How is gestational diabetes treated?

Gestational diabetes is diabetes restricted to pregnant women where the onset is first noted during pregnancy. The concern of this condition is the elevation of blood glucose levels above normal for pregnant women and the risks associated with this to the baby. 

This condition is best treated with several different approaches all being reinforced throughout the duration of the pregnancy.

First and foremost diet plays a critical role in managing this disease. 

A physician and or registered dietician or diabetes nurse educator (or all three) will provide nutritional guidance on the recommended amount of carbohydrate (and types which are preferred). This is a cornerstone in managing this condition. 

In addition depending on a woman’s health status (and recommendations/restrictions in place by a woman’s obstetrician), exercise will also help keep blood sugars in the desired range. Walking or more vigorous exercise (like mild aerobics or swimming) at least 20 minutes daily provides great benefit.

Glucose testing will likely be recommended. Standard and individual patient goals exist in this area and will best be outlined by the patient’s physician (endocrinologist and/or obstetrician). These goals are based on fasting and either 1 or 2 hour glucose targets. 

Medication- If glucose targets are not met, medication will be recommended. The treatment with the longest safety history is insulin but some clinicians may recommend other options. As a patient, the pregnant woman should be sure to fully discuss with her physicians the risks and benefits of any treatment plan.

During the pregnancy glucose levels will change as the pregnancy progresses. A pregnant woman must stay in close contact with her care team for the entire duration as treatment. Often the program will need to be modified.

In addition, the woman after delivery will need guidance in follow up management. Items requiring attention will include weight loss, follow up to ensure the gestational diabetes resolves (and if not what to do) and guidelines for breast feeding.   

When a woman is diagnosed with gestational diabetes she is placed on a modified diet as the first line of therapy.  Approximately 1/2 of women will be able to stabilize their blood sugars with just dietary changes (which basically include decreasing or stabilizing carbohydrate intake over the day).  Exercise can also help to control glucose levels and can be an important part of first line therapy (if otherwise approved by your obstetrician).

If dietary therapy is not successful the standard second line therapy is insulin injections.  In the last several years there have been investigations into the use of oral hypoglycemic medications that are used to treat Type 2 diabetes.  Some endocrinologists will offer these for treatment of gestational diabetes as well, but insulin still remains the standard second line therapy.

If you are diagnosed with gestational diabetes, you will learn how to check your blood sugar regularly with a finger stick monitor. A dietitian will give you guidelines and instruction in establishing and following a diabetic diet. Often, this is enough to treat the condition. If your blood sugars remain high, you may need to be treated with insulin.

Your doctor or midwife will work with you to develop a gestational diabetes treatment plan. You may also work with a registered dietitian (RD) or a diabetes educator.

Your team will develop a treatment plan that is tailored to your needs and describes in detail what you should do. The main goal of your plan is to make sure your blood glucose is controlled during your pregnancy. It may include some or all of these elements:

• A meal plan. A meal plan gives guidelines and example foods for your daily diet. It can help you control your blood glucose and ensure good nutrition for you and your baby.
• Consistent, moderate exercise. Exercise helps your body use insulin better, as long as you do it safely. Consult with your healthcare team before starting an exercise program.
• Self-testing of blood glucose. Self-testing requires you to prick your finger to get a small sample of blood, then use a glucose meter to measure the amount of glucose in the sample. Your healthcare team can show how to do this. (Different meters work in slightly different ways.) Your team can also help you understand the results so you'll know if your blood glucose is too high, too low, or just right.
• Medication. Your doctor may prescribe oral medication (pills) or insulin to help control your blood glucose.
• Regular meetings with your healthcare provider. If you have gestational diabetes, it's especially important to make and keep regular prenatal appointments. Your doctor or midwife needs to monitor your condition carefully. As your pregnancy progresses, your provider can adjust your treatment as needed and help you plan for a safe delivery.

Treating gestational diabetes means taking steps to keep your blood glucose levels within a target range. You will learn how to control your blood glucose using the following:

Meal plan: You will talk with a dietitian or a diabetes educator who will design a meal plan to help you choose foods that are healthy for you and your baby. Using a meal plan will help keep your blood glucose within your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels within your target range. You may be advised to do as follows:

• Limit sweets.
• Eat three small meals and one to three snacks every day.
• Be careful about when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack.
• Include fiber in your meals in the form of fruits, vegetables, and whole-grain crackers, cereals, and bread.

Physical activity: Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your health care team about the type of activity that is best for you. If you are already active, tell your health care team what you do.

Insulin: Some women with gestational diabetes need insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your health care team will show you how to give yourself insulin. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby's.

This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.

The contents of this website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Nor does the contents of this website constitute the establishment of a physician patient or therapeutic relationship. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.