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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 1: Screening and Diagnosis
8. Alternate Carbohydrate Sources
Alternate screening strategies, like using Jelly-Beans or a standard 600 kcal meal as the "carbo load" are well tolerated, but significantly less sensitive. On the other hand, Polycose, a polymer of d-glucose, is both better tolerated and more effective.
Boyd et al used 18 Jelly Beans consumed within 2 minutes. That was approximately 2 ounces of Brach and Brock Jelly-Beans with 150 per pound. Lamar et al used 28 Jelly Beans (Brach No. 110 Jelly Beans). As with the use of other complex carbohydrates in solid form, Jelly-Beans have a different uptake than liquid sources of simple carbohydrates.
Coustan et al 1987 evaluated plasma glucose level determined 1 hour after the ingestion of a standard 600 kcal mixed nutrient breakfast (breakfast tolerance test). The mean plus 2 SD for the breakfast tolerance test was 120 mg/dl. If this were used as the threshold for a screening test, 75% of cases of gestational diabetes would be identified (sensitivity), while 94% of normal pregnant women would be excluded (specificity).
Murphy et al 1994 found that Polycose, a polymer of d-glucose, mixed with club soda and unsweetened Kool-aid was well tolerated, and similar to glucose in sensitivity and specificity. This confirmed earlier work by Bergus and Murphy. Polycose was an inexpensive alternative for GDM screening, while the use of a candy bar needed more study. Here are some tips on recipes for Alternative Options for Screening. (WORD 119k)
