Gestational Diabetes: Treatment Overview

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Treatment Overview

Finding out that you have gestational diabetes can be scary. It can be reassuring to know that most women who have gestational diabetes give birth to healthy babies and that you are the most important person in promoting a healthy pregnancy.

Treatment for gestational diabetes involves making healthy choices. Most women who make changes in the way that they eat and how often they exercise are able to keep their blood sugar level within a safe range. Controlling your blood sugar is the key to preventing problems during pregnancy or birth.

You, your doctor, and other health professionals will work together to develop an individualized treatment plan. You do not need to eat strange or special foods, but you may need to change what, when, and how much you eat. You also do not need to start a fancy exercise program or join an expensive gym; walking several times a week can really help your blood sugar.

The lifestyle changes you make now will not only help you have a healthy pregnancy, they will help you prevent diabetes in the future. As you start making these changes, you will learn more about your body and how it reacts to food and exercise. You may also notice that you feel better and have more energy.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

• Eating a balanced diet. After you find out that you have gestational diabetes, you will meet with a registered dietitian to develop a healthy eating plan. You will learn how to limit the amount of carbohydrate you eat as a way to control your blood sugar. You may also be asked to write down everything you eat and to keep track of your weight.
• Getting regular exercise. Most doctors recommend that pregnant women exercise at least 3 times a week for at least 20 minutes. Regular, moderate exercise during pregnancy helps your body use insulin better and helps control your blood sugar level. If you have never exercised regularly or were not exercising before you became pregnant, talk with your doctor before you start exercising. Exercise that does not place too much stress on your lower body—such as using an arm ergometer, a machine that just works your arm muscles; or riding a recumbent bicycle, a type of bike with a seat that looks like a chair—are especially good for pregnant women. You may also want to try special exercise classes for pregnant women or other low-impact activities such as swimming or walking.
• Checking blood sugar levels. An important part of treating gestational diabetes is checking your blood sugar level at home. Every day, you will do a home blood sugar test up to 4 times a day (first thing in the morning before breakfast and 1 hour after each meal). If you take insulin, you will need to test your blood sugar up to 6 times a day (before each meal and 1 hour after each meal). Even though it can be overwhelming to test your blood sugar so often, knowing that your level is within a safe range can help put your mind at ease.
• Monitoring fetal growth and well-being. Your doctor may want you to monitor fetal movements and let him or her know if you think your baby is moving less than usual. You may also have fetal ultrasounds to see how well your baby is growing. If your baby is growing larger than normal, you may need insulin shots. If you take insulin, you may have a nonstress test to check how well your baby's heart responds to movement. Even if you do not take insulin, you may have a nonstress test as you get closer to your due date.
• Getting regular medical checkups. Having gestational diabetes means regular visits to your doctor. At these visits, your doctor will check your blood pressure and test a sample of your urine. You will also discuss your blood sugar levels, what you have been eating, how much you have been exercising, and how much weight you have gained.
• Taking insulin shots. The first way to treat gestational diabetes is by changing the way you eat and exercising regularly. If your blood sugar levels are still too high after changing the way you eat and exercising regularly, you may need insulin shots. Man-made insulin can help lower your blood sugar level without harming your baby.

Generally, it is not a good idea to diet while you are pregnant. Most doctors recommend that women gain to during pregnancy. However, if you are overweight or obese, your doctor may recommend that you eat less and gain less weight than other pregnant women. Overweight or obese women can have problems during pregnancy including high blood pressure and a blood circulation problem called preeclampsia.

Most doctors will recommend that you breast-feed your baby, if possible. Breast-feeding can help prevent your child from becoming overweight, which may reduce his or her chances of developing diabetes. While you are breast-feeding, be sure to continue checking your blood sugar levels.

During labor and delivery

Most women with gestational diabetes are able to have their babies naturally. Just because you have gestational diabetes does not mean that you will need to have a cesarean section (C-section).

Because a baby that has grown too large can be difficult to deliver safely, your doctor will do frequent fetal ultrasounds to check the size of your baby. If your doctor thinks that your baby is in danger of being too large, he or she may decide to induce labor or do a C-section in your 38th week of pregnancy.

During labor and delivery, you and your baby are monitored closely. This includes:

• Checking your blood sugar level at least every 1-2 hours. If your level gets too high, you may be given small amounts of insulin through a vein (intravenously, or IV). If your level drops too low, you may be given IV fluid that contains glucose.
• Checking your baby's heart rate and how well your baby's heart responds to movement. Fetal heart monitoring helps your doctor know how your baby is doing during labor. If the baby is large or does not seem to be doing well, you may need to have a C-section to deliver your baby. However, most women who have gestational diabetes deliver their babies naturally.

After delivery

After delivery, you and your baby still need to be monitored closely.

• For the first few hours, your blood sugar level may be tested every hour. Most of the time, blood sugar levels quickly return to normal.
• Your baby's blood sugar level will also be monitored. If your blood sugar levels were high during pregnancy, your baby's body will make extra insulin for several hours after birth. This extra insulin may cause your baby's blood sugar to drop too low (hypoglycemia). If your baby's blood sugar level drops too low, he or she may need extra sugar, such as a sugar water drink or glucose given intravenously.
• Your baby's blood may also be checked for low calcium, high bilirubin, and extra red blood cells.

What to Think About

Most of the time, the blood sugar levels of women who have gestational diabetes return to normal within a few hours after delivery.

If you have had gestational diabetes, you are at risk of developing it again in a future pregnancy. You are also at risk of developing type 2 diabetes, a permanent type of diabetes. The healthy choices and changes you made during your pregnancy, if continued, will help you prevent diabetes in the future. If you are worried about type 2 diabetes in yourself or in your child, talk to your doctor about your concerns. If you want to learn more about type 2 diabetes, see the topic Type 2 Diabetes.

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Last updated:	January 12, 2006
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Lois Jovanovic, MD - Endocrinology
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman