A nurse is caring for a client who is at 22 weeks of gestation and has been unable to control her gestational diabetes mellitus with diet and exercise.
Which of the following medications should the nurse anticipate a prescription from the provider for the client?
A Repaglinide
B Insulin
C Glipizide
D Acarbose
The Correct Answer and Explanation is:
The correct answer is B. Insulin.
Explanation:
Gestational diabetes mellitus (GDM) is a condition where a woman without diabetes develops high blood sugar levels during pregnancy. It usually occurs after the 20th week of gestation and is typically managed initially through diet and exercise. However, when lifestyle modifications are insufficient to control blood glucose levels, medication becomes necessary.
Insulin is the first-line medication for managing gestational diabetes when diet and exercise alone are not effective. Insulin is preferred because it does not cross the placenta, ensuring that the fetus is not exposed to the medication. This safety profile makes insulin the gold standard for managing GDM when pharmacological intervention is required.
Why Insulin Over Other Medications?
- Repaglinide and Glipizide are oral hypoglycemic agents that belong to the class of drugs called sulfonylureas and meglitinides, respectively. These medications work by stimulating the pancreas to produce more insulin. However, they are generally not recommended for use during pregnancy because they can cross the placenta and potentially cause fetal hypoglycemia or other complications.
- Acarbose is another oral hypoglycemic agent that works by slowing the digestion of carbohydrates in the intestines, thereby preventing blood sugar spikes after meals. However, it is not commonly used in pregnancy due to its limited effectiveness and potential gastrointestinal side effects, such as bloating and diarrhea.
The primary concern in managing gestational diabetes is to maintain blood glucose levels within the target range to reduce the risk of complications such as macrosomia (large birth weight), preeclampsia, and neonatal hypoglycemia. Insulin therapy is effective in achieving these goals without exposing the fetus to unnecessary risks.
Types of Insulin in Pregnancy:
Different types of insulin may be used depending on the patient’s needs, including rapid-acting, intermediate-acting, and long-acting insulins. The healthcare provider will tailor the insulin regimen to the individual’s blood glucose patterns.
In summary, when diet and exercise fail to control gestational diabetes, insulin is the preferred and safest option due to its efficacy in controlling blood glucose and its safety profile for both the mother and fetus.