Sugary Selena — Gestational Diabetes
Fasting glucose ↑, macrosomic baby risk — diet and monitoring come first
Selena fails her one-hour glucose challenge at 26 weeks and comes back for the three-hour test looking anxious. Her mother had diabetes late in her own pregnancies too.
Selena develops glucose intolerance during pregnancy as placental hormones increase insulin resistance. Untreated hyperglycemia crosses the placenta and causes fetal hyperinsulinemia, leading to macrosomia, birth trauma, and neonatal hypoglycemia after birth when the maternal glucose supply is suddenly cut off. Screening happens at 24–28 weeks with a glucose challenge test, and first-line treatment is diet and exercise, with insulin added if glucose remains uncontrolled. Insulin, not oral agents, is the preferred pharmacologic treatment because it does not cross the placenta. The main long-term risk is a macrosomic infant and future type 2 diabetes for Selena herself.
Read Sugary Selena's full story →The story arc
The setup
At 26 weeks, Selena's one-hour glucola screen returns elevated, and she is scheduled for the three-hour diagnostic test.
The turn
She is taught to check fasting and post-meal glucose and to follow a controlled-carbohydrate diet with regular activity.
The crisis
Despite diet changes her fasting glucose stays above 95 mg/dL, and an ultrasound shows a fetus tracking large for gestational age.
The save
Insulin is started and titrated to glucose logs, and after birth the nursery is alerted to monitor the newborn closely for hypoglycemia in the first hours of life.
NCLEX study section — Gestational Diabetes
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.