Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Blood Glucose Tolerance Test

Episode Date: September 5, 2023

If you’ve ever been pregnant or pregnant-adjacent, you may have heard of the blood glucose test to check for gestational diabetes. Many pregnant people find the process unpleasant and gross — which has prompted some pseudo-experts to speak out against it. Dr. Sydnee discusses the new discourse surrounding the test, how it works, and why, if your doctor recommends it, you should honestly just get it done.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talkies about some books. One, two, one, not a sense, the escalant macaque for the mouth. Hello everybody and welcome to Saul Bones, Marital Tour of Miscite at Medicine.

I'm your co-host Justin McElroy. And I'm Cindy McElroy. You okay there Justin? You know Sid Jettlag. I'm Jettlag. I was out on the west coast. Jettlag, it's so tough. Fine, back from fourth Across the country doing shows. There is nothing more exhausting than jet lag,

except maybe watching our children without me or else. Yeah. Except solo parenting, running the household, going to work, taking care of a sick kid. She's okay now, by the way. Thank you. Where were you all when she was sick? That's my question. Where were you when I needed a moxacillin for a near infection, not me, but our child anyway, all as well. Justin, we're not talking about Burning Man this week. That is not what we're talking about. That will be the first time since I've been back. You have not been talking about Burning Man.

So imagine my surprise. I do want to say, I feel like for posterity, I wanna get this on the record that I feel like there's probably a future episode that may come, if you're not following what's going on out at Burning Man, which is this, I don't even know, it's a big art festival, music art, whatever, live your truth festival out in the desert. I don't know, I've never been.

But I've watched documentaries about it. But anyway, it rained and they're on these, they're in this like ancient dried up lake bed that's made of like alkaline dust. Yeah. And then it rained, which I guess it like never does there. And so now it's this sort of mud that no one can move in You can't walk in it. You can't drive cars in it. You can't ride bikes in it So everybody's just kind of there's like 70,000 people stuck there

Although I guess a lot of people have by now hiked out the five or six miles out in the mud to the road and to hitch hike back to like Towns every few minutes and they'll just be in another room and all here. Well another truck got stuck. It's wild to say the the reason it interests me from solvans. And this is why I think maybe there's a future episode here So I'm put again, I'm going on the record It so this stuff isn't like regular mud It's like a salt flat. It's really alkaline It's the opposite of acidic right? It's really basic and It's really alkaline, it's the opposite of acidic, right? It's really basic.

And it like the pH is nine or 10 or something. So anyway, if you get it on your bare skin for long enough, it can cause kind of like chemical burns almost. Like it draws on the moisture out of your skin and you can get big cracks like opening, right? Cause your skin gets super dried out. And a bunch of people are walking around barefoot. And what I started looking up is what kind of bacteria

specifically thrive in alkaline environments because there are bacteria like we used to think like most and most bacteria like neutral environments, you know, like the pH in the middle. Some like really acidic, some like really alkaline. The ones who like really alkaline that might survive out in those salt flats. Now there's all these cracked open feet wandering around. There may be a really unfortunate but interesting episode of solbugs. Pending.

I got it on my... No one at Burning Man can hear me because they're stuck there, but like, please don't walk around barefoot. Please don't. I'm moisture eyes a lot when you get home. So anyway, I just want to go on the record and say that, uh, because several people are like, have already actually emailed to say, is this a, is this a topic? And I'm not sure yet, but I'm digging into it. There may be.

There may, I'm watching the, the amount of time Sunday is spending following the proceedings of Burning Man. Is any indication she will find the topic. I just thought it was regular desert. I didn't know it was a salt flat. That's a whole other. I just didn't know that. I missed that detail. Anyway, we are monitoring the situation closely here at the HQ. We got the news desk is all over it. Yeah. I hope everyone's okay. I do not wish anyone ill will. I'm sorry that I'm fascinated by it because that makes it seem like I'm detached and inhuman. I do hope

everyone is okay. Yeah. You would hope that goes without saying, but I do not want anyone to suffer, but I am watching to see what will happen. We're not talking about that. There was another issue. There was a lot of discourse on TikTok about this past week. And Justin, probably not on yours, I get a lot of like medical TikTok. Some of it is because I've messed up my algorithm permanently for all of you. Some of it is like fake medicine, TikTok stuff. And then other, it's like people calling out fake medicine stuff. I get a lot of that, which is always interesting because then it kind of alerts me to something new and weird that's out there.

And there has been this discourse about the oral glucose tolerance test. Yes, I read that. Yes, the idea being that, and if you've ever been pregnant or if you're familiar with this test from a healthcare perspective or because you know somebody who's been pregnant, basically it's a,

and I'm gonna walk you through it, but it's a test we do to look to see if somebody has or is at risk for gestational diabetes, meaning developing diabetes while pregnant. I remember this test because you thought it was really gross. Yes. The stuff that you had to drink it, you had to yell. Yes. And right now, the discourse is calling into question both the need for the test and

then the method that we use to perform it, specifically how we go about it and if it's really necessary. Just to walk you through it real quick before I tell you why it is necessary and why we do it the way we do it because that's my thesis statement. Right. Not to spoil it. Yes. Let me just say that at the beginning. a statement. Not to spoil it. Yes, let me just say that at the beginning. Okay, so if you have certain risk factors, this can be a little different. We screen you first of all based on history, like when do you need to have this test done and will you have one or two tests and all the stuff. And then the other part is like what your result is from the test, whether or not you have another one done. Just to kind of give you an example, our first child was really big.

That's what it is. The most isolated thing it was a big baby. Yes, it was a big baby. So big that we ended up with a C section. My second pregnancy, my doctor decided to go ahead and screen me earlier for gestational diabetes based on the idea that even though my test during my, I got all my screening in my first pregnancy, I did, I followed all the rules, but it said I didn't have it. But then he was kind of like, I don't know, did we miss it? Your baby

was really big. Maybe we should check, put you in a higher risk category, basically, and stratify you a little differently based on that. And I still tested negative. So I still didn't have it. I still did have another very large child. So I just have large children. She wasn't, I guess she was pregnant.

They were both over nine pounds on it. Those are big babies. Big babies. Anyway, so when you're having the test done, the regular one-hour glucose tolerance test, this is what everybody is going to have done. If you, I mean, if you're doctor orders it, you should have done between 24 and 28 weeks of pregnancy. Basically, the morning of the test, you go to the lab, you drink a glucose solution.

So, it's specifically a solution made of 50 grams of glucose. They're different kinds of sugar, right? There's fructose and sucrose and there's all kinds of sugars. Glucose is what you drink in this test. Yes. Okay. Yes, it is the one that I- Oh, sugar's right, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, I drank was orange. I think there are other flavors. I did not enjoy it. I've never heard anybody say like, love that glucola.

I mean, it's just, it's an incredibly sweet. It's just sugar. It's just pure sugar. Our kids would love it. I found it difficult because I also was a little nauseous that morning. And so, you know, it's unpleasant. But anyway, after 60 minutes, they check your blood glucose level. They have like an expectation that your body should be able to tolerate that glucose load,

like get it out of your bloodstream and into cells where it can be used for energy. And so if that level is under 140, and this cut off, by the way, can vary a little bit from doctor to doctor. Like, if you go to a different medical institution, you might find them say 135. There's a little bit of variability there. But generally speaking, if the level's under 140, then your body handled glucose. So what you expect it to, if it's over that,

then you may have gestational diabetes and we need to do further testing. And then further testing is a three hour glucose tolerance test, which is very, very similar, except for you drink the first they bring you in, they check your fasting blood sugar, meaning no food. Then you drink the stuff, and then they check it at one hour, two hours, and three hours. And they have cutoffs for all of those.

What should a fasting blood sugar be? What should a one hour, a two hour, and a three hour? Got it. Right. Okay. Same idea, except for that one was 100 grams of glucose. But same idea. All of this, along with, you know, an appropriate history and physical exam and everything, can help

your doctor decide if you have gestational diabetes and then can help you manage it if you do, right? We've talked about diabetes before and I'm not going to get into like, because we have a whole episode on diabetes and how we have known about diabetes for a since ancient times. We have described things that we now call diabetes malitis. Yes. Justational diabetes is a little more recent. And I think it's important to talk about how we figured it out

because it helps us answer the question. Let's say that you listen to some of these people on TikTok who are urging you either not to get the glucose tolerance test or to do it your own way. That's what I'm starting to see are people who are saying like, one, you just shouldn't do it. It's unnecessary. And this is like a nuanced topic. They're accusing doctors of medicalizing birth unnecessarily. We're intervening with something that is a natural process, and we should leave it be. And to some degree, I understand that concern,

having gone through to pregnancies, there are a lot of times where you just feel like, oh my gosh, why are we, like, why do I, the birthing process? Why do I have to be strapped to a bed on monitors on my back if things are progressing as expected and there are no complications? And so there are lots of ways we could debate

different aspects of the way we manage pregnancy and birth and why it's different all over the world. And outcomes are different in different countries and we don't always necessarily do things the best way here. Sure, there's lots of room for that conversation. When it comes to the glucose tolerance test and diagnosing diabetes,

the reason we do that is that prior to our ability to diagnose and treat gestational diabetes, a lot of people died. It's just that simple. The outcomes before were really bad. Once we were able to appropriately risk stratified diagnosis and treat people, the outcomes improved. This really isn't one of those areas. There is a lot of debate as to the exact threshold and when to test and who to test at what we

could get into all that, but the idea that is important to diagnose and treat this is not, is not debatable. Right. And trying to replace that glucola because it tastes so bad with like, I've seen like fruit drinks and coax and smoothies. It doesn't make sense because it has to be a certain amount of sugar for a test to work, right? It can't be like something sugary.

It has to be an exact amount of sugar, a test to work, right? It can't be like something sugary. It has to be an exact amount of sugar, right? Yes, and it also is proposing that there is something inherently dangerous about the sugar glucose, which is not. Yes, which is not. And then of course, the other like thing they'll throw in there is and it's got a food dionet,

which like mine was orange, so I am assuming. Yes. Yes, there was a food di in it, which like mine was orange. So I am assuming. Yes. Yes. There was a food diet in it. But it's playing on this idea that food dyes are inherently bad. And we've done a whole episode before about how like we don't have proof that artificial food dyes are inherently bad. Generally speaking, like we have talked about specific issues, generally speaking, they're not. So, when did we first figure out justational diabetes? I mean, can you got to imagine like, there have always been big babies. There have always been babies that were larger.

I'm proof of that. I'm gonna have far back you go. Yes. It's weird then when you think about the fact that not only would there have always been larger babies, but if like in my case, my doc was very clear with us that our first born was not coming out. Not coming out. In a vaginal delivery. This was not gonna happen if you had been Live in the 17 or 1800s. This baby would just end up Maserated inside of you

He said that and then you would become septic and die. That is what he told us By the way, I will say like I know that sounds like a really Shocking thing. He's like the dude like this guy's the guy. He delivered me. Yeah, I mean, he knows what he's talking about. He's been, yeah, he was an incredible doctor. And part of why he was talking to me that way is because I am also a physician. He knows me very well. He not only delivered me and was my doctor and delivered our oldest, he also trained me

in medical school. Yeah, he does have No sugarcoding. No, and he knew that I understood and I was being resistant because I had a certain idea of how I wanted everything to go and of course the best laid plans. But anyway, anyway, it was all for the best. Everyone came out fine. Yeah, all good. So and that's true.

And I'm sure that happened and it's weird that 1824 is when we get the first report of a large baby and that kind of started to clue people in. Maybe we could look at certain things that predispose pregnant people to giving birth to these very large children that pose, especially in our prior to anesthesia and a sterile O.R. and all that kind of stuff, prior to our ability to safely do a C-section, if you can't get the baby out vaginally, that's catastrophic. I mean, that's what we were looking at. Was a catastrophic fatal event for patients and child?

These are catastrophically chunky babies. As a catastrophically chunky baby, myself clocking in at a vivacious 11 pounds at birth, I understand the threat that we pose. And I know that we cannot go unsolved. You can't let us big babies run around unchecked. Dr. Heinrich Gottlieb Benowitz. Don't start me on that guy. We all talk about him with the big baby meetings. At the University of Berlin, he wrote up a case report. And this was when, like, we see, again, I'm sure there were big babies, but there have always been. But there were time and memorial big babies. We're linking it to he wrote up a case of a 22 year old woman, Frederica Pave, who during her pregnancy, this was her fifth pregnancy, she had gone to her doctor

complaining of she was thirsty all the time. She could not stop drinking fluids. She was constantly thirsty. And we've talked about the idea of like studying urine on this show many times. We've talked about the urine, color, and flavor wheel. Remember that, you can go and you can diagnose lots of things by about the urine color and flavor wheel. Remember that? You can go. And you can diagnose lots of things by the smell color and taste of urine. And specifically,

she had cloudy, stale smelling urine throughout her pregnancy. And then when it came to time to give birth, she had a what was described as Herculine. Yeah. 12 pound baby. Yeah. That's even bigger than you. Justin. Uh. Even bigger than you. It's not about that. It's just about being a big baby, honey.

It's not about comparing specific carriages. And this is when you first start to see this like, this connection between, okay, there's some symptoms and some things that are happening during pregnancy, and we can see like the patient is reporting stuff to us that they're observing, and then the urine is a signal there's something else there.

And then we have this big baby, which of course poses a problem for us. Listen, we've been very clear about that, where we stand on big babies. And this was really like, and this was just one, and there were several case reports that he wrote up, but this really laid the groundwork for throughout the 1800s us beginning to understand and establish like there is some sort of diabetic state that happens during pregnancy.

And we're not sure who's going to get it, but we probably need to figure out how. And so I'm going to talk to you about the development of that test, but first we gotta go to the billing department. Let's go. The medicines, the medicines that I skill at my God before the mouth. Somewhere in an alternate universe where Hollywood is smarter. And the Emmy nominees for Outstanding Comedy Series are Jet Pacula, airport Marriott,

Cruffle, Dear America, we've seen you naked and Aula in the family. In our stupid universe, you can't see any of these shows but you can listen to them on Dead Pilots Society. the family. I'm Jesse Gorn. Society on MaximumFun.org. I'm Jesse Gorn. Bullseye is celebrating 50 years of hip hop by bringing you an entire month of brand-new interviews with rappers. That means cheesy. I put my pain in the music. Energy stone. You know, we get hops. We call them hops back then.

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You're not going to want to miss any of this. Is it weird that I really want to try some of that goop now? It's so gross. Yeah. It's so, it's sickening like sweet. Yeah. Like, could they put it in a snow cone for you? You just have to eat it really fast. I guess. And it would dilute it, wouldn't it? You're supposed to just get it down all at once. Like, it's about how your body tolerates the load. Right. I gotcha. So where were we said? Okay. So we're in the late 1800s. And based on these early observations and the fact that like, we were able at least at this point to take these urine samples that we knew smelled a certain way. And again, like we're not too far removed from the time when people would like dip a pinky and taste a drop.

Yeah. Because that used to happen. And say this urine is sweet. It's sweet. There's sugar in it. Sorry. There's sugar coming out of this human into their pee. You got a big baby, bro.

And we already knew that sugar in your urine was connected with diabetes, because we already knew about diabetes at this point, right? Right. Like this was an entity. And now we're saying, okay, we have this person who before becoming pregnant, P was normal during pregnancy. Sweet P.

Sweet P. And so you get all of these sort of like a special unit was established in Scotland by James Matthews Duncan who started like to study these specific patients with these symptoms and monitor like what happens with these very, various diabetic patients, what is the outcome in their pregnancy? And what he was seeing is that from all of this, like he wrote up all of these observations, and this sort of underlines why we do this today, he saw that specifically, if you had this constellation of really thirsty pregnant people with this cloudy urine, and they have sugar in their urine. They figured

out they get these big babies and the mortality rates were like 60% for the pregnant people and 47% for the babies. So very, very high. And all of this was published in journals in the late 1800s to kind of underline, we need to figure out a screening test. But at that point, part of the reason there wasn't this big rush to figure out like, okay, how can we tease out the people who have gestational diabetes from those who don't, is because we still don't have a great treatment

for diabetes yet. So it's like highlighting it didn't make much sense. Yeah, like what are we gonna, other than knowing this could be catastrophic, like I don't know, you know, like you look at a pregnant person and say, okay, I can tell you from this constellation of things that you are very likely to have a giant baby that your pelvis cannot deliver. We are just at the point where we can maybe do C-sections, maybe, but even then,

like not everyone has access to it, not everybody can do it. So, I mean, what's the point? We found some ways of finding the big babies before this astroshawk, but didn't have a lot of great ways to getting the big babies out. Yes, and well, but we also didn't have a great way of managing gestational diabetes.

Oh, right. Because that can prevent having a giant baby. And there are other complications. I'm focusing on the size of the baby because you like to talk about that. But there are other complications. I'm focusing on the size of the baby because you like to talk about that. But there are other, like, part of what can happen in babies that are born to people with gestational diabetes

that isn't controlled, is that immediately after they're born, their bodies will, because they've been processing all this extra sugar from the pregnant parent. Their bodies will be producing all the insulin, but all that extra sugar isn't coming in anymore because now they're outside. And they become severely hypoglycemic, meaning low blood sugar. Inverse. Yes. So it is very common. And this is another thing that people get upset about. When a baby is born to somebody who's diabetic that they monitor their glucose levels You don't give it up. No, you don't give them a bomb bomb

And also just large babies if you remember ours were all babies get their sugar checked Large babies babies born diabetic parents that that you might have more monitoring closer monitoring Do you remember ours? Do you remember this happening? Our second. Yeah. She had her, her sugar was a little low. Oh, yeah. Remember?

Yeah. And I would have to like feed and they would check again and make sure it was okay. Yeah, yeah, that was a while. Yeah, this is why we're avoiding catastrophe that used to happen. And then we discovered insulin. And again, we've talked about this extensively in our diabetes episode in 1921, in Toronto,

Banting and Best, figured out how to get insulin from a dog's pancreas. And this was the beginning of our ability to manage diabetes and save lots of lives, right? Like this wasn't just about gestational diabetes. Like everybody with diabetes suddenly had a good way of managing it. We could give them the insulin that their body didn't have yeah, and Save lives. I mean because it before that it really it was a it was a mortality rate from diabetes in general was very high So we still need to figure out who's gonna develop it. Okay. Now we have insulin We can use it in gestational diabetes. Great. How can we's going to develop it so that we're not playing catch up?

Right? CP. And so it started with Dr. Priscilla White in 1949. She was working at the Jocelyn clinic in Boston. And she came up with a system called Whites Classification. And this was used for a really long time. And basically, it was like an alphabeticalist. And it was really a patient history-based.

So they were looking, it would be based on an interview. There wasn't necessarily any tests to do or anything like that. It was just, I'm going to ask you some questions and based on past pregnancies, based on your medical history. Do you have high blood pressure? Obviously, did you have your beddagnets at diabetes before Family history, like just stuff in the patient's history, they would give you a classification that would risk stratify you as to like, do we think you might develop diabetes? The doctor house says everybody lies. I saw that on your show.

Well, that's true. But patient history based is a, I mean, it's good. Patient history based screening is obviously critical in a lot of the decision making we make in medicine. But the problem too is that just station diabetes could affect people that you didn't necessarily predict. Mm-hmm. So there needed to be a nice standardized way

to check at some point in pregnancy, to just see if like, are you developing this and there was no way we could have known? I have an idea. What's that? What if I make him a super sweet goop and make him drink it? Well, that's exactly what happened in 1964.

I should mention though, it's not for science. I just love making pregnant people drink super sweet goop. It's kind of my thing. But if it helps science too, that's like a adipurk. I have to imagine the first people who tried this, like we're ready to throw it back in the researcher's face. You know I'm pregnant and I feel like crap and you want me to drink this. Well, maybe it was better then.

Maybe they were using like sprites syrup from the machine. It probably wasn't dyed. Like it probably wasn't. Why doesn't it need to be't. I don't know. I don't, I always wondered, you know, that, I don't know that point. Do you think like, it looks, it looks more like a drink that I've had in my life. If it was just a clear glucose substance, it's like drinking K-Rose syrup or something. Yeah, it's not fizzy or anything.

Yeah, yeah. You know what I mean? Yeah. It's like drinking K-Rose, syrup, or something like that. Yeah, it's not fizzy or anything. Yeah. You know what I mean? Yeah. It's like cool aid. Just getting thirstier and thirstier. We got to move on. So, John O'Sullivan and Claire Mahan invented originally the two-step oral glucose tolerance test. And basically, and this is, and when I say two step, I mean like a one hour and a

three hour, those are the two steps. So they were the ones who first standardized and came up with, will give you 50 grams of glucose. And then we will check your blood glucose in an hour. And then of course, in the second step, we check your sugar, 100 grams of glucose every hour for three hours. We check your sugar, 100 grams of glucose every hour for three hours. And the reason that we still use those amounts and those hour cutoffs and all that same criteria is because that's how they did the study. Any kind of screening tests we're using, not just screening test, diagnostic test, in order to come up with what's a positive answer and a negative answer,

unless we're just looking for something like, I guess, if you're checking someone's blood for bacteria, you don't really need a cutoff, right? It's either there or it's not. Right. But for a lot of other tests we do, we're using a... More of a gray area.

Yeah, we're using a cutoff range. So to know what a normal hemoglobin level is, they went out and sampled hundreds of thousands of people in the population. They just took their blood and looked at what their hemoglobin was. And this fell into a bell curve, right? Are you familiar with that? Yeah. Idea Justin, a bell curve.

Okay. And then they took the middle chunk of the bell curve and said, this is normal. And then everybody out of the tail isn't right? And so like that's where we get these ranges. And so when any any test that you're coming up against, if you're wandering like, well, why do we do it this specific way? It's because it was the way we did it when we first came up with the test. It's the way the test was standardized. And it's the only way that the test continues to work. If you do the test,

the data is dependent on this response, right? Yes. You can't compare it to other people's responses because the input is in standardized. We gave somebody who didn't have diabetes, we gave them a 50 gram glucose load, and then we checked their blood sugar in an hour. And then we did that over and over and over and over again, and we came up with what that cutoff number is. If you give somebody a pink drink from Starbucks, I don't know what their glucose level will predictably be in an hour.

I could give you some basic ideas based on, we kind of know how the body handles a sugar load and how a diabetic first non-diabetic person would handle that. We kind of have those ideas, but as far as like a perfect cutoff, of course I couldn't give you that because I never did a study where I gave a bunch of pregnant people pink drinks. And then not that you wrote down. I mean, you've done your own informal work. I tried the pink drink actually after pregnancy because there was a rumor that it would help with breast milk production. I don't really know that that is true, but I did like the pink drink. So, you know, there was that. I know. I just want to love the pink drink though. I've never seen you order one ever again.

No, I prefer coffee. Anyway, so that is why we continue to do the test that way is because back in 1964, when Osalvin first sort of wrote the cutoff values and everything that was diagnostic, this is how they did the test. There are different kinds of sugar in different beverages and foods and everything. Right. There are lots of forms of sugar. And they will, they will raise your blood glucose in slightly different ways to different levels and at different rates.

And so, and plus I don't know if you just say like I drank some Coke, how much and that's a different kind of sugar and exactly how you know how many hour or how many minutes have elapsed I can't use that diagnostically. So people who are advocating for you to Go against your doctor's orders and do the tests sort of in your own way You're not doing the test anymore. Yes, you're just drinking something. Yes. And so the data that your doctor gets to try to interpret will not mean anything.

And the risk of that is that you may be diagnosed with just station diabetes when you don't have it or you may not be diagnosed with just station diabetes when you do have it. And that's bad. Yeah. That for all the reasons we already talked about because the mortality rate of just stational diabetes was very high for both the pregnant person and the baby prior to our ability to test for it, diagnose it, and then treat it with insulin.

So anybody urging you not to do that. And now a lot of people point out there's been a lot of discourse through the years. We've had multiple like giant international workshops where they get experts, because basically we take all this data and then we get all of the experts together at a giant conference and make guidelines based on the data, right?

The data doesn't always. And just a wild part is that that just have chunky, ginnum baby bee conferences. I bet, you know, that'd be interesting to know The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always.

The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always.

The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always.

The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't always. The day doesn't. The day doesn't always. The day doesn't always. The day doesn't. The day doesn't always. The day doesn. The day doesn. The day doesn. The day doesn. The day doesn. The dayalongs by the fire. I bet dermatologists get the waters. You think? dermatologists. Everybody with perfect, touchably soft, creamy skin, the light reflecting off it. And just so, everybody's taking care of their look.

Everybody looks great. Everybody looks phenomenal. Looks like a friggin' hunger games. They've reached people up there with their perfect skin, incredible. Much of the golds up there. All right. I definitely think compared to a family doctor, when ours would be at a campsite, it would not be fancy because we're all, we don't make that kind of money.

Orthopedists would be wild too because they get drunk and be like, I want to fix any bones. I don't think they would get drunk. They take way too good care of themselves for that. They wouldn't drink. They'd be very well hydrated. They would all go, they'd all go jog together and then they'd lift.

They get high on lactic acid. They start fixing bones. Yes, they're healthier than we are. Anyway, so. Not healthier than me. I review video games. So they've held all these workshops through the years. I think this is important to bring up

because again, all of this stuff is nuance and you can't just acknowledge one side or the other. We have re-evaluated many times through the years from 1979 up to 2005. And then again, as of 2020, we've re-evaluated all of these guidelines over and over and over again. And different countries do manage this differently.

A lot of what I'm telling you is the way the United States has decided, you know, our medical organizations have standardized our care. There are other countries where they don't necessarily screen everybody based on the same criteria or at the same number of weeks. They look for different things. And the idea is there is a thought like, do you screen too much in the US, but there are other countries where we would argue

you don't screen enough because you're missing people and you're not managing their diabetes. So there's definitely room for people who are well-intentioned and understand the data who are experts in this field to sit and discuss and debate what is the best way to take this screening tool and apply it appropriately so that we save as many lives as possible. That's like a conversation we have about everything in medicine. But currently our best advice is do the test

when your medical provider recommends you do the test and do it in the way. Certainly, if you're going to do it, do it the way that they tell you to because otherwise like you've drunk some stuff, you got your blood drawn. Maybe you paid for it because it's the United States and we make you pay for medical care here. And if you did it wrong, it's meaningless and you've wasted your time and you got stuck with a needle for no reason. Like what's the point? If you're going to do it, do it right. And let me tell you, just do it. Just do it. Do the test. It's good to know. We can have a thing.

Maybe we'll have banana. You never know. Maybe we'll have banana. I don't know what flavors they have. Mine was orange. But before we had this amazing medical advance, the glucose tolerance test and insulin to manage diabetes, before that, a lot of people died unnecessarily. So that's why we do it. I think that's probably the best reason to do something in medicine because it prevents death. That's actually the first day.

They're like, why do we do all this? You would be asking, well, to prevent death. As long as we possibly can. Thank you so good job, Sid. Thank you so much for listening to our podcast. We hope you've enjoyed yourself. We hope that you'll have a wonderful rest of your week. Thanks to the taxpayers for using their song medicines

as the intro and outro of our program. And thanks to you for listening. That's gonna do it for this week on Soul Buzz. Until next time, my name's Justin McRoy. I'm Sydney McRoy. And as always, don't draw a hole in your head. Alright! Yeah! Maximum Fun! A work-around network of artist-owned shows,

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