my issue.

    Do you have any advice or ideas about what is going on? My hemoglobin A1c is good, my fasting blood sugar is good, I eat a fairly good diet, and my weight is good. I feel so defeated.

    • I’d definitely follow up with your doctor and home monitor your blood sugar closely in the meantime. Any reading over 200 can be considered diagnostic of type 2 diabetes (though lab readings with a venous blood sample are necessary vs. a finger stick to make that conclusion). A1c is a not a perfect measure and can be inaccurate for a variety of reasons, like anemia. In short, definitely follow up with your doctor to ascertain what’s going on, but know that it can be managed. Best of luck.

  17. I’m a labor and delivery nurse in a high-risk L&D unit with several years of experience in a multitude of both and high and low-risk, as well as urban and rural settings and am currently in graduate school to attain my MSN degree and license as a Certified Nurse Midwife. I’ve held the position of Childbirth Community Educator. Although health professionals like myself truly strive to help our patients make healthy and educated decisions about their pregnancies, I’ve found that blog posts like these tend to send other pregnant women reeling. You sound like you lead a healthy lifestyle so you’re likely to be low-risk. However when an OB or CNM cares for all types of women, we rely on various screenings and diagnostic testing to ensure that nobody falls into the cracks. It’s been my experience that some women get hung up on their pregnancies and deliveries going a certain way (in part from what they read online) that they force themselves into these cracks and decline treatment for complications that they truly have, but wish they didn’t.

    Glucola is nasty-tasting, I feel you. It has things in it, okay. I’ve been researching plain-old Coke (caffeine-free) as an alternative. Not everybody likes coke. The idea is to attain some level of consistency to the test, while working within an office setting where certain amounts of supplies must be ordered within a budget. Is it perfect and ideal for everyone– probably not.

    The glucose challenge is the first step in the screening process and that is why practitioners will follow-up with the 2 or 3-hour. There are a number of patients with poor attendance of their prenatal visits that may skip this test due to inconvenience, as well as non-compliant diagnosed gestational diabetics, who do not follow a diet to control their blood sugar, do not test themselves at all, “forget their logbook at home,” and do not take the oral medications or insulin prescribed to them. You can imagine this is frustrating. That said, testing yourself several times a day at home for several weeks in lieu of the 1-hour GTT seems like over-kill.

    The biggest problem I have with this post is that you blamed the sugar in your soap for your high results. In the hospital setting we use rubbing alcohol wipes to clean the finger before the test, wipe away the first drop or two or three of blood with gauze, and then apply the strip to the finger. Alcohol is sugar so not doing this will result in a higher number. If you were to do the test accurately with this step, it would reflect a true reading that is not elevated due to the soap.

    Yes, if you are health-conscious and avoid sugar then the glucose test itself might affect you differently than a person who follows a different diet than you. It’s important because normal physiologic changes in pregnancy which cause mild fasting hypoglycemia, post-prandial hyperglycemia, and hyperinsulinemia occur to ensure a continuous supply of glucose to the fetus. Insulin is a hormone, and changes in levels of estrogen, progesterone, human placental lactogen hormone, cortisol, and cellular immune inflammatory cytokines through pregnancy affect changes in glucose and insulin production within different trimesters. Whether the woman’s body is not able to accommodate to these normal physiologic changes and results in the pathology of gestational diabetes is random, and does not care what you eat or how much you work out.

    Further, the abnormal results of testing, according to the American Diabetes Association and American Pregnancy Association guidelines are as follows:

    Fasting: above 95 mg/dL
    1 Hour: above 180 mg/dL
    2 Hour: above 155 mg/dL
    3 Hour: above 140 mg/dL
    Random: above 200 mg/dL

    • I agree with some of what you have said, and I disagree with several points as well. I actively encourage ALL women to get tested for gestational diabetes – that may be via a glucola or it may not be. I encourage you to familiarize yourself with the IADPSG diagnostic criteria, the normal physiology of blood sugar during pregnancy (insulin resistance is a normal phenomenon of pregnancy; hyperglycemia after meals is NOT), and to listen to some of the dozens of interviews I have done on gestational diabetes (or read my book) before jumping to conclusions about what I stand for. This post on gestational diabetes is a must-read, especially for clinicians.

  18. I also failed the glycols 1hour screen. My maternal-fetal medicine doc said, “the good news is that you really failed and we won’t have you do the three hour.” I was glad for that because, like you, I do not feel well when I have that much sugar. And fasting would probably be even worse. I was at 201 an hour after chugging the 50g glucola. Prior to this pregnancy I put myself on the paleo diet and stuck to it pretty closely for about 3 months. It was pricey and took a lot of work. I considered sticking to it through pregnancy but when the nausea hit at around 7 weeks, I gave up.

    All of my fasting numbers are in the 70s, although I do have one or two in the 80s in the last three weeks. I had one 1-hour post meal reading in the 150s. By 2 hours it seems that I’m always down to the 90s. I’ve had a few in the mid 120s after 1 hour and it’s always when I’m testing out a “treat.”

    So I’ve questioned what all this means and been dumbfounded by some of the advice that’s out there about eating more carbs just to be put on insulin. I’m not following paleo now, but because of that, I felt comfortable right away with eating less carbs. And my numbers show that this is working for me.

    So, do I really have gd?

  19. I just received my test results yesterday, I failed by 4 points. My score was 134, my doctor doesn’t have her patients do the 3 hour test after failing the one hour one. We just get referred directly to a diabetic doctor. I’m a little frustrated with this because I know many women will fail the first test, and then pass the 3 hour test with flying colors. I guess I just don’t want to have to treat myself like I have diabetes for the next 12 weeks of pregnancy if the first one hour test isn’t enough to actually “diagnose” someone with GD..ya know? I’m very conflicted right now with how I should proceed. Maybe I will just do something like you did with your 2 week experiment and see how I fair with that. On a side note, I really enjoyed reading this blog post! 🙂

    • It’s not evidence-based practice to diagnose with a 50 gram screening glucola. It doesn’t hurt to check your blood sugar at home (with or without GD), but you may want to seek a second opinion as to whether or not you have gestational diabetes.

  20. Hi Lily, I currently am pregnant with twins and this is my second pregnancy. I passed my 1-hour test with my first pregnancy, never paid attention to my carb intake then and no problem.

    I don’t like sweets, rice or bread since childhood. I in general do not eat a lot of carb in my diet, other than fruits (at least 1-2 cups of fruit) and whole grain (about 1/2 cup/meal for lunch and dinner), I sometimes skip breakfast or eat a small snack on the fly for the most part, but I never really counted my carb intake, so I don’t have a good idea how much carb I actually eat whether pregnant or not.

    This time around since finding out pregnant with twins, I have been more careful with my carb intake than during my previous singleton pregnancy. And I don’t really crave for carbs just like usual. But to add protein, I have added 1 more serving of fruit, greek yogurt, whole milk, a muffin with pork patty and cheese in the morning, and a protein bar (about the only thing that comes with a substantial amount of processed sugar that I eat), which all contain a good amount of protein needed for twin pregnancy, but also comes with additional carb, which probably pushes my total carb intake to somewhere around 180-200g/day total(?) simply with rough estimation. Even with 200g/day for twin-pregnancy, I feel like I am still somewhat low-carb?

    And here I am, failed my 1-hour test of 50g sugar with 164 (threshold 140), and immediately before the test I ate a banana and several large strawberries (ugh); failed my 3-hour test of 100g sugar with 79 at fasting (threshold 95), 196 at 1 hour mark (threshold 190), 201 at 2 hour mark (threshold 165) and 125 at 3 hour mark (threshold 145).

    Now I am diagnosed with gestational diabetes but I am so lost. What am I supposed to do with my diet? I already don’t eat much carb to begin with, how am I supposed to cope with that and provide appropriate nutrients to the twins? If you can help shed some light on this, that will be much appreciated!

  21. Very interesting read! I really appreciate all your research-based information and also your story.

    I was diagnosed earlier this week at 28 weeks with GD and am still working my way through the panic. I came into this pregnancy with a bit higher BMI than I should’ve, but since the beginning of it I’ve been dairy intolerant, and recently am also unable to tolerate gluten and eggs. I can’t even remember when I had ice cream last (actually, I think it was around week 7. I made a milkshake and got positively sick!!). I’m usually a sweets person but haven’t been able to tolerate most, and we’ve actually started eating Paleo for at least our dinners in the past month.

    My GTT 1-hour was 230 🙁 I haven’t seen my specialist yet but I’m curious to know if it’ll be a case of false positive or if I really do have GD since I’ve had so many issues this pregnancy. I’ve only gained 6 pounds so far, which is very unlike my first pregnancy.

    I’m actually surprised I didn’t have it (or, that it wasn’t properly diagnosed) in my first. I gained 70 pounds, had an over-9lb baby, she had low blood sugar for days after birth, and I had a very rough postpartum (constantly sick, yeast infections, digestive issues, etc).

    It’s all just so strange and hard to wrap my mind around!

    • Definitely follow up with your provider. I’m unable to give medical advice in this format, but from a general standpoint, any numbers over 200 in pregnancy are worrisome.

  22. I am 9-10 weeks, and after GD in my last pregnancy, I’ve been hoping not to go through that again. Last time around it was always my fasting numbers that were bad (and if I had morning cereal, that never helped).

    Well, I just took the 1 hour glucola 2 days ago, and I knew I probably failed because I was wiped out at my 2 year olds bedtime the last 2 nights – like seriously wiped out. I don’t eat sweets in general, and I am pretty good about avoiding processed foods, etc, (but not always about eating noodles). I was even 8lbs less at start of pregnancy over my last go round. (but still very slightly over normal BMI).

    However, my genetics are stacked against me. Both my mom and her mom had progressively bigger babies (and likely GD thought they didn’t test for that then), and my grandma had hypoglycemia.

    I did fail the 1 hour – with a 173, and they wanted less than 140. I’ve refused the 3 hour, and my type A engineer personality will do a good job at two weeks of data collection. They are asking for fasting numbers and 1 hour after starting each meal. Is there any reason to collect 2 hours after as well? Advice for data collection, reading, etc is appreciated. I’ve really appreciated this blog post, and wish I’d found this site the last time around.

    Anything I can bring to my doctors office for consideration is appreciated. I’m in Ann Arbor, MI so they are open to reviewing anything I might bring them.

  23. At my doctor’s office they told me to fast overnight prior to the one hour 50g test. I did and failed (160). I’ve since read that I shouldn’t have been fasting prior to the test. Could that have interfered with the accuracy of the result or could it mean that the test result was actually even more reliable because I hadn’t eaten?

  24. and what was your result after the 3hr test?

  25. Lily, thank you for this post. I am still frustrated (at 29 weeks) that my midwife discredited my request for an A1c panel at my 8 week appointment. I had done some research early on, but in the moment I felt I was “overpowered” in the hospital environment. I wish I was more empowered to stick to my request – but it also scares me how LITTLE healthcare professionals know about nutrition. Someone like me, who did NOT go to medical school has to do research and ultimately curates evidence-based criteria and has to bring this to their attention.

    Long story short – this post was very helpful for me to see your experience, as I am also eating a low-carb-high-fat diet, and have been doing so now for 6 years and going. I have been told several myths (from your 9 myths about GD post) about GD and it was as if they just picked it right from your other post.

    I opted out of the 1-hr 50g test (with a lot of lecture, appointment with a dietitian) and will be monitoring my blood sugar levels at home just as you did after your 1-hr result.

    I have wondered at times too whether my fasting glucose levels are “too low” ! Appreciate the information shared in this post as I can relate, as I eat a LCHF/keto/whatever it is called these days – diet of real, nutrient dense food.

    My fasting level was high this morning at 92 and that surprised me – I will check the soap (ha!) 2 hours after breakfast the reading was 87. It was interesting to see you did a little bit of “stress testing” as well with some meals having a higher carb-count. I may do this as well as I am curious, and will do sometimes a 1hr plus a 2hr reading – just for my own knowledge.

    Thank you again! I just discovered you via a Diet Doctor post and will be watching your lectures and reading more of your work in the days to come.

  26. Hi Lily,

    Thank you so much for the information on the blog! I too just received a false pos on my 1 hr OGTT, with an A1c of 5% and all normal blood sugars (70-80s), both fasting and after meals when checking on a home monitor.

    I am seeing my healthcare provider next week to discuss the results. Could you briefly explain why these false positives can occur in healthy women on a lower carb diet during pregnancy? She is not aware of this potential phenomena.

    Thank you for your time!

    • The pancreas adapts insulin production to a person’s habitual diet. It’s been documented since at least the 1960’s in the medical literature that a lower carb diet can lead to inaccurate results on a glucose tolerance test. I delve into this topic in detail in this interview with Robb Wolf.

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