HOMA-IR: The CRUCIAL Insulin Resistance blood test Doctors don’t use
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- เผยแพร่เมื่อ 30 เม.ย. 2024
- It's such a shame that this blood test, HOMA-IR, is not commonly utilized. Here's what you need to know...
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Thanks for telling what our doctors never do.
I asked my doctor for a HOMA-IR test and she yelled at me.
Needless to say, I never went back.
Why did she yell ? Curious
Mine didn't yell, she just told me "We don't test insulin". I used to get a full lipid panel and the original lab actually measured LDL. Then they changed labs and the new one calculated LDL. Then they changed again and used an el cheapo analyser which didn't report triglycerides. I queried this with my the GP and she told me "We don't test trigs as we don't have a drug for them". I've since
heard this from numerous other parts of the country.
Strange, because I used the trigs/HDL ratio as an indicator of insulin resistance. The numbers are on my other computer but I doubled my HDL and reduced my trigs to between a fifth and a tenth of what they were through diet. Eventually I was offered metformin but by then there was no reason to take it.
She was dead against my low carb/paleo/keto diet but did admit after ten years "By now we would have expected you to be on two or three diabetes medications".
@@chrischillingworth4812Was this in the UK?
@@1Flyingfist Yes.
@@chrischillingworth4812 Trigs/HDL ratio? Is that how I can figure out if I'm insulin resistant? Thank you.
I’m 58 and a low carb guy for years. My recent labs calculate my homa-ir at .68. Love your channel! Keep fighting the good fight!!
Fantastic work Scott! Well done
Thanks for the review regarding the Homa-IR test. My hubby has a high A1c and will retest in June. I will ask him to get this test. He has a low BMI 21.5 AND only eats WHOLE foods.. 50% which we grow....If I purchase anything with an ingredient label....I read it and understand the contents...Let’s hope his A1C is low like mine 4.5..
Love your channel!!!
@@Loriejean54 Hi, please be aware that the "A1C" test is an individualistic test. That is to say, the Hb-A1C/glaciation (A1C) level of the Hemoglobin ("Hb") your red blood cells(RBCs) is highly dependent upon your own personal turn-over of red blood cells, such that for one person a certain specific actual blood glucose average over a a period of time (x) with a average blood glucose level of y, but with a high turn over of RBCs... this person will have a markedly lower A1c than another person who hasthe exact same average blood glucose level over the same time but who has instead a relatively low turn-over of RBCs, as the "A1C" test is a measure of the degree of glycation (by the glucose in the blood). if the RBCs have a short life span and are therefore renewed/replaced by the body at a higher rate therefore, then they will have an "artificially" low level of glycation comparatively, so your A1C level is a personal thing and one should be careful of comparing your A1C level to the level that other people have. For example, there is a genetic component to the rate of RBC turnover, and also, the rate of turnover is largely impacted by whether one is menstruating (M or F? Younger
Female pubesent female/ menopausal female etc) and how heavy/low much blood loss there is typically for the individual, and if there is any other acute or chronic source of blood loss or RBC damage (for example some folks have a spleen that is a higher rate of destruction of RBCs than others - this can be either a natural process/phenomenen , or it can be due to either acute or chronic changes in the splenic activity or structure. Then there is the genertic conditions such as the thalacemias and the hemophilias and the degree to which the carrier/suffer of these is impacted by them... and so on and so on with so many other impactors on the RBC turnover rate..
So, to summarize, the A1C test - be careful in comparing ones result with reference ranges which are used to indicate a particular degree of Blood glucose derangement and therefore treatment. You might discuss with your doctor whether you would be better of with a continuous glucose monitor (CGM), which you check the calibration of with a finger prick test once a month or whatever you are advised by the manufacturer of the CGM. This will give you a more accurtae and trustworthy view of where you Blod glucose level is at on an ongoing basis (every 5 minutes automaically is not uncommon) - you can then have real time fedback on what the effect of different food stuffs on your actual realtime blood glucose level is - and you are then armed to avoid, or alter the portion of certain foods in favour of other foods, and you will be able to see the realtime effect of exercise, and sleep , and meditation and other lifestyle components on your blood glucose.
Really, A1c is believed by many to be old technology - a bit like how we used to have to phone the speaking clock on the landline in order to know exactly what time is it now, except with the A1C, it is not evn that that you are getting.
Anyway chat to your doctor. CGMs are in the region of 40 or so dollars / euros per month nowadays, so not wild expensive for what you are getting. Sorry about the spelling inaccuracies above - in a bit of a hurry :)
Tehre is a good "pubmed" article on it there at this link... www.ncbi.nlm.nih.gov/pmc/articles/PMC3912281/
... or if the link does not work, just go to pubmed and search for article number PMC3912281.
Good luck to the hubby, and yourself.
Well done
The book brain energy details how schizophrenia can be put into remission when insulin resistance of the brain is reversed.
When I first heard another doctor on youtube saying about how common Insulin Resistance is, I remember thinking "I'm glad I'm not one of those poor folks with Insulin Resistance." Wow, I was clueless. Now dealing with it.
Carnivore diet.
I.R. will be gone in a few months.
Same 😢
Never knew about this and thanks for the information. I am not a diabetic now but when I was told I am likely to get diabetes and given medication to improve my insulin levels, I asked for a test to measure insulin levels and I was shocked when the Dr said no one does it and symptoms suggested that my insulin levels were low. I did insist and got a insulin test and my levels were just fine. Fortunately an alternative medical Dr asked me to improve my metabolism rather than trying to increase insulin levels. Thank you Dr and can confirm from my personal experience that diabetes is REVERSIBLE
It's amazing how most Dr's have no clue what this test is. The last few Dr's said they didn't know about it and it wouldn't be covered by insurance. Ridiculous
Oh they have clue but there is no money in it. They want to prescribe drugs.
You can call your insurance company and see if they cover it.
They don't have a clue about a lot of things.
You can call your insurance company and see if they pay for it. Then ask your Dr. As they say in drug commercials.
Insulin resistance is at the root all metobolic dysfunction. Hyperinsulinemia and Insulin resistance always go hand in hand. You must control your carb intake
Very true Dave!
Most doctors don’t want to have this test done because they don’t know enough about nutrition to treat the results!
Benjamin Bikman wrote about this in his book Why We Get Sick. He mentions "glucose is the typical blood marker we use to diagnose and monitor diabetes, but we really should be paying attention to insulin levels first." Anyone, it appears, can have insulin resistance with normal blood glucose levels so the confounding variable would be insulin.
Great read👍
I thank God for the gift of you. My heartfealt gratitude for what you are doing and advocating re lifestyle and diet intervention to reverse diabetes rather than swallowing pill after pill. A great help. This intervention is normally not the usual default of most doctors nowadays. Again, thank you. May the Lord Jesus bless you more abundantly.
@6:00 the important rule about junk food: "Anything that isn't part of a cow goes in the bin". (i.e. the burger is the healthiest part! 🙂
Imagine if the public health regulatory agencies actually cared this much about our actual health and wellbeing instead of profits for corporations and the billionaires that ultimately own the corps and our politicians.
Drs. like Dhand, Berg, Syed, Osborne, Merik, Campbell, etc. are the ethical roadmap for how our public health should be run. Instead, they are run by corporate revolving door toadies. So sad.
I have TD1 and get bloodwork every 3 months or so. I've never heard of this test, but I will check my blood results. If not done, will make sure I get it. Going in about 6 weeks. Thank you so much!
One problem is now they are putting some kind of chemical substance, Apeel, on even organic foods supposedly to limit food waste but the chemical content is worrying.
Bill G wants everyone sick
Very worrying and causes inflammation in me.
Stop eating plants.
Problem solved.
Meat, eggs, butter/ghee, salt, water: has everything you need.
You might want to supplement with iodine because most soils that are not near oceans have been depleted of it.
Vitamin D3 + K2 is also recommended for anyone not at the equator.
Type 1 diabetic thankful I have an excellent endocrinologist who checks everything under the sun every 3 months
You on the Bernstein Protocol?
Try and persuade your doctor to order this test and then try and get your insurance company to pay for it. Unless you have Type 1 or Type 2 diabetes, good luck.
YOU can simply go order it for yourself and pay for it for yourself... It's not difficult... Most don't realize that you can have your blood drawn and have the lab test for all kinds of things (just like ordering at a restaurant).... You may have to pay for it, but so many are affordable or at least worth it.... Definitely try to get your insurance to pay for it first...
@@JavaZombieWell I suppose if you have a couple of hundred dollars in disposable income then go for it.
There are options. If you don’t know how much it costs, merely appreciate that someone is willing to post a helpful comment. Good luck.
@@TiredEmpathThere are no options. If the medical profession had the public’s interest in mind, and they don’t, this test would have been ordered in a heartbeat if the patient had or was bordering on obesity. In regards to this this video, it’s about 5 years too late. And the avalanche of diabetes is well on its way. Nothing is slowing it down. The insanity of poisoning our food is irreversible. Make food at the cheapest price to maximize profit. Big Pharma is loving this. If I were you, I would find out the companies that are developing synthetic insulin and invest heavily in them.
Ulta labs $12.95@@michaelbirke6050
I find PCPs generally "Reactionary" that is they are happy to hear your problem and prescribe a medication most of the time. I wish my PCP would have talked about diet when my fasting BS/A1c labs started going up. Instead I was told I was IR and given Ozempic. When I complained it would cost me $10K a year we finally agreeded on Metformin/Jardiance which Medicare mostly covered. Eventually I found some great TH-cam vids [like yours] that helped me understand that diet and exercise was most helpful in controlling BS and A1c. Had a struggle to get my PCP to order a Fasting Insullin test, which was 2.7, so my HOMA-IR is 0.6. Medicare now provides CGMs for free so I can experiment with diet, exercise and medication. Thanks for the HOMA-IR tip, hadn't heard of it before now.
I asked for a fasting insulin test when I had blood work checked but was refused - saying it was not necessary...Good luck everyone...It seems we do have to go to outside sources and pay out of pocket.... Thank you for bringging this to our attention.....
My HOMAR is 3.74, I have work to do. Thank you for the math equation.
Glad you were able to calculate it Sandra
Carnivore diet.
Will fix it in a few months.
I asked my, former, primary care physician to please place an order for me to have a Homa-IR test done. I also told her if my insurance didn't cover the cost I would gladly pay out of pocket. She said she could not order it and to check with my pharmacist. The pharmacist said she never heard of the test but if they had one it would be with the pregnancy and paternity tests. PATHETIC
A LITTLE knowledge is a dangerous thing. So why don’t they say I will look it up, as I don’t know.
If you have Lab Corp in your area, I believe you can request a test with them yourself
Thank you so much for the LabCorp suggestion. I'll check them out!
Thank you, Dr. Dhand.
Another informative video. Thanks doc!🙏🏽
Doc thankyou for caring
There is a channel on TH-cam about a person with schizophrenia trying keto.
So far she's been able to reduce her meds considerably
My 8yo son is a type 1. Oh how I wish I could just change his diet to change it. We eat Paleo, his health issues really opened my eyes to the SAD.
Same here. I'm a Type 1 and I think Type 2's are lucky.
@@evolveyourself9518 💯
Good info. I will look into the HOMA-IR test.
Thank you 💕 for useful information,
Thank you, Dr.Suneel Dhand, your so right.
Thanks for such an educative video. Good work being done by you.
Thank you Doctor. Aussie Bob 😊
my Doctor had not heard of it.. I had to send him more info and he agreed to order it!
Thank you, your such a blessing to many. Never give up.
I just recently had my fasting glucose and fasting insulin done. I found an online homa calculator and mine is 1.8.
Thank you, thank you for finding the calculator! Mine is .6, even though my A1C is 5.8. WHEW! All this is so scary when you hit 70!
@@kathryn5742 5.8 is fantastic.
I started Keto 4 years ago. Lost 46 pounds in 9 months. Kept most off for a while. Certainly didn’t stay super strict but probably eat 10% of carbs most Americans eat. Started gaining weight. Tried hardcore Keto again and nothing. Insulin level just hit 101. My calculated Homa IR 28, yes 28. 2 weeks into Metformin. We shall see. My point is, not always super easy to reverse. I’m 54.
Persevere, possibly look into intermittent fasting, OMAD (one meal a day), berberine (plant extracts) can also help for fasting and controlling blood sugar levels, carbs should be below 50grams/day
@@doejohn8674 IM, OMAD are really just caloric restriction. I lost 46 not doing any of that. Tried Berberine. Didn’t do anything.
THANK YOU Dr Dhand... 🙂👍 -70SomethingGuy
Excellent dr. I created health score on 10 parameters which includes 7 key blood tests.
Thank you Dr.Dand!
Mine came back as .7, I have been pretty strict animal based for 2 + years now.
I Didn't know about this Dr. Thank you🙏🙏🙏
VERY INTERESTING!!
THANK YOU!
Happy to help Donna. Best wishes, Suneel Dhand
Thank you Sunil once again for an excellent lecture
Très bons conseils merci
I never eat good. I’m but learning how to change. I’m going to now visit my doctor for a HOMA IR. Thank you.
A great presentation. I have educated myself because of Doctors like you and three others from US that have the same view about type 2 diabetes. I forced my GP to include Fasting Insulin Serum test for last three 6 monthly tests and my last test had a fasting glucose of 7.8 mmol/L and an insulin level of 2.7 mU/L. I also had an HbA1C of 6.5. Based on the above my HOMA-IR is 7.8x2.7/22.5 = 0.94, which shows I am insulin sensitive
I was on Diabetes medication for almost 20 years and I decided not to take medication, changed my life style, eat a Keto Diet with OMAD. I do not take any medications.
My GP says and insists I take medication because my fasting glucose is way above the 5.8 and my HbA1c is greater than 5.8. I am 65 years old and since the day I changed my entire life style, never has any diseases for last 5 years.
I see how ignorant my GP and many other GP's of my friends.
In simple terms, I might consider myself as a borderline diabetes case, but insulin sensitive. I have told my GP, I will not take any medication for diabetes.
Also just for the record, I don't take any medication at all and have had good health for last 5 years since I changed my diet, lifestyle and exercise regimes.
Choosing to eat natural foods like fruit and vegetables and other non processed foods can get us back on the healthy choice, away from insulin resistance with or without the blood tests. Sounds good to me.
Modern fruit varieties have much higher levels of sugar than previous ones, I think fruit needs to be consumed in moderation. I mostly avoid it. The vaccine left me very sensitive to anti-nutrients in plants, so now I can only tolerate a few vegetables.
Fruit helps insulin resistance?
Hello Mcfly!
@@zamfirtoth6441 Basically bags of sugar water with a few vitamins and flavonoids.
Brilliant dr. Suneel I can attest my dr. Did not want me to have this test, I had to pressure another dr. To get my fasting insulin test so I could then work out my home-if number
Many many thanks Doctor Sir.
Gratitude Dr. Suneel i think i have insulin resistance because if i eat high carbohidrate i have neuropathy in my feet, doctor send me to do fasting glucose but it didnt show nothing, my family are diabetic
I have a similar situation and am 58. To keep from prediabetes and insulin resistance as I am aging, the recommendations Dr. Dhand lists are crucial: exercise, low-carb diet, stress management, and good sleep.
my Dr. had no vlue so I had to order my oen fasting indulin test and do my own calculayion my HOMA-IR id under 2 my A2C is5.5
Thank you for this information and for all your videos. You are a true hero fighting for public health. 👍❤
As I'm not English speaking I have to listen carefully to understand and I wish there wasn't music playing in the background. It makes it harder. Sorry.
Based on my last blood workup my HOMA-IR is .98 so I'm happy. BTW, thanks for the formular for calculating the HOMA-IR.
Thank you. I did the math, I’m .8 I have been eating low carb for awhile now as well as regular exercise.
My drugstore food section would pretty much dry up without shiny packages of food. Maybe they can sell athletic attire or local activity center memberships.
Maddening the confusion in nutrition advice! Low carb versus whole food plant based, ugh! I tried WFPB for 6 months and became prediabetic and my triglycerides doubled, having always been in the low 70s! Just got my Kaiser blood results with a fasting glucose of 79 and insulin of 3. This is what my doc ordered to determine insulin resistance. Those numbers are in the normal range but my A1C is 5.8 still. Are they meaningless! Not a peep from my doc about any of the results. So where can I get this HOMA-IR test without a doctor’s order? Thanks for keeping us in the know. New to your channel.
You have the numbers. With a FG of 79 and Insulin of 3 your HOMA-IR is 0.59 (I used an online calculator), so probably not Insulin Resistant. Something else could be raising your BG. Stress or other illness, as well as diet. You need to check everything. Remember it takes a minimum of 3 months to see a noticable change in your HbA1C, not much point in testing more frequently.
Thank you!
Dr Suneel Dhand thank you so much for sharing this insightful and valuable analysis covering various aspects of diabetes management, especially the importance of HOMA IR profile.
It is really an objective and scientific test.My physicians didn't like me getting this test done.
Nevertheless I got this test done.It is a real time valuable test.🎉❤🎉❤
Hi Dr. Dhand. I learnt of the HOMA-IR on my own but my Dr. said New York state does not pay for it.. i went to india and had a teat at Tata labs and paid Rs 900 for it. Mine was .9. But nobody explained what it meant. Am I insulan resistant. Thank you. You are a great doctor.ñ
I have been on Carnivore for over 19 months. My HOMA-IR is 0.9 : Fasting Glucose is 78 and Fasting Insulin is 4.7. Unfortunately, my Hba1c is 6.1. Dr. Paul Mason has suggested in interviews that this could be the result of having longer-lived RBC, so to determine that, I will have a test for the number of reticulocytes in my blood next month (a reticulocyte count). If it is low, this could indicate that the majority of my RBC are living longer and therefore older, which would mean that they are also more glycated, skewing the results.
Thank you for the video!
Oh yes, great point! I've known a few people whose A1c was significantly different from what spot blood readings would suggest. Either higher or lower.
I admire your courage and honestly in helping us! I'm a T2 Diabetic and have to take 2 tabs a day... would the HOMA-IR test be useful to me and would the drugs not distort the results?
I have dr apt today!
I’ll be asking for this test.
Hi there, did you ask your doctor? What was the response?
Dr Dhand, Thanks for all you do to keep us educated during this insane times. Where can one go to get this blood test done(US residents)if your PCP don't order this for you? Thanks!!
Asked my GP as she said she wouldn't ask for it!!!
Low carb is the best. Ive lost weight and feel good.
How's this compare to proinsulin and testing of that. Thanks.
From Trinidad
Are there benefits to this test for people who've had diabetes for years?
I will be asking my complementary therapist about HOMA-IR at my next appointment. It is a real shame that big pharma and big food, are cashing in with products that addict the masses, to become affected by so many chronic lifestyle illnesses, that, someone has to be affluent, elite, or a well known celebrity in order to be heard, that it is not a privilege , to free from the the influence and lifestyle illnesses produced by big pharma and big food.
Hi Dr is NHS GP doin this test? Let me know.
Requested my doctor in the UK to do this test, they refused, stating it’s of no significance, but offered a blood sugar test instead...walked out and never returned....
First I have a question. Sugar makes me happy. If my depression starts to get bad, if I have a large serving of cake or cookies, I feel happy and it lasts many days. Yes, I have had psychotherapy and still take an SSRI. I have suffered depression since childhood, which is due to the situation I grew up in. Tapering off the SSRI causes me to crash and burn.' I don't want to use sugar,, or sleep deprivation. I do have hobbies and social activities. Any physiological guidance would be much appreciated. Note, I am no spring chicken 😁
On another and happy note, I have nearly cut out all flour products, and my joint aches and pains have gone away. I allow myself a slice of bread a day because I love breads so much and this keeps me from feeling deprived. I rarely have sugar. I rarely eat between meals. I made this transition a couple years ago. My typical meal consists of a protein and vegetables.
Valuable test. Question: one can lose weight and once you lose enough reverse insulin resistance (perhaps by reversing pancreatic infiltration by fat) but you can lose the weight by plant based (even the extreme potato diet) or by eating keto or just animal protein with veggies and fruit (skipping grains). Thoughts?
Is a C peptide test alongside blood glucose test equally good or better?
If so, what ratio of fasting blood sugar ( mg/dl) to c peptide (ng/ml) indicates high insulin resistance?
can i get this test done without going to a doctor ?
❤
My go has point blank refused to give me this!
Get a new doctor. Buy the Fasting Insulin test yourself if necessary. Figure out your own Glucose figure yourself, then look up the mathematical formula for HOMA-IR. Done.
Dump that doctor - they’re a dime a dozen
He mentions the formula @4:40
Homa Simpson? 😮
@@glennso47😂😂😂
Dr. Dhand. I’m in the UK and my Doctor will not order the tests that I want, even though I offered to pay for them. Do you know of a reputable company I and others can approach to have these tests carried out by? I am also searching for a good Functional Medicine doctor.
Dr. Dhand can you comment on the use of the carnivore/keto diet to reverse Hashimoto's thyroiditis? I have listened to a number of people say this diet can correct many autoimmune diseases because processed and other inflammatory foods are eliminated from the diet. What are your thoughts?
How many tests?
What purpose if you are oknand have no symptoms?
I have had a similar test by Labcorp. 0 means great 100 the worst. Low carb diet has moved me from 70 down to 40.
💕💕💕
What is the length of time(hours) a person needs to fast before the blood test?
My HbA1C rose to 6% despite eating a low carb diet, working out regularly, and staying at 12% body fat. Yesterday I asked my doctor about having my HOMA-IR tested, she had no idea what I was talking about 😒
I'm a dietitian, and let me tell you about my experience here. Sugar doesn't cause health problems, if... IF!!!! the fat in the diet is kept very low (
Hmmmm. I wonder.
@@albarb38 Don't wonder, read Kempner's data.
👌
I don't think pathology labs in Australia will take anyone without a referral. They would if they could, I'm sure! And charge like a wounded bull...
Agree. They were just doing IGT tests and no Doctor got my insulin levels checked. I got it done overseas and even that Dr was suggesting that no one gets Insulin levels checked but medication is decided on Fasting results as well as IGT
Thank you, you are amazing 😂
I ask for the HOMA-IR But my doctor said they don’t do this. Instead they have said they can offer the hbA1c blood test. Is this just as good??? I’m in uk in Yorkshire area.
I asked for this test last week. If you are poor and have Medicade forget about getting a test like this. The only way is to pay out of pocket.
🎉🎉❤❤
Well....for myself....i make a huge salad daily, dividing it into 2....one for am, and one for pm.
I chop up apple, avocado, jalapeño, onion, many spices, including nutritional yeast and blu/green algae, ground flax seeds, sometimes dry, Unsweetened coconut...I then add as much cut cabbage as possible, I use big bowls, and splash on extra-virgin olive oil and vinegar, either acv, balsamic or red wine vinegar.....mix and enjoy!! Sometimes I add nuts like walnuts, Brazil nuts or pecans.
Chill the other half for later, and I enjoy fresh food every day!! It's really delicious, but, it is time consuming, but I think it's Very worth it. ...I Make the time to prepare my nutritional cabbage salads! ❤️🥗❤️🥗❤️
that sounds wonderful and so very good for the gut
I do similar using MD Vegan’s garlic cashew nut dressing which lasts over a week in fridge.
Please do a video about formula for babies. I was shocked when the formula my granddaughter was getting that was “Number 1 recommended by doctors” first ingredient was corn syrup. So many formulas are juke with corn syrup and hydrogenated vegetable oil. No actual milk in the first ingredients. Setting babies up for diabetes. It’s so sad.
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Was always taught being overweight was a huge cause of diabetes . In my family my Dad and his brother both have diabetes 2 and are normal weight. His sisters are obese at minimum 100 pounds overweight and no diabetes.
Homa -IR is the same test as IR?
It surprises me I have never been tested for this (UK). I was told I had PCOS and was put in metform for years it gave me a lot of issues like feeling really unwell if I hadn’t eaten. They told me they couldn’t check it.
Get this. I'm registered with a particular UK practice, so is my son.
I asked for a FI test, I was refused but my assigned Dr could recommend a consultant to get the test. Fee: £145. I got the test done in the EU via walk-in clinic for £8. They emailed me the result the next day.
My son asked his Dr (in the same UK practice) and request was granted. Go figure.
It seems to me like the same racket as lawyers and barristers. You gotta go thru a lawyer to talk to a barrister. It's back scratching.
My ha1c was 41, i can't tolerate oř rat carbs daily even in every meal but without them i Have no energy ,no glykogen but with them fat And all That.
I did ask for this test but practitioner never heard of it so of course they were not going to request one for me. Do you know where one can get this test done?
Try asking for a fasting glucose and a fasting insulin and then do the calculation yourself. FG xFI /405
Dr Bozo, my husband’s GP, just told us that HOMA-IR is not necessary(pretending he knew what it was), when we asked. So, how to order it when an ignorant provider refuses to do it?
My husband and daughter start to shake if they they haven't eaten and have to eat something sugary, what that telling me.
Would this number help with determining gestational diabetes? Or fighting gestational diabetes?
*test