Maternity Nursing: Antepartum Q 38

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Clients with gestational diabetes are usually managed by which of the following therapies?

  

     A. Diet

     B. NPH insulin (long-acting)

     C. Oral hypoglycemic drugs

     D. Oral hypoglycemic drugs and insulin

    

    

Correct Answer: A. Diet.

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Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. The initial treatment in these patients with Type 2 diabetes and gestational diabetes is by diet modification and in the event of failure of control with diet, the treatment is shifted to insulin to achieve tight glucose control with no risk of placental transfer.

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Option B: Insulin therapy remains the standard of care for type 1 diabetes, type 2 diabetes, and uncontrolled GDM during pregnancy. Regular insulin, insulin aspart, insulin lispro, and NPH have the most human pregnancy data.

Option C: There are significant concerns about recommending oral hypoglycemic agents in pregnancy because of their possible risks of transplacental passage and consequent fetal teratogenesis, hypoglycemia, hyperbilirubinemia, and polycythemia.

Option D: The pathogenesis of both gestational diabetes and Type 2 diabetes are insulin resistance and inadequate insulin secretion, and hence the beneficial role of sulfonylurea is evident.

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