How To Manage Gestational Diabetes

If you are pregnant, you know that there is a lot to think about and manage. When it comes to the health of your baby, there is a lot involved. 

Gestational diabetes is another potential condition to keep in mind during pregnancy. Our goal is to help you feel less overwhelmed by it all. 

You already have a lot on your plate, so let’s clarify gestational diabetes and how to manage it.

What is gestational diabetes?

Gestational diabetes is a form of glucose intolerance. It either begins or is first recognized during pregnancy. 

Testing for gestational diabetes occurs between weeks 24 and 28 of pregnancy. Testing involves a 50 gram one hour glucose challenge test. If the results of this test are high, then your doctor will run a 100 gram three hour oral glucose tolerance test (OGTT).

Diagnosis for gestational diabetes is as follows:

  • Fasting blood glucose higher than 105 milligrams per deciliter (which is 5.8 millimoles per Litre)

  • One hour test higher than 190 milligrams per deciliter (which is 10.5 millimoles per Litre)

  • Two-hour test higher than 165 milligrams per deciliter (which is 9.2 millimoles per Litre)

  • Three-hour test higher than 145 milligrams per deciliter (which is 8.0 millimoles per Litre)

How to manage gestational diabetes

It may surprise you to know that there are no large trials to show that screening and treating gestational diabetes affects the health of newborn babies. This is why several major guidelines do not recommend routine screening for gestational diabetes. They are waiting for more complete data to become available.

However, this does not mean there are no adverse pregnancy outcomes in those with a gestational diabetes pregnancy. Even though the data to support screening isn’t perfect, some health experts say that it’s still important. 

There are biologically plausible reasons for adverse outcomes in babies born to people with gestational diabetes. This is why screening for gestational diabetes is still common. There is lots of research on gestational diabetes. And it’s present in 2.5 percent of pregnant patients.

If you still have high blood sugar with healthy dietary changes, then your doctor will likely prescribe insulin injections.


There is no one perfect diet for people with gestational diabetes. The current dietary recommendations are from expert opinions.

The American Diabetes Association (ADA for short) suggests getting nutritional counseling from a registered dietician. It’s important that your diet supports the needs of a healthy pregnancy. However, carbs should also be restricted to 35 to 40 percent of your daily intake.

You don’t want to restrict calories too much, though. If you reach ketosis, this could increase the risk of reduced psychomotor development and IQ in children of people with gestational diabetes.

If your body mass index before early pregnancy is more than 30 kilograms per meter squared, then you may want to lower your daily calorie intake. The ADA recommends lowering it by 30 to 33 percent. This helps prevent ketonemia (ketones in the blood).

Regular exercise can also help to improve glycemic control in gestational diabetes.

Oral hypoglycemic medications

Oral hypoglycemic medications are not always a good choice in the treatment of gestational diabetes. This is because they raise concerns about teratogenicity (birth defects)

They can also result in the transport of glucose across the placenta. This can cause neonatal hypoglycemia (this is when the baby’s blood sugar is low).

Researchers believe that the medication glyburide may be a safe and effective medication for gestational diabetes management. However, they believe there should be more randomized controlled trials supporting its use before doctors prescribe them.

Researchers also believe that metformin could help people with polycystic ovary syndrome (PCOS). In patients with PCOS, metformin would decrease the future incidence of gestational diabetes. 

It could also reduce the rate of miscarriages that occur in the first trimester. Metformin also does not increase any birth defects when women take them during pregnancy, so it may be an option to speak to your doctor about if you have PCOS.

Insulin therapy

Insulin therapy during gestational diabetes can help to reduce the risk of neonatal macrosomia. This is when an infant is born at a larger size and weight than what is healthy. 

Your doctor will likely get you on insulin therapy if your fasting blood sugar is over 105 milligrams per deciliter (5.8 millimoles per liter). If your blood sugar is more than 120 milligrams per deciliter (6.7 millimoles per liter) two hours after a meal, your doctor may recommend insulin as well.

Postpartum management

If you have gestational diabetes, you likely won’t need to take insulin after you give birth. Insulin resistance quickly resolves in the postpartum period, and so too does the need for insulin.

In fact, if you are controlling your diabetes through the diet, you do not even need to check your glucose levels after delivery. However, your risk of developing overt diabetes or developing type 2 diabetes is higher if you’ve had gestational diabetes. 

Six weeks after delivering your baby, you may need to test your fasting glucose or have a two-hour oral 75-gram glucose tolerance test.

After this, you should go for diabetes screening once a year. This is especially true if you had high fasting blood sugar levels during your pregnancy.

It is good to note that breastfeeding improves glycemic control. If you have gestational diabetes and can breastfeed your infant, it can help your blood sugar levels.

It is also important to note that if you have gestational diabetes mellitus, you are at higher risk of having it in any future pregnancies. If you wish to use hormonal contraception, there are no limits due to your history of gestational diabetes. 

By preventing weight gain, losing weight, and exercising, you can significantly decrease your risk of developing diabetes after pregnancy or during your next one.


If your doctor diagnosed you with gestational diabetes, it’s no reason to panic. As you can see, research is mixed on whether gestational diabetes even leads to negative perinatal outcomes in your baby. 

Another piece of good news is that your blood sugar levels are within your control. Make changes to your diet and physical activity routine. 

Under the direction of your doctor, use insulin or medications as needed. You can do something about gestational diabetes, so take control and speak to your health care provider today.

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  1. Turok, DK; Ratcliffe, SD & Baxley, EG. (2003). Management of gestational diabetes mellitus. American Family Physician. 68 (9), 1767-73.

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