MARIA ELLAH C.

BELASOTO BSN 2A STUB28

Case Scenario: GDM-3

K.C. is 34 years old. She is a gravida 2, para 0. Her first pregnancy ended in a stillbirth. At her first prenatal
visit, her diabetes screening was negative. However, in her second trimester, she is diagnosed with
gestational diabetes. Her weight is appropriate for her height, and her weight gain has followed the
recommended pattern in pregnancy.

1. What risk factors does K.C. have for gestational diabetes?

● Maternal age over 35
● Macrosomia (fetal) previous baby was large…example: >9 lbs
● Multiple pregnancies

2. What test was probably used to diagnose K.C.'s diabetes?

● Oral Glucose Tolerance Test (OGTT)

3. K.C. has been advised to return in one month for another three-hour oral glucose tolerance test. What
should the nurse teach her about preparing for this test?
● 3 hour oral glucose tolerance test (administer if 1 hr ogtt abnormal)
• Patient comes back to the office on another day to have performed
• Fasting required
• Blood drawn at the following times: fasting (then will drink 100 gram glucose solution), 1, 2, and 3
hours

4. Why do you think K.C.s blood glucose was normal on her first prenatal visit, but became abnormal during
her second trimester?
● During the second to third trimester, as the baby is really growing (needing energy), its demand for
glucose starts to increase. The baby receives glucose from mom (glucose from mom’s blood travels
to the placenta, which delivers glucose via the umbilical vessels to the baby).
● Normally, the mom’s body (pancreas) can regulate and maintain normal glucose levels by altering
how the pancreas’ beta cells work (their size and number increases). As a result, there is enough
insulin in mom’s body to maintain a normal glucose level: proper term is euglycemia.
● However, in moms who develop gestational diabetes this regulation by the mom’s body is NOT
occurring correctly. This leads to more glucose hanging out in her blood and going to the baby. The
insulin cells just aren’t into using the glucose because they really can’t due to the hormones affecting
how insulin works.