The glucose drink in pregnancy is done between 24-28 weeks of pregnancy to test for gestational diabetes. However, more and more women are looking for natural glucose drink alternatives after looking into the glucose drink ingredients or simply to avoid the taste. Additionally, some women are against the logic behind how the glucose test works. Many women are beginning to search “glucose test 1 hour”, “glucose test 3 hour”, “glucose test pregnancy fasting”, and “glucose test at home”. So, let’s jump into all these things in this post to answer each of your questions and concerns.
What is Gestational Diabetes?
Gestational diabetes mellitus (GDM) is a condition that affects about 7-10% of all pregnancies [1, 2, 3, 4]. It is when your body doesn’t make enough insulin to keep your blood sugar levels in a healthy range after eating carbohydrates.
During pregnancy all women’s blood sugar levels are a bit higher because hormones from the placenta generally slow the hormone release of insulin which regulates blood sugars after carbohydrates are ingested. Some women can overcompensate for this physiologic change and are fine, while others, for different reasons, don’t overcompensate for the slowed insulin release during pregnancy.
*Insulin is a hormone whose job is to help glucose in your blood enter cells in your muscle, fat, and liver, where it is converted to energy.
Additionally, there are risk factors to gestational diabetes for women, one of them including an excess amount of weight gain or obesity in pregnancy. However, the diagnosis of gestational diabetes is less about an unhealthy weight in pregnancy and more about meal patterns and pairing. Women who go for really long periods of time without eating, eat inconsistently, or don’t have good balances of carbohydrates, fats, and proteins in their snacks and meals are more likely to have gestational diabetes and blood sugar issues.
For more tips, check out: 5 Ways You Can Help Prevent Gestational Diabetes
With gestational diabetes, the unregulated, excess blood glucose during pregnancy can cross the placenta and tax the developing baby’s system as he or she grows, possibly causing complications over time.
What Are the Risk Factors for Gestational Diabetes?
The risk factors for gestational diabetes can include:
- Obesity
- A family history of diabetes
- Having a history of gestational diabetes during a previous pregnancy
- Gaining a significant amount of weight in early adulthood and between pregnancies
- Gaining an excessive amount of weight during pregnancy
- Being pregnant with multiples, such as twins or triplets
- High blood pressure
- Polycystic ovary syndrome (PCOS)
- Taking glucocorticoids
What Are the Symptoms of Gestational Diabetes?
There are some early symptoms of gestational diabetes and general blood sugar instability. However, it doesn’t always come with obvious signs. Some women may experience:
- Extreme fatigue
- Increased urge to urinate very frequently
- Extremely dry mouth and constant thirst
- Nausea after eating (Check out the Best Remedies for Pregnancy Nausea here!)
- Tingling in hands or feet
How Does the Gestational Diabetes Test Work?
There are two different gestational diabetes tests that are typically used in the U.S. healthcare system.
The Glucose Challenge Test:
For this test, you will be instructed to fast for 2 hours beforehand. Then when you arrive in the office, you drink the 8-ounce orange Glucola drink within 5 minutes, which contains 50 g of dextrose sugar. One hour later, a health professional draws your blood and if your blood sugar levels are still high from the drink, your OB-GYN or midwife will schedule a glucose tolerance test.
The glucose tolerance test:
This test is also used for measuring your body’s response to glucose and determining how well your body handles lowering glucose levels after a meal. You will be asked to fast overnight to prepare for this test. Once you arrive in the office, your OB-GYN or midwife will measure your fasting blood sugar. Then you will drink an 8-ounce glucose solution with 100g of dextrose sugar, then you will have your glucose levels measured once per hour for the next 3 hours.
What Are The Glucose Drink Ingredients?
One 8 oz serving of Glucola may contain:
- 50g of dextrose sugar, an ingredient in corn syrup
- Purified water
- Citric acid
- “Natural flavor” According to the Food and Drug Administration (FDA) Code of Federal Regulations, natural flavors are created from substances extracted from these plant or animal sources [5]. Furthermore, “Natural flavor” may be used as an umbrella term similar to “fragrance” when looking for non-toxic products. This means companies can put multiple ingredients under this term without having to disclose what they added under “natural flavor.”
- Food starch modified
- Brominated soybean oil, which is banned in Europe and Japan because it can inhibit thyroid function, irritate mucous membranes (the membranes that line your body cavities and the surfaces of your organs and can cause neurological symptoms [6].
- Artificial colors and dyes, including FD & C yellow #6 for the 1-hour glucose test. And sometimes, Red Dye 40 has been seen on the ingredient list of the 100 g 3-hour glucose drink. The inflammatory effect of artificial colors and dyes is being studied. Although the amount in the glucola drink is minimal, many people want to avoid unnecessary exposure [7]. Furthermore, Red Dye 40 is a food dye made from petroleum. The Center for Science in the Public Interest has questioned the safety of Red Dye 40 as its consumption is thought to cause migraine and allergies [8, 9]. Additionally, synthetic food colors are thought to cause behavioral symptoms in children because they may cause chemical changes in the brain, inflammation from an allergic response, and the depletion of minerals, such as zinc, that are involved in growth and development [10]. With this, there seem to be growing numbers of mothers avoiding Red Dye 40 for their children and themselves.
- The preservative, sodium benzoate
- Sodium hexametaphosphate, a salt composition generally used in food as a texturizer, sequestrant thickener, and emulsifier [11].
Side Effects of the Glucose Drink in Pregnancy
Glucola has a lot of sugar in it. You may experience some brief side effects after you drink it, such as:
- Elevated heart rate
- A sugar “crash” once the energy from sugar wears off
- Nausea
- Feeling thirsty for water or wanting to drink something else to get the taste out of your mouth
Is the Glucose Drink in Pregnancy a Good Test for Gestational Diabetes?
Some argue that using the Glucola drink is not a good test to use for diagnosing gestational diabetes. The diagnosis of gestational diabetes often comes with a lot of shame, fear, and interventions such as induction of labor, so it’s important to keep these diagnoses for the women who truly have insulin resistance (serious trouble lowering their blood sugar levels after eating) with their daily diets and lifestyles.
The Glucola drink has more sugar in it than a bottle of soda, and for most women the Glucose Challenge Test and the Glucose Tolerance Test, shock their systems with an abnormally high number of sugars during a time when their bodies and hormones are physiologically different. Additionally liquid sugar gets digested much quicker than a meal with high sugar contents.
Most women aren’t drinking or ingesting 50 g of sugar at one time. So, it really is not an accurate representation of how the body handles a healthy diet daily. Instead, tracking your blood sugars for two weeks at home or the 2-hour postprandial test are good glucose testing methods for any pregnant woman regardless of a “good” it “bad” diet. For either, these could work great for you and your practitioner to assess if you have gestational diabetes.
Furthermore, for many women, getting their blood drawn is a stressful event that can increase cortisol, thus increasing blood sugar levels further and possibly giving an inaccurate blood sugar reading. On top of that, anybody who is really stressed and worried about this diagnosis and how it will possibly adversely affect their birth plans may start to feel worried if they feel bad from fasting and then quickly drinking 50 g of sugar on an empty stomach. They may view their feelings as a “bad sign” of having gestational diabetes, which can further increase their cortisol and blood sugar levels.
Is the Glucose Drink in Pregnancy Optional?
Every test in pregnancy is optional. However, since gestational diabetes can develop without some women noticing or having many side effects of the condition, most OB-GYNs and midwives will desire to do some form of monitoring and testing around 24-28 weeks to check on how your body is regulating its glucose intake.
At minimum, there should be a discussion about the benefits, risks, and alternatives to glucose testing and what gestational diabetes side effects can be, to make an informed decision. This process of discussion between you and your OB-GYN or midwife should be discussed regarding any and every test or intervention in your pregnancy, birth, and postpartum care.
Glucose Testing for Two Weeks At Home
An alternative some OB-GYNs are adopting are for women to track their blood sugars with at-home A1C testing (or a needle-free diabetes test, such as SugarBEAT) for two weeks regularly with their meals around the same 24-28 week testing period.
This glucose testing method likely leads to less diagnoses of gestational diabetes as this would be a more accurate representation of women’s daily blood glucose levels and insulin responses based on their individual diets and lifestyles.
The 2-Hour Postprandial Glucose Test:
The 2-hour postprandial glucose test
With a homebirth midwife it is common to have a 2-hour postprandial glucose test. This test is where you eat a specific meal planned with your midwife that consists of about 100 g of carbohydrates. For the 2-hour postprandial test:
- Your healthcare provider will give you instructions for the test.
- You will eat a specific meal planned with your practitioner that consists of about 100 g of carbohydrates.
- Tell your provider if you did not finish the meal or drink, or if you vomit.
- You will be advised to rest for the 2 hours before your blood is taken, as activity can give a false blood sugar reading.
- Do not smoke, eat, or drink during the 2 hours.
- Then, your blood sugars will be measured 2 hours after the meal with an at-home A1C test or a needle-free diabetes test such as SugarBEAT.
This can better represent how your body handles glucose when you eat a high carbohydrate meal compared to drinking 50 g of sugar, sometimes on an empty stomach.
Candy Alternatives to the Glucose Drink in Pregnancy
For the women who want to continue avoiding some of the ingredients that may be present in the Glucola drink, or if you just hate the taste from prior experience, you may want to try an organic candy alternative consisting of 50 g of sugar instead of the Glucola drink.
However, the only concern with this method is that there are different forms of sugar in these candies compared to the 50 g of dextrose sugar in the Glucola drink. Researchers don’t know if this can lead to missed diagnoses of gestational diabetes or not, as different kinds of sugars have different effects on blood sugar levels [12].
A research study from 1999 concluded that the important part of the glucose test is the 50 g of sugar, not the source. The results in this study were the same when a group of women given Glucola was compared to a group of women given jellybeans [13].
Organic Alternatives to the Glucose Drink in Pregnancy
Organic alternatives to the Glucola drink include:
- 60 of these organic jellybeans
- If you object to being tested for gestational diabetes with the Glucola drink because of the additives, another option is to buy organic dextrose, measure out the grams needed, and drink the dextrose dissolved in 8 ounces of water. Still, there is currently no evidence of doing this yet.
- 6 ounces of organic orange juice and 1 banana
- 16 ounces of orange juice
- Pancakes with organic maple syrup
- 10-12 ounces of non-GMO grape juice
- 10 ounces of non-GMO apple juice
- Fresh Test
- Glucoganics
So, You Have Gestational Diabetes. Now What?
If you have received the gestational diabetes diagnosis, I highly recommend seeing a prenatal nutritionist, and remember that this is a hormonally driven issue. There are things that can decrease the risk of gestational diabetes, but sometimes they still don’t work for everyone.
The prenatal nutritionist will help you with carb portions, pairing them, timing meals and snacks, and consistency of foods to help you regulate your gestational diabetes.
If your gestational diabetes can be regulated, you can carry on with whatever birth plan you desire. If it cannot, an OB-GYN or midwife may be a bit more concerned about some of the potential risks of gestational diabetes.
What Are the Risks of Gestational Diabetes?
The most common risks of gestational diabetes include macrosomia and hypoglycemia in the baby after birth.
Macrosomia is not just a “big baby” it is where the fat deposits in a larger baby are stored more in their shoulders, posing a risk of shoulder dystocia at birth. Again, big babies are not a risk for shoulder dystocia, but macrosomia is.
If your gestational diabetes is regulated with the assistance of a prenatal nutritionist, you should be able to carry on with whatever your birth plan was before your gestational diabetes diagnosis. However, if your gestational diabetes is unmanageable, this is where potential problems can arise.
Additionally, if you were an uncontrolled diabetic coming into pregnancy and have gestational diabetes, this is when practitioners see the even more serious effects like stillbirth and respiratory issues in babies and will likely talk to you about more interventions for your pregnancy and birth.
Have any questions or comments? Please leave them down below.
You are encouraged, educated, and empowered. Talk soon, mama!
– Katelyn Lauren
References:
[1] Xiong X, Saunders LD, Wang FL, Demianczuk NN. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001;75:221–8.
[2] Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: a systematic review and meta-analysis. J Diabetes Res. 2018;2018:6536974.
[3] Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30:S141–6.
[4] Adam S, Rheeder P. Screening for gestational diabetes mellitus in a South African population: prevalence, comparison of diagnostic criteria and the role of risk factors. S Afr Med J. 2017;107:523–7.
[5] https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.22
[7] Vojdani A, Vojdani C. Immune reactivity to food coloring. Altern Ther Health Med. 2015;21 Suppl 1:52-62. PMID: 25599186.
More References:
[8] https://www.fda.gov/industry/color-additives/color-additives-history
[9] https://www.cspinet.org/sites/default/files/attachment/food-dyes-rainbow-of-risks.pdf
[10] Stevens, L. J., Kuczek, T., Burgess, J. R., Stochelski, M. A., Arnold, L. E., & Galland, L. (2013). Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutrition reviews, 71(5), 268–281. https://doi.org/10.1111/nure.12023
[11] https://foodadditives.net/phosphates/sodium-hexametaphosphate/
[12] Wong JM, Jenkins DJ. Carbohydrate digestibility and metabolic effects. J Nutr. 2007 Nov;137(11 Suppl):2539S-2546S. doi: 10.1093/jn/137.11.2539S. PMID: 17951499.
[13] Lamar ME, Kuehl TJ, Cooney AT, Gayle LJ, Holleman S, Allen SR. Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening. Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1154-7. doi: 10.1016/s0002-9378(99)70099-2. PMID: 10561636.
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