How to Manage Gestational Diabetes

JanelMS, RD, LDN, CBS

Read time: 7 minutes

What to know about gestational diabetes

  • What is gestational diabetes and who is at risk

  • How to help manage your blood sugar after a diagnosis

  • When to call your doctor

What is gestational diabetes?

Diabetes is a health condition that affects how your body is able to handle blood sugar.1 When food is broken down into sugar (glucose), the body uses it to power its cells. The hormone that helps glucose get into the cells is called insulin.

When the body is not able to produce enough insulin, or the cells can’t use insulin very well (which is called insulin resistance), glucose is locked out of cells and instead stays in the blood stream causing high blood sugar levels.2 Overtime, these uncontrolled high blood sugar levels (also called hyperglycemia) can lead to other health issues such as heart and kidney disease.1

Gestational diabetes, or GDM, is a type of diabetes that develops during pregnancy, affecting about 7% of all pregnancies.3,7

All pregnant women have some degree of insulin resistance. This is because hormonal changes and weight gain in pregnancy interfere with our cells’ ability to use insulin.4 While most women can produce a bit more insulin to help overcome this slight resistance, some cannot. That’s when GDM develops.

Risk factors for developing gestational diabetes

Pregnant women at higher risk for developing GDM include women who:

  • Are overweight before they get pregnant

  • Have had GDM before

  • Gave birth to a baby from a prior pregnancy who weighed more than 9 pounds

  • Have prediabetes (higher than normal blood sugar levels)

  • Are of advanced maternal age (older than 35 years)

  • Have high blood pressure during pregnancy

  • Have polycystic ovary syndrome (PCOS)

  • Have a history of heart disease4,5,6

It’s important to note that even people without risk factors can develop gestational diabetes.6

Learn about: How much Weight should I Gain during Pregnancy?

Symptoms of gestational diabetes

Most women who develop gestational diabetes do not show or feel any symptoms at all. If you do experience any, they may be mild, such as being a little extra thirsty, having to urinate more often, blurred vision, or bladder infections.14

How is gestational diabetes diagnosed?

GDM is diagnosed based on blood sugar levels. Non-diabetic pregnant women are first given a glucose challenge test consisting of drinking a sugary beverage and having blood drawn an hour later.7 If you pass this screening test by having a low blood sugar level, you’re done and are considered GDM-free.

If this screening test indicates a higher-than-normal blood sugar level, you’ll need to undergo a more extensive glucose test. This test is called an Oral Glucose Tolerance Test (OGTT).7 For this test you’ll still drink the sugary beverage, but you’ll then have blood drawn four times: before you drink the beverage and then one, two, and three hours afterwards.7

If your blood sugar levels fall within a certain range above normal, you will be diagnosed with GDM. Or if your levels are not quite in the GDM range but still a bit higher than normal, your healthcare provider might still recommend modifying your diet to reduce the risk of developing GDM later in pregnancy.

Learn about: Does Gestational Diabetes Matter Postpartum?

What are the risks associated with gestational diabetes?

It can feel unsettling and even alarming to learn that your blood sugar level is higher than normal, but for most people GDM usually goes away after you deliver your baby.3

The risks and the reasons you’ll want to keep those blood sugar levels in check include:

  • People with GDM are more likely to develop preeclampsia (high blood pressure and too much protein in the urine)

  • People with GDM may deliver by C-section more often due to babies gaining more weight from the excess circulating blood sugar

  • People with GDM have a higher risk of developing type 2 diabetes postpartum

  • Those with the goal of breastfeeding may experience breast milk production delays or issues3,8

What should I do if I’ve been diagnosed with gestational diabetes?

The good news is that lifestyle habits, particularly diet and exercise, can play a critical role in helping to control our blood sugar levels.

Diet with gestational diabetes

All carbohydrates are broken down into sugar (glucose) by the body to use as fuel. This is the macronutrient responsible for raising your blood sugar levels. Carbohydrates are found in grains (including bread, pasta, and cereals), potatoes, corn, legumes, beans, juice, non-diet soft drinks, dairy, sweets, and fruit.

How much of each of these foods you eat at one time, and what other foods you eat with them, will play a role in how high your blood sugar goes up in response.

Eat these carbohydrates less often: Carbohydrates that are refined and highly processed, such as sweets, sugar, juice, sweet tea, soda, refined white bread and pasta, sugary cereals, etc, are easy to digest and make your blood sugar go up high and fast.9

Choose these carbohydrates more often: Complex carbohydrates that have lots of fiber and are whole grains will affect your blood sugar less. You’ll want to choose these types of carbs most often: non-starchy vegetables, whole fruit, whole grains, and beans.9

Remember that no matter which type of carbohydrate you eat, the serving size matters.9 A small amount of carbohydrates will make your blood sugar go up just a little, while a large amount of carbohydrate will make it go up a lot.

How many carbohydrates a pregnant woman with GDM can handle is highly individual. Your health care provider can help you develop a meal and snack plan to suit your personal carbohydrate limitations.

For more guidance and ideas on how to stick to your plan, reach out to our team of registered dietitians and lactation consultants for free! They’re here to help on our free to live chat from Monday – Friday 8am - 6pm (ET), and Saturday – Sunday 8am - 2pm (ET). Chat Now!

Read more: Meal Plan for Gestational Diabetes

Exercise and gestational diabetes

Exercise is another important way to help control your blood sugar levels.6 For both cardio and strength exercises, your body uses sugar as fuel, helping to keep blood sugar levels stable. It also allows your body to use insulin more efficiently.

The American Congress of Obstetrics and Gynecologists recommends all women engage in aerobic (cardio) and strength-conditioning exercises before, during, and after pregnancy.10 Not only does regular physical activity during pregnancy help reduce the risk of gestational diabetes, but it also improves or maintains physical fitness, helps with weight management, and enhances psychological well-being.10

Be sure to chat with your health care provider before starting any new pregnancy-friendly exercise programs.

Learn about: Exercise During Pregnancy

Will I have to take medication if I’m diagnosed with gestation diabetes?

Some people are able to manage gestational diabetes with diet and exercise alone, while others may need to take a medication to help manage their GDM, such as insulin. Using your blood sugar levels as a guide, your doctor will help you find the path that best fits your and your baby’s needs.

Tips on what to do if you are diagnosed with gestational diabetes

Keep track of your blood sugar levels and foods you eat

If you are checking your blood sugar levels on your own, write down all your blood sugars and time of day when checking.11

While you’re at it, write down what, when, and how much you eat and drink along with when and how much you exercise.

Keeping these records will help you see any patterns and allow you to understand which activities or foods raise, lower, or help maintain your blood sugar.

Eat on a consistent pattern

Try to eat every 3 hours. Eating 3 meals and 3 snacks each day will keep you on track and help prevent you from getting too hungry and overeating. It will also help prevent you from going too long and having your blood sugar drop too low. Try to avoid skipping meals or snacks.

Having a snack before bed can also be important for helping to keep your blood sugar stable over the nighttime hours.15 Choose a high protein food for this snack.

Include protein and healthy fats with all meals and snacks

Neither protein nor fat affect your blood sugar. And in fact, eating them alongside carbohydrates can help prevent your blood sugar from going up too high.

Read more:

Healthy Snack Ideas during Pregnancy

Protein: Getting Enough and the Best Sources

Types of Fats: What’s Best for Mom and Baby?

Favor higher fiber and lower carbohydrate foods

Beans, fresh and frozen fruits and vegetables, and whole grains are great choices. Read your labels and make sure the package says 100% whole grain and keep an eye on portion size.

Non-starchy vegetables like broccoli, tomatoes, kale, cauliflower, lettuce, spinach, asparagus, cucumber, bell pepper, as well as proteins like fish, chicken, nuts, cheese, and seeds are especially good foods to reach for when you are hungry but want to keep your carbohydrate count and blood sugar down.

Learn about: Meal Plan: How to Eat more Fruits and Vegetables

Avoid foods that cause blood sugar levels to spike

Skip concentrated sweets and highly refined grains: sugar, juice, soda, sweet tea, white breads, white pasta, chips, crackers, etc. These are high in calories, low in nutrients, and cause your blood sugar to rise rapidly.

Likewise, avoid having too many carbohydrates at one time. Chat with your health care provider or registered dietitian to know how much is right for you at any given meal or snack.

Exercise daily

If you are cleared for exercise by your healthcare team, check out these suggestions to help get you started: Exercise for Non-Exercises at Every Stage

Follow your healthcare provider’s recommendations about testing your blood sugar

Testing your blood sugar is a very important way to monitor your health and to know when to make adjustments to diet, exercise, or medications if necessary.

Prevent and treat low blood sugar or hypoglycemia

Keeping your blood sugar from going too low, especially if you are on insulin, is equally important.

Hypoglycemia can cause lightheadedness, shakiness, anxiety, sweatiness, and blurred vision, among other things. If you feel any of these symptoms, check your blood sugar.11,12

If your blood sugar level is below 70 mg/dl, eat approximately 15 grams of a fast-acting carbohydrate such as 4 ounces of juice or a few glucose tablets.13 Wait 15 minutes and check your sugar again. If still below 70 mg/dl, eat your next scheduled snack or meal.

Have a set of instructions from your doctor on hand if your blood sugar drops and discuss it with loved ones, friends, and coworkers in case you are unable to treat yourself.

Know when to call your doctor

If you experience any of the below, call your healthcare provider immediately:

  • If you are sick and cannot eat or are having trouble controlling your blood sugar levels

  • If you have recurrent hypoglycemic episodes or are experiencing severe hypoglycemia, call 911

  • If you have a blood sugar level outside the range of what your healthcare team recommends

  • If you have breath that smells fruity

  • If you have dim or blurry vision

  • If you have any cramping or bleeding16,17

You can have a healthy pregnancy even while being diagnosed with gestational diabetes

While the diagnosis of gestational diabetes may cause some anxiety, know that you are still able to have a healthy pregnancy. Making some changes to your diet and exercise can help keep your blood sugar levels stable and help keep risks at bay. Also know that if your doctor recommends using medication to help stabilize your blood sugar, this is safe to take during pregnancy as long as you follow their advice.

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For more on this topic, check out the following articles:

Healthy Snacks during Pregnancy

Does Fiber Matter for Babies, Tots, and Mama?

Food Safety during Pregnancy

How much Should I Eat while Pregnant?