Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most appropriate pharmacotherapy for a woman with gestational diabetes when blood glucose management worsens?

1. Canagliflozin

2. Insulin Glargine

3. Repaglinide

4. Pioglitazone

The correct answer is: Insulin Glargine

Insulin Glargine is the most appropriate pharmacotherapy for managing worsening blood glucose levels in a woman with gestational diabetes. During pregnancy, maintaining tight glucose control is crucial for the health of both the mother and the fetus. Insulin is the preferred medication because it does not cross the placenta, which ensures that the fetus is not exposed to the potential risks associated with oral hypoglycemic agents. Insulin Glargine, a long-acting insulin, provides a stable baseline level of insulin, facilitating better blood glucose management throughout the day and helping to prevent hyperglycemia. Its pharmacokinetics make it suitable for pregnant women who need consistent glucose control, especially as their insulin resistance may increase during pregnancy. The other medications listed are not recommended for use during pregnancy. Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which is contraindicated in pregnancy due to potential risks to the fetus. Repaglinide, an oral hypoglycemic agent, is typically avoided because it can cross the placenta and affect fetal glucose levels. Pioglitazone, a thiazolidinedione, also poses risks during pregnancy and is not indicated for use in gestational diabetes. Therefore, the