Susan Littlehorse (28 years old, obese, and pregnant) complains of burning urine to you, her physician at the Indian Health Service. Blood tests show hemoglobin A1c concentrations over 9%. What is your initial diagnosis? How do you test your idea? How
should her condition be treated? What are some potential problems she may experience in the future?
What will be an ideal response?
Susan seems to have gestational diabetes. You will need to perform a glucose challenge test to confirm your initial diagnosis. You should suggest to her that she begin a healthier lifestyle: a better diet and regular exercise. If the condition is not resolved, then you may need to prescribe insulin or other medications.
There is risk to Susan of developing preeclampsia during pregnancy and of having a baby with excessive birth weight, which could lead to a difficult delivery or a cesarean section. Furthermore, Susan may subsequently develop type 2 diabetes. The child has a greater chance of becoming obese and of having type 2 diabetes later in life.
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