Question
A pregnant woman not previously known to be diabetic, who is at 26 weeks gestation, had a routine 50-g (GTT) with a 1-hour blood glucose value of 144 mg/dL. A follow-up 100-g, 3-hour oral GTT revealed plasma values of fasting blood sugar of 102; 1 hour, 180; 2 hours, 162; and 3 hours, 144. You should do which of the following?
| A. |
begin American Diabetes Association (ADA) diet and daily glucose monitoring
|
| B. |
repeat the GTT in the early or mid-third trimester
|
| C. |
start oral hypoglycemic agents in the diet
|
| D. |
perform an immediate Contraction Stress Test (CST)
|
Show Answer
[ads id=”53026″]
|
Correct Answer � A
Explanation
|
|
Ans. A
Many authorities advise universal screening of pregnant women with a GTT because at least one-third of women with gestational diabetes will be missed when only women who have risk factors for diabetes are screened. Based on the Fifth International Workshop-Conference on Gestational Diabetes, a diagnosis of gestational diabetes is made if two or more of the four values meet or exceed the following:
Fasting serum glucose concentration >95 mg/dL (5.3 mmol/L)
One-hour serum glucose concentration >180 mg/dL (10 mmol/L)
Two-hour serum glucose concentration >155 mg/dL (8.6 mmol/L)
Three-hour serum glucose concentration >140 mg/dL (7.8 mmol/L)
Since the fasting and all three other levels meet or exceed these values, this patient has gestational diabetes and would therefore be recommended to start an ADA diet (under the counseling of a diabetic nutritionist), monitor fasting, and postprandial sugars daily. If values consistently exceed 90 and 140 (1-hour postprandial), medications would be instituted.
Like this:
Like Loading...
