I admitted a woman for a labor induction at 39 and a half weeks. This was her first baby, and I had the opportunity to review her prenatal record before her arrival. It was one of those lucky days on the unit where things could occur at a leisurely pace. I found a curious piece of information that was quite vague. Her “problem list” reported “glucose intolerance”. Her one hour glucose loading test was 142. Anything 140 or greater requires a follow up glucose challenge test. This was done as well, and 2 of the 4 values were elevated. Not borderline…. Clearly above the normal limits.
But no where on her record was Gestational Diabetes.
Her visit notes reported that she was checking her blood sugars at home with fair results. Diet and exercise were not cutting it, and so in the last two weeks she was started on an insulin sliding scale.
Now, call me what you will, but isn’t this diabetes? Unfortunately her doctor was not available to question when I was initially reviewing this information. Perhaps the words GESTATIONAL DIABETES just didn’t make it on paper.
Getting back to the patient…I escort her to her labor room and begin to discuss what to expect. I tell her that I have lots of questions for her, some that will seem repetitive, but I needed to make sure we had all the correct information.
She’s as pleasant as can be and answers everything I ask. I then said, “Well, it looks like you have gestational diabetes, correct?”
“No, I don’t.”
“I read in your prenatal records that you were checking your sugars at home and recently started insulin.”
“Yes, that’s true.”
“My understanding is that this is gestational diabetes,” I begin cautiously. I’m treading into some choppy waters here. Clearly something isn’t connecting, and I’m confident enough to believe it’s not me. Did her doctor never tell her she had diabetes? How was the blood sugar checking and insulin explained? Was this woman’s head in the sand?
“No, Dr. X said I have glucose intolerance, not diabetes.”
“Ok.” I look at her for a moment to gather whether I am missing something here. “So how come you are being induced today?”
“Because my doctor is afraid my baby is too big.”
Uck! My next favorite reason. But that’s a different story.
Once Dr. X is on the unit and has seen her patient, I ask about the blood sugars. “Did I miss a new criteria for gestational diabetes diagnosis?”
Dr. X looks at me funny. “What?”
“Well your induction patient down there seems to have it, but nothing in her record actually states it and she claims that it’s ‘glucose intolerance’”.
Dr X didn’t answer for a minute. “Well, technically it is glucose intolerance.”
Technically, I wasn’t buying this, as my understanding of the diagnosis of glucose intolerance is not used in pregnant women. I pointed out her glucose tests were clear cut for gestational diabetes. And then flippantly I asked, “What? You didn’t want to offend her?”