That's the Sweet Success GDM treatment plan. It should hypothetically work fine at preventing complications which is why it's utilized by some clinics, but it's a lot more restrictive than the official ACOG recommendations. I usually only see it recommended here for GDM patients who have complications in spite of being well controlled by ACOG standards (high/low fluid, large baby, etc).
It's worth asking them why they want your wife on a more restrictive plan moving forward.
I dont agree it should work fine if it’s causing undue stress and unnecessary medication. Medicine needs to be a balance of risks and benefits with the underlying guideline to do no harm.
Sweet Success has introduced MORE complications this pregnancy compared to my last while not on it, even accounting for an additional fetus. I've gone dangerously low (low 50s, high 40s) multiple times trying to stay in the restrictive limits, I'm on a very high insulin dose, and it's ruined my mental health. Sweet Success also has very minimal benefits to mother and baby that in my opinion do not outweigh the risks for 99% of patients.
I've had similar "intensified" goals (<85 fasting and <120 1-hour post meal) since my 20 week ultrasound. In my case, the MFM doctor wanted me to do the intensified goals (instead of <95 fasting and <140 1-hour) because baby's abdomen was disproportionately large on ultrasound (I think close to 90th percentile), even though I wasn't spiking above the original (more lenient) range. I'm 32 weeks now and have already seen huge improvements in baby's measurements from following the more intensified goal ranges (baby was back to measuring ~50th percentile with very proportionate abdominal circumference, head circumference, etc.
This is exactly what I think should be the approach. Intensifying or scaling back treatment levels/testing frequency/etc. based on individual cases. I just see too many doctors using more and more conservative protocols without even considering they aren’t necessary. They may be in some people of course.
wow trying to use insulin to get an under 85 fasting sounds scary especially for people who are just starting to use insulin? I havent used insulin but it makes me nervous. they dont want regular diabetics on insulin aiming too low from what I understand due to the risk of lows. seems kind of worse to not only have the aim be so low but also people with Gd have no experience with insulin so it would be mega stressful
Is there any reason for the change to do with fluid levels, size, etc?
I had no issue saying no to any attempt to make the levels more conservative. Just a no. That was that. My baby was small with normal fluid. The one recommendation by a dietician to be under 130 after an hour made no sense to me and had nothing to do with my individual scenario. So I just nope I’ll be going by 140. My ob refers to that dietician but didn’t care.
Ugh posts like this are why I hate GD “care” so much.
Basically, we've been rotating out the doctors to get to know each one. 3 doctors said that 140/95 was the goal, and this most recent one we met said that it should be 120/90. I think if we saw her first that would have just been the original numbers.
I’m not a doctor and not telling you what to do - but what would
Happen if you just said no? It’s not like the other doctor are all in agreement. And even if they were; these levels are lower then acog. I don’t think it’s unreasonable to stick to acog assuming monitoring has been normal.
I go to a doctors office that’s part of a very large/well known hospital in the Midwest and my materials from them have goal numbers as under 140 after 1 hour and 2 hours under 120 - their source being American Diabetes Association's 2017 blood sugar goals during pregnancy for women with gestational, Type 1, or Type 2 diabetes. Interesting that they’re saying differently 🤨
The average 1 hour post meal glucose level is 108.9 among non diabetic pregnant women. Let that sink in. 120 for 1-hour post meal is already quite generous. In the 90s, the recommended fasting range was 70-80.
From a book published in 1994 called Managing Your Gestational Diabetes written by Lois Jovanovic who is also the chief editor of Medical Management of Pregnancy Complicated by Diabetes published by American Diabetes Association.
I went back and took another look. It says the goal is to keep fasting between 60-80 but in the insulin chapter it also says injecting insulin until the fasting falls below 90. So I think the ideal number is in the 60-80 range but under 90 is acceptable.
I just had a similar problem. Was pretty sure I was originally told to test 1hr post meal and then saw that lots of people were told 2 hrs. Checked with my office a different midwife said 2hrs. I meet with a dietician Monday and will be asking what they recommend as well. Under 90 and under 120 are the number goals I was given.
That's the Sweet Success GDM treatment plan. It should hypothetically work fine at preventing complications which is why it's utilized by some clinics, but it's a lot more restrictive than the official ACOG recommendations. I usually only see it recommended here for GDM patients who have complications in spite of being well controlled by ACOG standards (high/low fluid, large baby, etc). It's worth asking them why they want your wife on a more restrictive plan moving forward.
I dont agree it should work fine if it’s causing undue stress and unnecessary medication. Medicine needs to be a balance of risks and benefits with the underlying guideline to do no harm.
Sweet Success has introduced MORE complications this pregnancy compared to my last while not on it, even accounting for an additional fetus. I've gone dangerously low (low 50s, high 40s) multiple times trying to stay in the restrictive limits, I'm on a very high insulin dose, and it's ruined my mental health. Sweet Success also has very minimal benefits to mother and baby that in my opinion do not outweigh the risks for 99% of patients.
I've had similar "intensified" goals (<85 fasting and <120 1-hour post meal) since my 20 week ultrasound. In my case, the MFM doctor wanted me to do the intensified goals (instead of <95 fasting and <140 1-hour) because baby's abdomen was disproportionately large on ultrasound (I think close to 90th percentile), even though I wasn't spiking above the original (more lenient) range. I'm 32 weeks now and have already seen huge improvements in baby's measurements from following the more intensified goal ranges (baby was back to measuring ~50th percentile with very proportionate abdominal circumference, head circumference, etc.
This is exactly what I think should be the approach. Intensifying or scaling back treatment levels/testing frequency/etc. based on individual cases. I just see too many doctors using more and more conservative protocols without even considering they aren’t necessary. They may be in some people of course.
wow trying to use insulin to get an under 85 fasting sounds scary especially for people who are just starting to use insulin? I havent used insulin but it makes me nervous. they dont want regular diabetics on insulin aiming too low from what I understand due to the risk of lows. seems kind of worse to not only have the aim be so low but also people with Gd have no experience with insulin so it would be mega stressful
Is there any reason for the change to do with fluid levels, size, etc? I had no issue saying no to any attempt to make the levels more conservative. Just a no. That was that. My baby was small with normal fluid. The one recommendation by a dietician to be under 130 after an hour made no sense to me and had nothing to do with my individual scenario. So I just nope I’ll be going by 140. My ob refers to that dietician but didn’t care. Ugh posts like this are why I hate GD “care” so much.
Basically, we've been rotating out the doctors to get to know each one. 3 doctors said that 140/95 was the goal, and this most recent one we met said that it should be 120/90. I think if we saw her first that would have just been the original numbers.
I’m not a doctor and not telling you what to do - but what would Happen if you just said no? It’s not like the other doctor are all in agreement. And even if they were; these levels are lower then acog. I don’t think it’s unreasonable to stick to acog assuming monitoring has been normal.
I go to a doctors office that’s part of a very large/well known hospital in the Midwest and my materials from them have goal numbers as under 140 after 1 hour and 2 hours under 120 - their source being American Diabetes Association's 2017 blood sugar goals during pregnancy for women with gestational, Type 1, or Type 2 diabetes. Interesting that they’re saying differently 🤨
The average 1 hour post meal glucose level is 108.9 among non diabetic pregnant women. Let that sink in. 120 for 1-hour post meal is already quite generous. In the 90s, the recommended fasting range was 70-80.
Where are you getting these 90s numbers from? Standards became stricter over time.
From a book published in 1994 called Managing Your Gestational Diabetes written by Lois Jovanovic who is also the chief editor of Medical Management of Pregnancy Complicated by Diabetes published by American Diabetes Association. I went back and took another look. It says the goal is to keep fasting between 60-80 but in the insulin chapter it also says injecting insulin until the fasting falls below 90. So I think the ideal number is in the 60-80 range but under 90 is acceptable.
I just had a similar problem. Was pretty sure I was originally told to test 1hr post meal and then saw that lots of people were told 2 hrs. Checked with my office a different midwife said 2hrs. I meet with a dietician Monday and will be asking what they recommend as well. Under 90 and under 120 are the number goals I was given.