A nurse is reviewing the laboratory results of a pregnant woman who is being screened for gestational diabetes.

The nurse notes that the woman has a fasting blood glucose level of 100 mg/dL.

Which of the following actions should the nurse take?

The correct answer is

C. It transports glucose from the bloodstream into the cells for energy production.

Insulin is a hormone that regulates the metabolism of carbohydrates, fats, and proteins.It promotes the absorption of glucose from the blood into cells, where it can be used for energy or stored as glycogen or fat.It also inhibits glucose production and secretion by the liver and stimulates lipogenesis and protein synthesis.Insulin is essential for cell metabolism and low insulin levels can cause catabolism of body fat.

A. It converts glucose into glycogen for storage in the liver and muscles.

This statement is partially true, but not the main role of insulin.

Insulin does stimulate the formation of glycogen from glucose in the liver and muscles, but this is not its primary function.Glycogen is a form of stored glucose that can be mobilized when blood glucose levels are low.Insulin also inhibits the breakdown of glycogen (glycogenolysis) and the synthesis of glucose from amino acids and fatty acids (gluconeogenesis) in the liver.

B. It breaks down glucose into carbon dioxide and water for excretion in the urine and lungs.

This statement is false.

Insulin does not break down glucose, but rather facilitates its uptake by cells.

Glucose is broken down by a process called glycolysis, which produces pyruvate and ATP (energy).

Pyruvate can then enter the Krebs cycle and the electron transport chain to produce more ATP, carbon dioxide and water.Carbon dioxide is exhaled by the lungs and water is excreted by the kidneys.

Insulin has no direct role in these processes.

D. It stimulates glucose synthesis from amino acids and fatty acids in the liver.

This statement is false.

Insulin does not stimulate glucose synthesis, but rather inhibits it.

Glucose synthesis from non-carbohydrate sources, such as amino acids and fatty acids, is called gluconeogenesis.

This process occurs mainly in the liver and is stimulated by glucagon, a hormone that opposes insulin.Gluconeogenesis helps to maintain blood glucose levels when dietary intake or glycogen stores are low.Insulin suppresses gluconeogenesis by inhibiting the enzymes involved in this pathway.

The correct answer is choice A. The nurse should monitor the woman’s blood glucose levels every hour during labor.This is because maternal blood glucose levels around the time of delivery are directly related to the risk of neonatal hypoglycemia.Therefore, achieving maternal euglycemia in women with gestational diabetes mellitus is critical to decreasing the risk of neonatal complications.

Choice B is wrong because every two hours is not frequent enough to ensure optimal glucose control during labor.

Choice C is wrong because every four hours is even less frequent and may miss significant fluctuations in blood glucose levels.

Choice D is wrong because every six hours is too infrequent and may put the mother and the baby at risk of adverse outcomes.

The maternal glucose should be maintained between 4.0 and 6.0-7.0 mmol/L during labor.Most women with gestational diabetes, especially if they require less than 1.0 units/kg/d of insulin, can simply be monitored without intravenous insulin.However, women who are taking medication for gestational diabetes require more frequent glucose monitoring, typically with hourly evaluations.