A pregnant woman is found to have gestational diabetes mellitus (GDM). Her fasting blood glucose is 5.8 mmol/L and 2-hour post-glucose load is 9.2 mmol/L on OGTT. Initial management should be:

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Nursing QUESTION #9141

Question 1

Insulin therapy immediately
Medical Nutrition Therapy (MNT) + physical activity for 2 weeks, then reassess✔️
Oral metformin 500 mg twice daily
No treatment needed as values are within acceptable GDM range

Correct Answer Explanation

Gestational Diabetes Mellitus (GDM) — Diagnosis by OGTT (WHO 2013 / IADPSG criteria):

Test	Threshold	This Patient
Fasting	\(\geq 5.1\,\text{mmol/L}\)	\(5.8\,\text{mmol/L}\) ✓
1-hour	\(\geq 10.0\,\text{mmol/L}\)	Not tested
2-hour	\(\geq 8.5\,\text{mmol/L}\)	\(9.2\,\text{mmol/L}\) ✓

Initial Management (NICE/ADA guidelines):

Medical Nutrition Therapy (MNT): Carbohydrate control (40–45% of calories), low GI foods, 3 meals + 2–3 snacks/day
Physical activity: 30 min moderate exercise daily (e.g., walking)
Self-monitoring blood glucose (SMBG) 4× daily
Reassess in 1–2 weeks

Target glucose levels:

Fasting: \(\leq 5.3\,\text{mmol/L}\)
1-hour post-meal: \(\leq 7.8\,\text{mmol/L}\)
2-hour post-meal: \(\leq 6.7\,\text{mmol/L}\)

If targets not met with MNT after 2 weeks → Add insulin (preferred) or metformin. Insulin does not cross placenta; metformin does but is used in many guidelines.

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