Which of the following is the most appropriate next step of management?

Your patient, a 25-year-old G1P0 female at 26 weeks gestation presents due to an abnormal glucose tolerance test. One week prior, she was given 50 g of oral glucose and demonstrate a venous plasma glucose level of 156 mg/dL one hour later.

Which of the following is the most appropriate next step of management?
A . Repeat the 50 g oral glucose challenge
B . Administer an oral, 3-hour 100 g glucose dose
C . Advise the patient to follow an American Diabetic Association diet plan
D . Begin insulin treatment
E . Order a fetal ultrasound examination

View Answer

Answer: B

Explanation:

Gestational diabetes is typically asymptomatic but identified via a 1-hour 50g oral glucose challenge administered at 24C28 weeks of gestation. A venous plasma glucose blood level of > 140 mg/dL is suggestive, and must be confirmed with a 3-hour 100g oral glucose tolerance test. After administration of the 100g glucose challenge, at least two of the following are required for diagnosis: (1) fasting glucose > 95 mg/dL, (2) one-hour glucose >180 mg/dL, (3) two hour glucose >155 mg/dL, and (4) three hour glucose > 140 mg/dL. Choice A C To diagnose gestational diabetes, a positive 1-hour 50g oral glucose challenge must be followed up by a three-hour 100g oral glucose challenge. The diagnosis is only confirmed after both challenges are completed and the thresholds are met. Choice C C Following the diagnosis of gestational diabetes, the first step is strict glycemic control (fasting glucose).