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How is gestational diabetes treated?

Once a woman is diagnosed with gestational diabetes (GDM), immediate treatment is necessary. The first step is nutrition counseling and glucose monitoring. Although diet does not always control GDM by itself, it is the first step in management. Doctors recommend exercise for all women who do not have a medical contraindication to physical activity. Exercise for women with GDM is important because it can increase muscle mass, which improves tissue sensitivity to insulin. In obese women with GDM, exercise can achieve weight loss, which may improve glycemic control.

If diet and exercise fail to control blood glucose levels, your obstetrician may prescribe medications such as Metformin, glyburide and insulin.

Women with GDM are seen more frequently by their obstetrician and will also likely see a high-risk maternal-fetal medicine doctor to help manage the pregnancy. The fetus will also be closely monitored for growth and well-being throughout the pregnancy.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

If you're diagnosed with gestational diabetes and behavioral changes don't seem to help, it certainly is worth talking to your doctors about prescription medications that can alter your blood sugar levels.

First in line is usually glucophage, which stimulates the liver to listen more carefully to the insulin; the second in line is called glyburide, which increases the release of insulin from the pancreas. Insulin itself is typically given if nothing else works. (All but insulin cross the placenta.)

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Gestational diabetes is treatable. Most women have healthy pregnancies and healthy babies when they take the steps to control their condition. Meal planning, physical activity (be sure to check with your healthcare professional before starting any kind of exercise program) and home blood glucose monitoring are the cornerstones of therapy for women who have gestational diabetes.

Because women who have had gestational diabetes are at a higher risk for developing type 2 diabetes later in life, it's important to continue with healthy lifestyle habits. The goal is to keep your blood sugar levels within normal ranges (less than 95 mg/dL when fasting, less than 130 to 140 mg/dL one hour after eating). You can usually do this by following a specific diet high in complex carbohydrates (such as whole-grain cereals) and low in simple sugars, such as those found in cakes and candies. Ask to meet with a nutritionist to develop the right diet for you.

You may also need to monitor your blood glucose yourself. Self-blood glucose monitoring allows you to track your glucose levels at home without extra trips to your healthcare professional. You may need to test your blood several times a day, usually first thing in the morning before eating and one to two hours after each meal.

You do this with a device that pricks your finger for a drop of blood. You put the blood on a test strip, insert it into a small machine and the results appear on the monitor.

If you can't control your blood sugar levels through diet alone, you may need insulin, a hormone you take via a shot that helps return your blood glucose levels to normal.

Treatment for gestational diabetes is based on the results of your glucose tolerance test. You may start with nutrition therapy and perhaps with exercise, if you are able. You may need to start insulin therapy, too. Because of the emphasis on keeping blood glucose levels close to normal, you will need to monitor frequently, perhaps four or more times a day.

If you have gestational diabetes, carbohydrates raise your blood glucose level much more than other foods, such as meat and meat substitutes, vegetables or fats. Your dietitian can help you plan how much food with carbohydrates to have at each meal and snack. If you're checking your blood glucose levels at home, you'll see how carbohydrate foods affect your levels after you've eaten. For many women, it's harder to keep blood glucose levels on target in the mornings because of increased insulin resistance. That's why your dietitian may suggest that you have your carbohydrates later in the day.

Unfortunately, there is no known cure for gestational diabetes. However, if you manage your condition effectively, you can expect a healthy, normal pregnancy. Your doctor will determine a target blood glucose range. Sticking to this range, following a special diet, and exercising regularly will be the major components of your treatment plan. You may also need to take insulin, though only a small percentage of women will need this medication to treat gestational diabetes.

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.

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.

Dr. Deborah Raines, MSN
Nursing Specialist

The primary treatment for gestational diabetes is diet. A nutritionist is consulted to work with the woman to design and follow a diet that maintains the serum glucose level at the desired level. However, in a small percentage of pregnant woman small doses of insulin is needed to maintain glucose control.

Dr. Charla Simon, MD
OBGYN (Obstetrician & Gynecologist)

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.

Ximena Jimenez
Nutrition & Dietetics Specialist

If you develop gestational diabetes, the goals are an optimum pregnancy and a healthy baby. Follow these principles:

  • Follow a carbohydrated-controlled meal plan created by your registered dietitian
  • Keep food and blood sugar records for better control
  • Exercise can help to manage your blood sugar levels

Your doctor or midwife will work with you to develop a gestational diabetes 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.

Your day-to-day choices play a big part in helping you manage your gestational diabetes. Be consistent, pay attention to your body and play it safe.

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 healthcare team about the type of activity that is best for you. If you are already active, tell your healthcare 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 healthcare 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.

Ms. Vandana  R. Sheth
Nutrition & Dietetics Specialist

Gestational Diabetes is managed by:

  • Enjoying a healthy diet including carb-consistent, meals and snacks
  • Regular physical activity
  • Monitoring your blood sugar regularly
  • Stress management
  • Working closely with your healthcare team (physician, registered dietitian, certified diabetes educator)

If your blood sugars are not successfully controlled with these measures, you might need medication such as Insulin or an oral medication such as glyburide. Approximately 10-20 percent of women with gestational diabetes might need insulin to achieve their target blood sugar goals.

Laura Motosko, MSEd, RD
Nutrition & Dietetics Specialist

Carbohydrate intake directly affects your blood glucose levels and should be monitored carefully to control gestational diabetes. Uncontrolled blood glucose levels can result in a large baby at birth which can make delivery difficult or dangerous, low blood glucose in the infant after birth, and breathing problems.

Healthy carbohydrates to include in moderate portions are whole grains, whole fruit, beans, starchy vegetables and dairy. A Registered Dietitian can help design a meal plan for you with adequate nutrition and carbohydrate intake for a healthy pregnancy.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.