Which statement best reflects management of insulin therapy in gestational diabetes?

Which statement best reflects management of insulin therapy in gestational diabetes?

• A. Insulin is never used in gestational diabetes.
• B. Insulin therapy is only used in the third trimester.
• C. Insulin may be required in the second half of pregnancy if glucose levels remain high.
• D. Oral hypoglycemics are preferred over insulin.

Answer: (C)

Gestational diabetes is managed with diet and exercise first, with meds added only if glucose stays high. The correct statement reflects that insulin may be required in the second half of pregnancy if glucose levels remain elevated despite lifestyle changes. As pregnancy progresses, placental hormones raise insulin resistance, so the mother may need exogenous insulin to keep blood glucose in target range. Insulin is preferred during pregnancy because it does not cross the placenta in a way that harms the fetus, while oral hypoglycemic agents cross to the fetus and have more variable safety data. So, starting insulin in the latter half of pregnancy when targets aren’t met with lifestyle measures is the appropriate step.

Gestational diabetes is managed with diet and exercise first, with meds added only if glucose stays high. The correct statement reflects that insulin may be required in the second half of pregnancy if glucose levels remain elevated despite lifestyle changes. As pregnancy progresses, placental hormones raise insulin resistance, so the mother may need exogenous insulin to keep blood glucose in target range. Insulin is preferred during pregnancy because it does not cross the placenta in a way that harms the fetus, while oral hypoglycemic agents cross to the fetus and have more variable safety data. So, starting insulin in the latter half of pregnancy when targets aren’t met with lifestyle measures is the appropriate step.