A patient with gestational diabetes uncontrolled on diet presents with fasting 110 mg/dL and 2-hour postprandial 170 mg/dL. What is the priority nursing action?

• A. Reinforce diet/exercise plan and collaborate with provider for glucose monitoring and potential insulin therapy.
• B. Begin insulin infusion immediately and admit to hospital.
• C. Advise stopping all carbohydrate intake and increase physical activity only.
• D. Order immediate fetal growth ultrasound and terminate pregnancy if macrosomia signs appear.

Answer: (A)

The key idea is that controlling maternal blood glucose to target levels is the priority in gestational diabetes, and this is done first with nonpharmacologic measures plus close monitoring to determine whether medication is needed.

Here, fasting is 110 mg/dL and a 2-hour postprandial is 170 mg/dL—both above typical targets for gestational diabetes. That means diet alone isn’t achieving glycemic control. The safest next step is to reinforce the current diet and exercise plan and establish a structured glucose monitoring routine so the provider can judge how well the client responds and whether pharmacologic therapy, such as insulin, is needed. This approach keeps the patient in a safe outpatient setting when possible and avoids unnecessary escalation to insulin infusion or hospitalization.

It’s not appropriate to abruptly stop all carbohydrates or to rely on exercise alone without supervision, since careful dietary management preserves maternal nutrition while preventing ketosis and fetal risk. Immediate fetal ultrasound or pregnancy termination isn’t the immediate priority based on these glucose values; ongoing management of glycemic control is what will most influence fetal outcomes.