4/5/05njm

Q. Are there alternatives to the oral glucose tolerance test? A
breakfast tolerance test?

A. Yes, there are several alternatives. Polycose is best. Mixed meals
are not a reliable.

The best tolerated and most accurate alternative method is the polycose
solution below. Polycose is an ingredient to infant formula.

Mixed meals with jelly beans or breakfast foods are helpful if the
patient is intolerant of other methods, but they are less reliable for
accuracy and precision. Please see the recipes for 50 g and 100 g loads
below.

######## Appendix A

**[Alternative Options for Screening]{.underline}**

[Regional center based screening]{.underline}

A.  Give 50 g of Polycose solution. Polycose is the best tolerated,
    e.g., no nausea, bloating, or lightheadedness and most reproducible.

> Polycose can be prepared ahead of time in the Pharmacy in the
> following manner:
>
> 50 g of Polycose\*, 50 mL of unsweetened club soda, and 1.5 gm of
> unsweetened lemon-lime Kool-Aid mix. Use standard blood glucose
> screening cut-off.
>
> \* This can be easily prepared in the Pharmacy: Polycose 50 g = 100 mL
> of 43% polymer solution
>
> (2 cal / mL)

B.  Give either 28 each Brach, No. 110, or 18 each of the Brach 150
    jellybeans per pound. Use

> standard blood glucose screening cut-off.
>
> Please note: This has poor sensitivity compared to Polycose.

C.  **[50 gram Breakfast load]{.underline}**

Menu

Two scrambled eggs (3 oz)

Two slices toast or one English muffin

Two pats of butter or margarine

8 oz orange juice

8 oz whole or skim milk

One cup coffee or tea (no sugar)

Contents

Carbohydrate 52 gm (210 kcal)

Protein 28 gm (110 kcal)

Fat 31 gm (280 kcal)

D. **100 Gram Carbohydrate Test Breakfast**

On the morning of the test, your breakfast must follow one of the three
breakfast

menus listed below [exactly]{.underline}. The right amount of
carbohydrate is needed for accurate test results. Take no more than half
an hour to eat breakfast. Eat nothing more until the test is over, and
do not take a nap. The blood sample must be drawn fasting, 1 hrs., 2
hrs., and 3 hrs. after you began to eat, so please note the time you
started eating.

Breakfast #1 Breakfast #2

½ cup cold cereal 10 gms 4 (4" across) pancakes 30 gms

(not sugar coated) 2 ½ tablespoons syrup 30 gms

1 cup milk 12 gms 1 cup milk 12 gms

2 slices toast 30 gms 1 cup orange juice or

1 tablespoon jelly 15 gms one small banana 30 gms

1 teaspoon sugar 5 gms Total: 102 gms

1 cup orange juice or

one small banana 30 gms

Total: 102 gms

Breakfast #3

"Lemonade" Mix:

¼ cup lemon juice 4 gms

½ cup sugar 96 gms

1 cup water \--

Total 100 gms

If you are unable to eat the types or amounts of foods indicated,
contact your clinic for help with substitutions.

####### **Village clinic based screening**

A variety of methods are being tried. The most accurate, is to send a
glucola drink to the health aide to be administered in clinic. A gray
top tube is drawn at 1 hour and the plasma separated off within 2-3
hours, refrigerated, and sent in.

Other options include:

Have the health aide obtain a capillary random glucose value by using a
portable glucometer. If a value of 120 mg/dL or greater is found, then
consult the referral physician.

Send a Standard 100 gram glucose drink to the health aide and have
him/her

administer half of it, followed by a 1 hour capillary glucose. If a
value of 120

mg/dL or greater is found, then consult the referral physician.

Have the health aide give a simulated glucola drink, made by dissolving
four tablespoons table sugar in eight ounces of water. Flavor with some
lemon juice, if possible. Follow with a 1 hour glucose determination. If
a value of 120 mg/dL or greater is found, then consult the referral
physician.

[Please note]{.underline}:

Table sugar, or sucrose, is metabolized differently than glucose. The
table sugar method is better than nothing, but sending out a glucola
bottle is far superior.

**Other Resources:**

**Alternate Carbohydrate Sources** page of

DIABETES IN PREGNANCY: PART 1: Screening and Diagnosis

[[http://www.ihs.gov/MedicalPrograms/MCH/M/DP08.asp#top]{.underline}](http://www.ihs.gov/MedicalPrograms/MCH/M/DP08.asp#top)

**Alternative Options for Screening**

[[http://www.ihs.gov/MedicalPrograms/MCH/M/DPao.asp]{.underline}](http://www.ihs.gov/MedicalPrograms/MCH/M/DPao.asp)

**Diabetes Mellitus in Pregnancy Screening and Management Guidelines**

ANMC Women's Health Service

(Look on Appendix 15)

[[http://www.ihs.gov/MedicalPrograms/MCH/M/documents/DMPreg102504_000.doc]{.underline}](http://www.ihs.gov/MedicalPrograms/MCH/M/documents/DMPreg102504_000.doc)

**Article References:**

[Bergus GR, Murphy
NJ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1580171&dopt=Abstract).
Screening for gestational diabetes mellitus: comparison of a glucose
polymer and a glucose monomer test beverage. J Am Board Fam Pract. 1992
May-Jun;5(3):241-7.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1580171&dopt=Abstract>

[Boyd KL, Ross EK, Sherman
SJ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8610782&dopt=Abstract).
Jelly beans as an alternative to a cola beverage containing fifty grams
of glucose. Am J Obstet Gynecol 1995 Dec;173(6):1889-92 (Level II-2)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8610782&dopt=Abstract>

[Coustan DR, Widness JA, Carpenter MW, Rotondo L, Pratt
DC](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3688066&dopt=Abstract).
The \"breakfast tolerance test\": screening for gestational diabetes
with a standardized mixed nutrient meal. Am J Obstet Gynecol 1987
Nov;157(5):1113-7 (Level II-2)\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3688066&dopt=Abstract>

[Dornhorst A, Frost
G](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10703798&dopt=Abstract).
Jelly-beans, only a colorful distraction from gestational
glucose-challenge tests. Lancet 2000 Feb 26;355(9205):674 (Level III)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10703798&dopt=Abstract>

[Lamar ME, Kuehl TJ, Cooney AT, Gayle LJ, Holleman S, Allen
SR](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10561636&dopt=Abstract).
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 (Level III)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10561636&dopt=Abstract>

[Landy HJ, Gomez-Marin O, O\'Sullivan
MJ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8598962&dopt=Abstract).
Diagnosing gestational diabetes mellitus: use of a glucose screen
without administering the glucose tolerance test. Obstet Gynecol 1996
Mar;87(3):395-400 (Level III)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8598962&dopt=Abstract>

[Murphy NJ, Meyer BA, O\'Kell RT, Hogard
ME](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884757&dopt=Abstract)
Carbohydrate sources for gestational diabetes mellitus screening. A
comparison. J Reprod Med 1994 Dec;39(12):977-81 (Level I)

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884757&dopt=Abstract>