If you’re pregnant, you likely have a number of worries on your mind. Finding out that you have gestational diabetes, a types of diabetes that occurs during pregnancy, can be frightening. Your thoughts might range from, “What did I do to cause this?” to “Will my baby be OK?” First, keep in mind that it’s perfectly normal to feel scared and worried. Second, while gestational diabetes (GDM) is indeed serious, remember that, with proper management, you can have a healthy baby.
Once you’re diagnosed with gestational diabetes
If you find out that you have gestational diabetes, be prepared to learn a lot about diabetes! Along with working with your obstetrician, you’ll likely be referred to a diabetes educator and a dietitian. You might also be referred to an endocrinologist, a doctor who specializes in diabetes and other endocrine disorders. In most cases, you’ll be seen by a member of your healthcare team about every two weeks.
Be prepared to start checking your blood sugars using a meter, checking your urine for ketones, following a healthy eating plan, staying active, and keeping track of your food and blood sugar levels. You might also be started on medicine to help keep your blood sugars in a target range (you might even need to start on insulin). This can all seem overwhelming, and GDM management certainly involves a lot of changes and adjustments to your lifestyle. Let your healthcare team know if you are struggling or need additional support during this time.
Treating gestational diabetes
There are a number of ways in which GDM is treated, and they all work together to help ensure that your blood glucose levels stay in a safe range throughout your pregnancy. Remember that the goal is to keep your blood sugar in a normal range. When blood sugar levels are too high, the extra sugar, or glucose, crosses the placenta to the baby. Too much glucose can cause your baby to be too large and may cause other complications for both you and your baby during delivery and later on, including type 2 diabetes.
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The saying that “you’re eating for two” during your pregnancy is partly correct. You ARE eating for two, but you’ll need to pay careful attention to what, when, and how much you eat. An eating plan provides adequate calories and nutrition for you and your baby, helps you manage your blood sugar, and prevents ketone formation. Your eating plan should be tailored to you (hence the importance of seeing a dietitian) and will be controlled in carbohydrate, with an emphasis on portion control and timing.
General guidelines for healthful eating for GDM include eating:
- Plenty of whole fruits and vegetables
- Moderate amounts of lean proteins and healthy fats
- Moderate amounts of whole grains
- Fewer foods that contain sugar, such as soft drinks, fruit juices, candy, and pastries
Your dietitian may recommend that you eat three smaller meals daily, with one or more snacks to help you keep your blood sugars stable. Try not to skip or delay meals and snacks.
You need to eat carbohydrate (carb) during your pregnancy; in fact, anywhere from 40% to 55% of calories should come from carbohydrate. The amount of carbohydrate that you need depends on your pre-pregnancy weight and level of blood glucose control.
Here are some tips for balancing your carb intake:
- Start counting carbs (aka “carb counting) to help you balance your carb intake throughout the day. Common carb goals are 30-45 grams for meals and 15-30 grams for snacks.
- Eat less carb at breakfast, since blood sugars tend to be higher in the morning. A typical carb goal at breakfast is 15-30 grams.
- Include a source of protein at each meal. Examples include eggs, cottage cheese, plain yogurt, poultry, fish, lean meat, and tofu.
- Eat a bedtime snack to keep your blood sugar steady overnight. Include a source of carb (15-30 grams).
Another approach for healthy eating is the plate method, which is a simpler but effective way of balancing out your carbs and calories. Work with your dietitian to tailor your eating plan to meet your needs. For more on carbohydrate foods, visit MedlinePlus.
In terms of weight gain, your obstetrician will discuss with you the recommended amount of weight to gain during pregnancy. If you are overweight, your weight gain target might be lower. A meal plan can help ensure that you gain the right amount of weight. Be prepared to keep food records and bring them to your appointments.
Checking blood sugars
Your healthcare team may ask you to start checking your blood sugar with a meter, usually four times each day (before breakfast and one hour after the start of each meal). In general, blood glucose targets are:
- Less than 95 mg/dl before breakfast
- Less than 140 mg/dl one hour or less than 120 mg/dl two hours after a meal
Keep a log of your glucose readings, as well. A diabetes educator should show you how to use a blood glucose meter and how to check your blood glucose using a lancing device. Practice checking your blood glucose while you are with the educator to make sure that you feel comfortable doing so and that you’re using your meter correctly (today’s meters are fast and easy to use!).
Urine ketone testing
Ketones are formed when fat is burned for fuel. If you have ketones in your urine during pregnancy, it may be a sign of “starvation ketosis” — this means that you aren’t getting enough calories in your eating plan, and you may be losing weight, as well. (Starvation ketosis is not the same thing as diabetic ketoacidosis, a very serious condition that can occur in people with type 1 diabetes and in those with type 2 diabetes who take insulin).
In order to check for ketones, you’ll need to purchase ketone strips at your pharmacy. You’ll get a sample of urine in a clean container and dip the ketone strip into the urine. A pad on the strip will change color after a certain amount of time (follow the instructions on the container). You’ll then compare the color on the strip to the color on the container to determine the amount of ketones in your urine. The presence of ketones with a normal blood glucose levels usually means that you need to eat more; this is often done by eating a bedtime snack. Ketones along with a high blood glucose reading may indicate a need for insulin.
Being active before, during and after pregnancy is important in many ways. Physical activity helps with blood glucose control, can reduce insulin resistance, and can prevent excessive weight gain. Also, regular activity can provide relief to some common pregnancy-related issues, such as constipation, swelling, back pain, and trouble sleeping.
Talk with your obstetrician about how much activity is safe for you to do, as well as at what level of intensity. Walking and swimming are good choices, but there are other options, too. There may be types of activities that you should avoid, as well, such as contact sports or scuba diving. Aiming for about 30 minutes most days is a good goal, ideally, after eating a meal (when your blood glucose will be at its highest).
If a healthy eating plan and regular physical activity isn’t enough to keep your blood sugars in your target range, you may need to take insulin. Insulin will not harm your baby.
According to the American Diabetes Association’s Standards of Medical Care in Diabetes – 2021, “Insulin is the preferred medication for treating hyperglycemia in gestational diabetes mellitus. Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus. Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data.” Metformin, if used to treat polycystic ovary syndrome and induce ovulation, should be stopped by the end of the first trimester.
Your healthcare team should discuss medications options with you and provide you with education and guidance. If you do start on insulin, ask your obstetrician to refer you to a diabetes educator for appropriate teaching and additional support.
For more information about gestational diabetes, visit the CDC’s website.
Want to learn more about gestational diabetes? Read “Gestational Diabetes: Are You at Risk?,” “Treatment for Gestational Diabetes: Once You’re Diagnosed,” and “Gestational Diabetes: More Treatment Approaches.”