BC ADM Gestational & Pregestational Diabetes Management 2 — Questions and Answers
Question 1: What are the ADA-recommended blood glucose targets for women with gestational diabetes?
- Fasting <95 mg/dL, 1-hr postprandial <140 mg/dL, 2-hr postprandial <120 mg/dL (Correct answer)
- Fasting <110 mg/dL, 1-hr postprandial <160 mg/dL, 2-hr postprandial <140 mg/dL
- Fasting <80 mg/dL, 1-hr postprandial <120 mg/dL, 2-hr postprandial <100 mg/dL
- Fasting <100 mg/dL, 2-hr postprandial <150 mg/dL
Correct answer: Fasting <95 mg/dL, 1-hr postprandial <140 mg/dL, 2-hr postprandial <120 mg/dL
ADA GDM targets are fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, and 2-hour postprandial <120 mg/dL—stricter than standard non-pregnancy targets.
Question 2: What is the preferred first-line pharmacologic treatment when lifestyle modifications are insufficient for GDM?
- Oral metformin due to convenience and low cost
- Glyburide due to its long safety record in obstetrics
- Insulin therapy because it does not cross the placenta (Correct answer)
- Liraglutide as a GLP-1 receptor agonist
Correct answer: Insulin therapy because it does not cross the placenta
Insulin is the preferred first-line agent for GDM requiring pharmacotherapy because it does not cross the placenta and has the most established pregnancy safety profile.
Question 3: Which insulin type is most appropriate for addressing postprandial glucose excursions in a woman with GDM?
- NPH insulin given twice daily
- Rapid-acting insulin analogs (lispro or aspart) dosed with meals (Correct answer)
- Regular insulin given 30-45 minutes before each meal
- Insulin glargine given at bedtime
Correct answer: Rapid-acting insulin analogs (lispro or aspart) dosed with meals
Rapid-acting analogs (lispro, aspart) are preferred for postprandial coverage in GDM due to their convenient mealtime dosing and established safety in pregnancy.
Question 4: A GDM patient on a carbohydrate-controlled diet has persistent fasting glucose 105-115 mg/dL but acceptable postprandial values. What is the most appropriate pharmacologic intervention?
- Rapid-acting insulin at breakfast to address morning glucose
- Bedtime NPH or basal insulin to suppress overnight hepatic glucose output (Correct answer)
- Pre-meal regular insulin at dinner
- Twice-daily premixed insulin 70/30
Correct answer: Bedtime NPH or basal insulin to suppress overnight hepatic glucose output
Isolated fasting hyperglycemia in GDM is driven by unrestrained overnight hepatic glucose production and is best addressed with bedtime intermediate or basal insulin.
Question 5: Why is glyburide no longer considered first-line pharmacotherapy for GDM in current clinical guidelines?
- It causes severe maternal hypoglycemia at therapeutic doses
- It crosses the placenta and is associated with increased neonatal hypoglycemia and macrosomia risk (Correct answer)
- It is teratogenic in the first trimester
- It has no clinically meaningful effect on GDM glucose levels
Correct answer: It crosses the placenta and is associated with increased neonatal hypoglycemia and macrosomia risk
Glyburide crosses the placenta and has been associated with higher rates of neonatal hypoglycemia and macrosomia compared to insulin, leading most guidelines to recommend insulin as first-line.
Question 6: What macronutrient distribution is generally recommended for medical nutrition therapy in gestational diabetes?
- 10-20% carbohydrate, 65-75% fat, 10-20% protein (very low-carbohydrate)
- 33-40% carbohydrate, 20-25% protein, 35-40% fat (moderate carbohydrate restriction) (Correct answer)
- 55-65% carbohydrate, 15-20% protein, 20-25% fat (standard dietary guidelines)
- 45-50% carbohydrate, 30% protein, 20-25% fat
Correct answer: 33-40% carbohydrate, 20-25% protein, 35-40% fat (moderate carbohydrate restriction)
GDM nutrition therapy typically recommends moderate carbohydrate restriction to 33-40% of calories to control postprandial glucose while providing adequate protein and fat.
Question 7: What is the most significant fetal complication directly associated with poorly controlled gestational diabetes?
- Spontaneous preterm birth before 34 weeks
- Fetal macrosomia leading to birth trauma and shoulder dystocia (Correct answer)
- Neural tube defects due to periconceptional hyperglycemia
- Congenital cardiac defects from first-trimester glucose exposure
Correct answer: Fetal macrosomia leading to birth trauma and shoulder dystocia
Fetal macrosomia (large for gestational age) is the hallmark fetal complication of GDM, driven by excess glucose transplacental transfer causing fetal hyperinsulinemia and overgrowth, which can result in shoulder dystocia and operative delivery.
BC ADM Gestational & Pregestational Diabetes Management 2
What are the ADA-recommended blood glucose targets for women with gestational diabetes?