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Gestational diabetes screening — MCCQE Part 1 MCQ

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HardPregnancyGestational diabetes screeningMCCQE Part 1

A 31-year-old at 28 weeks has gestational diabetes. After two weeks of nutrition therapy, fasting glucose values are consistently within target, but most one-hour post-breakfast values remain 8.8–9.5 mmol/L. Fetal growth is appropriate. Which treatment adjustment is most precise?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Add rapid-acting insulin before breakfast and continue nutrition therapy

Add bedtime basal insulin while leaving breakfast intake unchanged: Bedtime basal insulin primarily targets fasting glucose, which is already controlled. Begin a full basal-bolus insulin regimen at every meal and bedtime: A complete basal-bolus regimen adds treatment at times for which no hyperglycaemia has been demonstrated. Continue nutrition therapy alone until fetal overgrowth is documented: Medication should not be delayed until fetal overgrowth because maternal excursions already exceed treatment targets. Start an SGLT2 inhibitor before breakfast and continue glucose monitoring: SGLT2 inhibitors are not used to treat gestational diabetes because pregnancy safety and fetal renal concerns preclude this choice. Add rapid-acting insulin before breakfast and continue nutrition therapy: Rapid-acting insulin at the meal producing the excursion targets the abnormal value while limiting unnecessary insulin exposure.

Reference: https://guidelines.diabetes.ca/cpg/chapter36