COMMENTS
1. At
17.40 on
9 July 2010, Angi Stewart wrote:
Hi all, I'm a student midwife in Scotland. We also use Lucozade to do the gtt. But we tell the women that they must fast from midnight the night before. We then bring them in at 9am take a blood sample from them. Give them the required amount (which is measured out correctly using a sterile syringe) we them keep them in the unit for the allocated time, do another blood sample to compare to the first. Our ladies get the result the next day.
2. At
18.04 on
9 July 2010, anon wrote:
I don't know where Mr Smethurst's partner had her GTT, but if what he says is correct then the test may be questionable as to its reliability and validity anyway.
Perhaps the GTT across the Trusts need to be re-evaluated to ensure that it is of an acceptable standard.
At the Trust where I work, we do use original Lucozade for GTT's and the first test as we all know should be fasting being NBM since midnight other than water. The first blood test is taken and the lady is given the drink (measured by the member of staff attending her) and she is then asked to sit for two hours before repeating the blood test. It is requested that they do not walk around other than using the toilet during that time. The result is followed up by staff on the maternity day unit over 24-48 hours who ring the women to inform them of the result; FU by the diabetic team is then arranged if the result is high.
A bottle of original Lucozade is inexpensive and in today's market that is a consideration. Due to our pregnant population getting bigger with obesity, the GTT is a necessity and much more frequent and gestational diabetes is being picked up more frequently, helping to save babies’ lives. In many Trust's the women are expected to purchase the Lucozade themselves.
3. At
18.11 on
9 July 2010, Rebecca wrote:
That does seem a little strange. At our Trust we take blood, give out a specific measure of a glucose drink (not lucozade) and then wait 2 hours and repeat the bloods. Yes it means you have to wait around, but the test is pretty accurate. We also say to eat nothing before the test and they are all done first thing in the morning. Yes surely any food you eat will affect the reading?? Finally we get the results the next day and telephone if there is a problem or women can phone in. It seems to work for us.
4. At
18.12 on
9 July 2010, Midwife, London wrote:
At our unit women are asked to bring it in only if they prefer, and the amount and correct type is monitored by staff, women are advised NOT TO EAT BREAKFAST and to come to the unit early at 8 am, bloods are taken THEN the glucose drink monitored, women are then advised to get comfortable, and sit and exactly 180 mins after consuming the glucose drink bloods are retaken again and sent to the lab, women are then free to consume their normal breakfast and activities.
5. At
18.30 on
9 July 2010, Nikki wrote:
As a student midwife I was interested to hear your opinions regarding this topic. Whilst I can see that you have a valid point, the way in which our Trust carries out the GTT is slightly different to some of the points you have made. Firstly we ask women to come into the clinic and we provide them with the set amount of Lucozade, which they have to drink at the clinic before sending them off for 2 hours. We also advise women not to eat, drink, smoke or chew gum for 12 hours before their appointment, and we carry out all GTTs as early as possible in the morning so that no other factors come into play. I do however agree with your point regarding the content of Lucozade and I too share your concerns. I am sure that there must be a drink (albeit not particularly tasty!) that does not contain 'sunset yellow'.
6. At
19.15 on
9 July 2010, Amelia O'Leary wrote:
I've had this test in pregnancy in two different hospitals and was given the Lucozade at the hospital following fasting from 8.30 the previous evening. Only if your finger prick test is unsatisfactory do the hospital give you the drink and then ask you to wait for two hours. This is annoying and very tedious but seems to be far more satisfactory than the Lucozade at home scenario. I would not be happy with a diagnosis procured that way. I think the whole glucose tolerance procedure should be re considered and the use of Lucozade, especially uncontrolled, should be stopped.
7. At
19.29 on
9 July 2010, midwife in a South central hospital wrote:
At my hospital we do offer Lucozade - 310ml equivalent to 75g glucose. But this is done under a controlled environment in our antenatal day assesment unit. She must fast from midnight the evening before, which I’m afraid we have to trust the women to do so (as with any fasting test). We then advise the women to remain in our department for 2 hours resting and not exerting any energy to offer a true picture of how the body is coping with the hit of pure glucose. It sounds as if the control of the test is being missed and you are right giving a skewed result.
8. At
21.38 on
9 July 2010, Midwife F wrote:
Dear Steve,
I think I just wanted to make the comment that perhaps the trust where your wife is experiencing her care is a little different. Where I trained as a midwife, women were invited in first thing in the morning having been asked to starve from midnight, the test was done and before they left the hospital the blood results would be documented within the green hand held notes. At the hospital I trained we were also the ones to administer the drink in the correct quantity and were the ones that made sure it was the correct drink.
You raise a good point as I’m not sure why we use Lucozade- all I know is that it has to be a set sugar load (which was surmised from quite a lot of research) – perhaps women found it an acceptable way to deliver the sugar... I’m only guessing here.
9. At
22.23 on
9 July 2010, Catherine wrote:
As a midwife we performed glucose tolerance tests in the hospital. If we have had an abnormal glucose blood test we would ring the woman and invite her into to the day assessment unit for a glucose tolerance test. We explain they are to be nil by mouth from midnight the will required to drink a glucose drink (from the laboratory) specially measured out – and asked to drink the drink quickly. 2 hours later we would perform another blood test and give the woman a choice of a sandwich and a hot drink. Results are sometimes ready by the end of the day if not the next day - and she would be informed of results. (Meant to put that a blood test is taken when she initially comes in as well as at 2hrs after consumed glucose drink)
10. At
23.31 on
9 July 2010, anon write:
What on earth are you talking about? For a glucose tolerance test (which is what I presume you are describing), the woman should have nothing to eat or drink (except water, or black tea or coffee) from midnight, then attend early the following morning to have some blood taken (a fasting glucose sample.) She is then given a measured amount of glucose to drink (NOT Lucozade) and an hour later she has a second blood test taken. Who does anything else?
11. At
09.27 on
10 July 2010, Midwife, Norfolk write:
Some of this makes sense, but women are supposed to fast before the GTT, and have fasting blood sugars done, so I don't know whether Mr Steve is ill informed or did the test incorrectly.
12. At
10.46 on
10 July 2010, Jude Nicholas wrote:
I agree completely. Using Lucozade also gives a subliminal message that health service professionals approve of it in general. We use Polycal in the unit where I work and do a conventional 75g oral glucose tolerance test. Anything else is not evidence-based practice, as it is not recommended by NICE guidelines. As Steve points out accuracy is a hit or miss affair; and appropriate actioning of results is absolutely essential.
13. At
11.58 on
10 July 2010, regional midwife wrote:
Our unit does use Lucozade original, but the client must come in fasting at which time she will have fasting urine and blood testing done before we measure the amount of Lucozade for her to drink in front of us. We also have to document the timings very accurately.
Seems the way you have described does indeed leave a lot to be desired.
14. At
12.09 on
10 July 2010, student midwife wrote:
This is a very good point, and I fail to believe that this is the case in some hospitals. In the trust I work, the test is done in hospital, with a set amount of Lucozade (still this additive galore drink however!) after a fast from midnight. Surely it is time that all trusts tightened up to the same standard. I understand your point about the results, however with many people with unreliable and changing numbers, letter still seems to be a good and confidential way of informing people of results, however a choice of how to receive the results could be a good, and cost saving, option.
15. At
12.31 on
10 July 2010,
Hackney
midwife
wrote:
In our unit the women are asked to fast from 9 pm the night before, come in to the unit with their Lucozade at 9 am, have a fasting blood-sugar taken, then drink the Lucozade, and have another blood-sugar taken 90 (or 120) minutes later. The GTT should be done properly. Our practice should be based on research, and not as slapdash as described above. I do agree with Steve Smethurst that we should not force women to drink Lucozade. It is product endorsement. We should offer the women a glucose solution that the hospital provides.
16. At
14.30 on
10 July 2010, Diabetes
midwife wrote:
Sounds a very odd way of conducting a glucose tolerance test and definitely not the way we do it in my area!
17. At 10.42 on 10 July 2010, Jenny wrote:
Great comment. We use polycal, a measurable carton we provide. Good work, keep campaigning. Sometimes a lone voice does it... Let’s hope so. (J midwife).
18. At 20.39 on 10 July 2010, Gwen wrote:
When I had my glucose tolerance test 23 years ago I had to come in fasting (6 weeks after the birth) and then drink a measured amount of pharmacy prepared glucose drink... how we have progressed!!!
19. At 23.09 on 10 July 2010, Scottish Midwife wrote:
I am not sure where your partner’s test was obtained. I am a midwife and our women are fasted from midnight the night before the test and have a sample taken at 0900 hrs, which is a fasting blood glucose level. They are then given the correct amount of the original Lucozade by the midwife. 2 hours later another sample is obtained which allows a comparison between the 2 levels to give a more accurate result. Only after the second sample being obtained is the woman able to eat and drink as she wishes. The Lucozade drink is much more palatable than the glucose solution previously used for this test!
20. At 09.02 on 11 July 2010, a midwife wrote:
If it wasn't done and your wife had GDM you would complain... so please look at the positives as well.
Maybe in the hospital you go to they are using it incorrectly but please do something more constructive than berate the NHS in public when they are doing what they can with the lack of resources that they have!!!
21. At 09.02 on 11 July 2010, Midwife, Lincs
We use lucozade for Diabetes test but only after fasting for 12 hours!
22. At 10.14 on 11 July 2010, anon wrote:
I am a midwife, but 40 years ago I worked in the laboratories of a sweet known ‘sweet’ manufacturing company exporting all over the world. E110 was used then, as I recall, known as Sunshine Yellow. Many countries would not import sweets that contained this E factor thus recipes were adapted. There must be some research regarding this yet it is still being used as a colouring agent.
23. At 15.11 on 11 July 2010, Mary wrote:
‘Eat as normal before the test,’ I have worked in five different maternity units and never come across this advice. It was always fast from midnight, then attend ANDU next morning at 09.00 am for a fasting blood test, then drink the Lucozade 253 mls (replaced the glucose solution drink) administered by the midwife then it was half hourly blood sugar tests (5) which later became 1 hourly (2) to monitor the blood sugar levels rise and fall to see if it was within normal range. There is definitely a need to review the evidence and procedure for this test and for it to be standardised throughout the UK.
24. At 18.22 on 11 July 2010, Louise Stephens wrote:
This is not common practice throughout the UK. In the unit where I work the modified glucose tolerance test is performed after women have maintained a normal diet for 3 days, nil by mouth from midnight on the day of the test. The women then attend the antenatal clinic where they will consume the glucose drink Polycal, which is measured out by the midwife. The blood test for glucose will be then taken 2 hours after consuming the Polycal. Results are available the same day. Raised glucose tolerance will then be referred to antenatal day unit for a full glucose tolerance test.
With regards to women arriving late for the test then unfortunately most pregnant women are fit and well and have to take some responsibility for themselves!
25. At 18.35 on 11 July 2010, Angela wrote:
Are you sure you weren’t given a leaflet for a postprandial blood sugar? A test where you wouldn't have Lucozade but you are told to eat as normal beforehand and go for a blood test 2 hours afterwards. It depends upon your unit’s guidelines. But I do agree with you it does sound odd.
26. At 23.05 on 11 July 2010, a Yorkshire midwife wrote:
I completely agree Steve. It doesn't make sense. I think you will find that many hospitals do have sense and ensure women have a fasting blood test prior to taking an accurately measured pharmaceutical drink and then have a repeat blood test two hours later. Hopefully reducing inaccuracies. I can't understand why all units don't do this. Surely the few pence extra it may cost would be outweighed by accuracy of results and therefore only appropriate treatment.
27. At 11.38 on 12 July 2010, anon wrote:
I think people are referring to 2 separate tests. In my area we offer a glucose tolerance test to any women identified to be at increased risk of gestational diabetes whereby they attend the ANC and drink special glucose drink, with a fasting blood sugar prior to drinking it and another test 2 hours after. The ‘Lucozade challenge’ is offered to all women in the area at 28 weeks, regardless of any relevant history to assess how well they are processing glucose - it is NOT diagnositc of gestational diabetes and if it came back high then a 'proper' GTT would be done. The Lucozade challenge is not recommend by NICE and I agree with Steve - it is not at all scientific and should be changed!
28. At 13.27 on 12 July 2010, a Leicester midwife wrote:
I agree that there appears to be confusion about your wife's test. However, I think that using Lucozade sends out the wrong message – but this does save the NHS money by having to provide an alternative (very few women complain about buying the Lucozade.)
29. At 14.35 on 12 July 2010, Titi wrote:
Dear Steve,
You have helped to highlight the need for clear and concise leaflet by your Trust. Quicken reporting process to no more than 24 hrs to 48 hrs. The review of Lucozade use up and down the country in view of the ‘E’ content, and follow the NICE guideline. Well midwives, this is your chance to make a woman/ fetus friendly sugar drink for this purpose.
30. At 21.36 on 12 July 2010, Terri wrote:
It sounds like a pretty substandard test if the patient was allowed to eat before hand and then drink an unmeasured amount of the glucose drink.
We advise fasting then administer polycal, which has the correct amount of glucose in.
31. At 21.09 on 13 July 2010, a midwife wrote:
I have worked in a number of different units countrywide, and am puzzled by this couple's experience. It is many years since I used Lucozade. Our clients are asked to fast from midnight the night before, then come at 0800, have a fasting specimen, drink a measured amount of glucose (provided by the laboratory) dissolved in a prescribed dilution within 5 minutes and two hours after the initial specimen a second is obtained. The woman is then given 'breakfast' and her results are available later that day. She can then either phone in or will be contacted by us or her community midwife if follow-up is necessary.
32. At 22.22 on 15 July 2010, a midwife wrote:
I wonder whether some Trusts use Lucozade instead of the pharmacological preparation, as many women are unable to tolerate the very sickly concoction & vomit profusely, which must be distressing.
However if the trust has a policy of nil by mouth from 2200 hrs and fasting blood sugar before giving a measured result I cannot see what the problem is. I do feel that women should be told that they will be contacted as soon as, to tell them of an abnormal result. The GTT screener would be there all day otherwise ringing out normal results.
33. At 12.10 on 19 July 2010, midlife
midwife wrote:
The unit in which I work uses this letter format when performing a glucose screen at 28 weeks gestation. This is not a GTT. Only if the result is raised is a GTT performed, unless of course other health issues are identified which require GTT - twin pregnancy etc. This would of course require fasting from midnight, followed by a fasting blood glucose in the ANC and loading of glucose followed by a blood glucose estimation after two hours. Either a measured amount of Lucozade or powdered glucose is used depending on the client’s preference. If this is (as it sounds) the same format, we use the words glucose screen are used in the letter not GTT. The woman is contacted if the glucose screen is raised or is welcome to come to the clinic to check her results if she prefers. I agree it really does vary a lot between units. The obstetric/endocrine team agrees the policy in the unit in which I work.
34. At 08.19 on 1 September 2010, doctor wrote:
The
test described does not follow any guideline and is a short GTT and merely a
screen. WHO recommend a 75gm test after fasting following which a fasting blood
is taken, then tests at 1 and 2 hours after drinking glucose. I started using
Lucozade Original in 1991 for this purpose and was reprimanded by our
Diabetologist. I can find no evidence to support his stance. The test as
described will not be valid and may produce a false positive. The reason I used
Lucozade was that it's more palatable than NHS glucose drinks. As for the
colouring, children have drunk Lucozade since forever. We are now parents and
grandparents and if we were ever affected by it then it certainly didn't harm
my schooling, undergraduate nor postgraduate education. But maybe I would have
been PM rather than a doctor!
35. At
18.36 on
10 September 2010, Midwife from Cornwall wrote:
In our unit they started using Lucozade (supplied by the woman) as an alternative to Polycal if the woman preferred to. Some women found Polycal very difficult to tolerate and would vomit after drinking it, thereby rendering the test void.
36. At
19.42 on
11 October 2010, Lisa wrote:
I’m not a Dr or midwife, I’m 17 weeks pregnant and they use polycal in the maternity hospital where I’m going. Problem is I’m frightened of being sick and you say that many women are sick after consuming polycal. Is there any other alternative to polycal for gtt test please? Otherwise I will have to refuse the test.
37. At
19.14 on
11 January 2011, Bonnie wrote:
This is exactly how it was done at my surgery and they called it the ‘Lucozade challenge’. The first time I had this done was two years ago when my first was born. I have just had my Lucozade this morning (for baby 2). After drinking the Lucozade an hour before the blood test, I had forgotten the amount so I looked it up and one of the NHS surgeries said 265ml, which is what I drank. I later found the note from my midwife saying I was supposed to drink 273 ml (?!). Ooops. Oh well. Then the nurse was a few minutes late, so when I told her I drank the Lucozade about 1 hr 8 mins prior, she said ‘Oh then we should definitely get the bloods before I do the paperwork.’ Also, I was allowed to eat before the test. I agree it seems sort of unscientific - what if I ate a mars bar right before I took the Lucozade? (FWIW I ate a slice of wheat toast with peanut butter and a banana, an hour before I took the Lucozade.)
