امرأة عمرها ٣٠ سنة حامل في الأسبوع ٢٨، اختبار تحمل الجلوكوز أظهر سكري الحمل. سكرها الصائم ١٠٢ رغم الحمية أسبوعين. وزن الجنين فوق المعدل. ما الخطوة المتوقعة؟

A 30-year-old at 28 weeks’ gestation has gestational diabetes on glucose tolerance testing. Fasting glucose remains 102 despite two weeks of diet, and fetal growth is above average. What is the expected next step?

1. Start insulin as ordered
2. Wait for delivery because glucose will normalise by itself
3. Stop eating after mid-afternoon every day until delivery
4. Start high-dose glibenclamide without monitoring

Answer: A) Start insulin as ordered. If gestational diabetes is not controlled by diet and activity, insulin is started as it is safe and does not cross the placenta. High glucose increases fetal size and birth complications.