A 34-year-old woman comes to the office for postpartum follow-up. The patient had gestational diabetes mellitus which was diagnosed during routine screening at 28 weeks gestation; she was treated with dietary modification and exercise and required insulin briefly. She has continued to follow dietary recommendations since delivery 12 weeks ago, and her blood glucose has been fairly well controlled without insulin. Fasting blood glucose levels of 100-120 mg/dL. Medical history is otherwise unremarkable. BMI is 23kg/m². Physical examination shows no abnormalities. Her gestational diabetes and fasting hyperglycemia are suspected to be genetically predisposed. This patient's condition is most likely caused by reduced activity of which of the following enzymes?

Question

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Eductional Objective: Insulin release by pancreatic beta cells is stimulated by increased glucose metabolism and ATP production.  Glucokinase functions as a glucose sensor in pancreatic beta cells by controlling the rate of glucose entry into the glycolytic pathway.  Mutations in the glucokinase gene lead to a state in which higher glucose levels are required to stimulate insulin secretion and are a cause of maturity-onset diabetes of the young.

A 34-Year-Old Woman Comes to the Office for Postpartum Follow-Up