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Gestational diabetes fasting hyperglycemia — USMLE Step 3 MCQ

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HardOB/GYNGestational diabetes fasting hyperglycemiaUSMLE Step 3

A woman at 30 weeks with gestational diabetes follows an appropriate nutrition plan. For 1 week, fasting glucose values are 103 to 112 mg/dL, whereas every 1-hour postprandial value is below 135 mg/dL. Fetal growth and amniotic-fluid volume are normal. Which pharmacologic approach is most appropriate?

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Reveal the answer and explanation

Correct answer: C — Begin basal insulin for fasting hyperglycemia and continue meal-time glucose monitoring

The best answer is “Begin basal insulin for fasting hyperglycemia and continue meal-time glucose monitoring”. Persistent fasting values above the pregnancy target despite lifestyle treatment warrant medication. Basal insulin addresses the isolated overnight hepatic-glucose pattern while avoiding unnecessary prandial doses; therapy is titrated using fasting measurements.

Reference: ADA Standards of Care: Management of Diabetes in Pregnancy: https://diabetesjournals.org/care/article/49/Supplement_1/S328/163919/15-Management-of-Diabetes-in-Pregnancy