BC ADM Gestational & Pregestational Diabetes Management 5

Question 1

A woman with GDM at 38 weeks has consistently normal fasting glucose but elevated 1-hour postmeal values. The most appropriate pharmacologic intervention is:

Accepted Answer

Rapid-acting insulin with meals

Answer

Isolated postprandial hyperglycemia in GDM is best treated with rapid-acting insulin at meals to blunt the postprandial glucose excursion.

Question 2

Which finding on ultrasound most specifically indicates fetal hyperinsulinism secondary to maternal hyperglycemia?

Accepted Answer

Fetal abdominal circumference > 90th percentile

Answer

Excessive fetal abdominal circumference reflects hepatic and visceral fat deposition driven by fetal hyperinsulinism, a hallmark of diabetic fetopathy.

Question 3

What is the recommended timing for the oral glucose tolerance test postpartum in women who had GDM?

Accepted Answer

4–12 weeks postpartum with a 75g OGTT

Answer

ACOG and ADA recommend a 75g, 2-hour OGTT at 4–12 weeks postpartum to screen for persistent glucose intolerance or type 2 diabetes.

Question 4

A pregnant woman with type 1 diabetes reports increasing nocturnal hypoglycemia in the second trimester. The best adjustment to her insulin regimen is:

Accepted Answer

Reduce basal insulin dose and increase bedtime snack if needed

Answer

Reducing the basal insulin dose targets nocturnal hypoglycemia, and a small bedtime snack can stabilize overnight glucose without causing daytime hyperglycemia.

Question 5

Which condition is a contraindication to expectant management beyond 39 weeks in a woman with well-controlled GDM on diet alone?

Accepted Answer

Suspected macrosomia with estimated fetal weight >4,500 g

Answer

Estimated fetal weight >4,500 g in a diabetic patient raises the risk of shoulder dystocia and brachial plexus injury, prompting earlier delivery or cesarean consideration.

(BC ADM) Advanced Diabetes Management Certification Practice Test

(BC ADM) Advanced Diabetes Management Certification Practice Test

BC ADM Gestational & Pregestational Diabetes Management 5