A nurse is preparing to administer insulin to a pregnant woman who has gestational diabetes.

Which of the following types of insulin should the nurse use?

The correct answer is choice A. “I should check my blood glucose levels four times a day.” This statement indicates that the woman understands the importance of monitoring her blood glucose levels after delivery to detect any changes or abnormalities.Most women with gestational diabetes will not have severe hyperglycemia after delivery, but they should be followed for at least 6–12 weeks to determine their glucose status.

Normal blood glucose levels are between 70 and 130 mg/dL before meals and less than 180 mg/dL two hours after meals.

Choice B is wrong because “I should drink juice or soda if I feel thirsty.” This statement indicates that the woman does not understand how to manage symptoms of hyperglycemia after delivery.

Drinking juice or soda can raise blood glucose levels and worsen hyperglycemia.

The woman should drink water or sugar-free beverages if she feels thirsty.

Choice C is wrong because “I should report any vaginal discharge or itching to my doctor.” This statement indicates that the woman does not understand how to recognize symptoms of hyperglycemia after delivery.

Vaginal discharge or itching can be signs of a yeast infection, which can occur more frequently in women with diabetes, but they are not specific to hyperglycemia.

Symptoms of hyperglycemia include increased thirst, frequent urination, blurred vision, fatigue, and headache.

Choice D is wrong because “I should stop taking my insulin or oral medication after delivery.” This statement indicates that the woman does not understand how to manage her blood glucose levels after delivery.Although most women with gestational diabetes will have normal blood glucose levels after delivery, some may have persisting hyperglycemia that requires medical management.The woman should consult with her doctor before stopping any medication and follow the guidelines of the American Diabetes Association and other relevant organizations.

The correct answer is choice A. The nurse should check the newborn’s blood glucose level within one hour after birth.This is because newborns of mothers with gestational diabetes are at risk of developing hypoglycemia due to hyperinsulinemia.Hypoglycemia can cause neurological damage or death if not treated promptly.

Choice B is wrong because two hours may be too late to detect and treat hypoglycemia in a newborn at risk.

Choice C is wrong because three hours is definitely too late to check the blood glucose level of a newborn at risk of hypoglycemia.

Choice D is wrong because four hours is way too late to check the blood glucose level of a newborn at risk of hypoglycemia.

The normal blood glucose level for a newborn is between 70 and 150 mg/dL.However, some infants may have transient low blood glucose levels as low as 25 mg/dL within the first two hours of life, which is physiologic and self-limited.Infants with risk factors for hypoglycemia, such as maternal diabetes, should be screened at 2 hours of age and then before each feeding for the first and second days of life.A blood glucose level of less than 45 mg/dL in an asymptomatic infant or less than 36 mg/dL in a symptomatic infant is considered hypoglycemic and requires treatment.