A gestational diabetic patient at 36 weeks has a fasting blood glucose consistently around 105 mg/dL despite dietary measures for 2 weeks. Her 2-hour post-meal glucose is 145 mg/dL. The NEXT management step per FOGSI/ADA guidelines is:

• A Initiate insulin therapy ✓
• B Continue dietary management for 4 more weeks
• C Start metformin 500 mg twice daily
• D Schedule elective caesarean section at 37 weeks

Explanation

ADA and FOGSI guidelines recommend pharmacotherapy (preferably insulin) when dietary measures fail to achieve glucose targets after 1–2 weeks: fasting BG ≤95 mg/dL and 2-hour postprandial ≤120 mg/dL. This patient exceeds both thresholds. Insulin is the preferred agent in pregnancy due to its safety profile, established efficacy, and absence of placental transfer. Metformin and glyburide may be used where insulin is declined but are not first-line in India.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.