A 30-year-old G3P2 obese woman at 26 weeks' gestation with no significant past medical history states that diabetes runs in her family. Her other pregnancies were uncomplicated. The results of a 3-hour glucose tolerance test show the following glucose levels:* 0 (fasting): 90 mg/dL 1 hour: 195 mg/dL* 2 hours: 155 mg/dL 3 hours: 145 mg/dLAs a result, she is diagnosed with gestational diabetes. She is counselled to start diet modification and exercise to control her glycemic levels. 3 weeks after her diagnosis, she presents her values:* Fasting: 95 mg/dL 1 hr pp: 185 mg/dLWhat is the best management?

Ans. is b, i.e. Start insulinRef. Dutta Obs. 7/e, p 285In the question patients GTT showedFasting =90mg/dL (upper limit =95mg/dL, i.e. normal)1 hour pp =195mg/dL (upper limit =180mg/dL, i.e. abnormal)2 hour pp =155mg/dL (upper limit = 155, i.e. normal)3 hour pp =145mg/dL (upper limit = 140, i.e. abnormal)Thus 2 values are abnormal, i.e. patient is a confirmed case of gestational diabetes.As indicated, she was put on diet modification for 3 weeks and after 3 weeks, herFasting value =95mg/dL2 hour postprandial =180mg/dLRemember: Metabolic goals of diabetes areFasting <=95mg/dL2hourPP <=120mg/dLIf these goals are not achieved by diet alone, insulin should be started.