Obstetrics- DM
harry206 - 05-12-09 10:51

A 29-year-old female who emigrated from India about five years ago comes to your office for a routine visit. The patient has no medical problems, and is on the 26th week of her first pregnancy. She is asymptomatic and takes prenatal vitamins. Her family history is positive for type-2 diabetes on her father"s side. She does not smoke or drink. She lives with her husband and works as a research assistant in a pharmaceutical company. She denies any over-the-counter medication use. On physical examination, she is five feet (150 cm) tall and weighs 180 lbs. (81 kg). The rest of the examination is unremarkable. Her one-hour blood glucose level after ingesting 50-gm glucose is 160 mg/dL.
After the appropriate evaluation, a diagnosis of gestational diabetes is made. A diet and exercise regimen is started. The patient says that she is usually compliant with her diet, but she occasionally overeats. Her weight gain and blood pressure during pregnancy are within normal limits. She checks her fasting and post-lunch blood glucose values daily. On the third week of dietary restriction, her fasting blood glucose values range from 90 and 110 mg/dL, and her 2 hour post-lunch glucose values range from 120-140 mg/dL. What is the most appropriate way to manage this patient?