BC ADM Gestational & Pregestational Diabetes Management 2

Question 1

What are the ADA-recommended blood glucose targets for women with gestational diabetes?

Accepted Answer

Fasting <95 mg/dL, 1-hr postprandial <140 mg/dL, 2-hr postprandial <120 mg/dL

Answer

Fasting <110 mg/dL, 1-hr postprandial <160 mg/dL, 2-hr postprandial <140 mg/dL

Answer

Fasting <80 mg/dL, 1-hr postprandial <120 mg/dL, 2-hr postprandial <100 mg/dL

Answer

Fasting <100 mg/dL, 2-hr postprandial <150 mg/dL

Question 2

What is the preferred first-line pharmacologic treatment when lifestyle modifications are insufficient for GDM?

Accepted Answer

Insulin therapy because it does not cross the placenta

Answer

Oral metformin due to convenience and low cost

Answer

Glyburide due to its long safety record in obstetrics

Answer

Liraglutide as a GLP-1 receptor agonist

Question 3

Which insulin type is most appropriate for addressing postprandial glucose excursions in a woman with GDM?

Accepted Answer

Rapid-acting insulin analogs (lispro or aspart) dosed with meals

Answer

NPH insulin given twice daily

Answer

Regular insulin given 30-45 minutes before each meal

Answer

Insulin glargine given at bedtime

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?

Accepted Answer

Bedtime NPH or basal insulin to suppress overnight hepatic glucose output

Answer

Rapid-acting insulin at breakfast to address morning glucose

Answer

Pre-meal regular insulin at dinner

Answer

Twice-daily premixed insulin 70/30

Question 5

Why is glyburide no longer considered first-line pharmacotherapy for GDM in current clinical guidelines?

Accepted Answer

It crosses the placenta and is associated with increased neonatal hypoglycemia and macrosomia risk

Answer

It causes severe maternal hypoglycemia at therapeutic doses

Answer

It is teratogenic in the first trimester

Answer

It has no clinically meaningful effect on GDM glucose levels

Question 6

What macronutrient distribution is generally recommended for medical nutrition therapy in gestational diabetes?

Accepted Answer

33-40% carbohydrate, 20-25% protein, 35-40% fat (moderate carbohydrate restriction)

Answer

10-20% carbohydrate, 65-75% fat, 10-20% protein (very low-carbohydrate)

Answer

55-65% carbohydrate, 15-20% protein, 20-25% fat (standard dietary guidelines)

Answer

45-50% carbohydrate, 30% protein, 20-25% fat

Question 7

What is the most significant fetal complication directly associated with poorly controlled gestational diabetes?

Accepted Answer

Fetal macrosomia leading to birth trauma and shoulder dystocia

Answer

Spontaneous preterm birth before 34 weeks

Answer

Neural tube defects due to periconceptional hyperglycemia

Answer

Congenital cardiac defects from first-trimester glucose exposure