Diabetes in pregnancy (GDM, T1DM, and T2DM) Quiz: Ace Your Exams

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A 36-year-old woman, gravida 3, para 2, at 32 weeks estimated gestational age (EGA) with newly diagnosed gestational diabetes mellitus (GDM) presents for a routine antenatal appointment. A copy of her first glucose log is shown in the table below. She has a nutrition consult scheduled, but her appointment is not until next week. Aside from GDM, her pregnancy has been uncomplicated. Her history is notable for two prior uncomplicated pregnancies and term vaginal deliveries. Her only medication is a prenatal vitamin. Her pre-pregnancy body mass index was 27 kg/m2, and she has gained 24 lbs (10.9 kg) this pregnancy so far. Temperature is 36.7°C (98.1°F), pulse is 79/min, respirations are 18/min, and blood pressure is 126/85 mmHg. On exam, the abdomen is non-tender, and the fundal height is 32 cm. The fetal heart rate is 140/min. Which of the following interventions is most appropriate for reducing this patient’s risk of complications? 

Table: Glucose values (mg/dL) 

      Fasting     1-hr PP Breakfast     1-hr PP Lunch     1-hr PP Dinner    
 Monday     94     130     125     120    
 Tuesday     91     132     139     136    
 Wednesday     87     126     120     129    
 Thursday     92     118     130     135    
PP: postprandial 

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