Managing Gestational Diabetes: What To Know

The medication metformin is typically the first line treatment doctors prescribe for people with type 2 diabetes. It’s generally considered safe and effective, as well as affordable.

By contrast, insulin has long been considered the first line medical treatment for gestational diabetes in pregnant people whose sugar levels can’t be managed with lifestyle and diet changes alone, which is nearly 30%.

However, insulin therapy for gestational diabetes requires injections. Pregnant people who develop gestational diabetes and need insulin must learn to give themselves injections of insulin to manage their high blood sugar levels.

In recent years, some research has found that oral hypoglycemic medications such as glyburide (glibenclamide) and metformin may be good alternatives for insulin. Among the benefits, oral medications are less expensive and easier for patients to take than insulin.

Glyburide was a previous treatment for some cases of gestational diabetes. However, there were some ongoing concerns about whether glyburide can cause complications for the baby, including concerns about increased birth weight, large-for-gestational-age babies, and newborn hypoglycemia.

However, a recent study found no difference in outcomes among pregnant people using glyburide compared with those using insulin injections.

The researchers noted that insulin remains the first line of treatment for gestational diabetes, as that’s the recommendation in guidelines from the American Diabetes Association and the American College of Obstetricians and Gynecologists.

More research is needed about the long-term safety outcomes for both babies and mothers who undergo treatment with glyburide or metformin when compared with insulin.

Unless you’re at high risk, your doctor will begin gestational diabetes testing between the 24^th and 28^th week of your pregnancy.

The first step is the glucose challenge test, a 1-hour test designed to gauge your blood glucose levels after you drink a super-sweet glucose beverage. Ideally, your blood sugar levels should be below 140 mg/dL. If they are, you don’t have gestational diabetes.

If not, you’ll take the 3-hour oral glucose tolerance test.

Your doctor will measure your blood sugar levels every hour for 2–3 hours after drinking another glucose drink. If your blood sugar levels are high, that means you have gestational diabetes.

Once you begin treatment, the goal is to bring your blood sugar levels back down to expected levels. The American Diabetes Association recommends the following targets:

• Before eating a meal: 95 mg/dL or less
• One hour after a meal: 140 mg/dL or less
• Two hours after a meal: 120 mg/dL or less

Insulin is the most likely medication your doctor will recommend that you take to help you keep your blood sugar levels in the expected range.

However, when you receive a diagnosis of gestational diabetes, your doctor will likely also recommend that you change your diet to help you lower your blood sugar levels. This may require some adjustment on your part, with meal planning and regular exercise.

Some people are able to manage their blood sugar levels with just those changes. Others, however, will need the insulin.

Regardless, you’ll also have to test your blood sugar levels daily.

Generally speaking, you should eat a healthy diet that’s rich in whole fruits and vegetables, with moderate amounts of healthy fats, lean protein, and whole grains.

But you want to go easy on the foods that tend to be high in sugar, such as soft drinks, pastries and cookies, fruit juices, and candy. In fact, your doctor may advise you to minimize your intake of simple carbohydrates, such as white rice, potatoes, french fries, and candy, because they make your blood sugar rise quickly.

Usually, your blood sugar levels will drop after you give birth. Your doctor will test your blood sugar about 12 weeks after delivering your baby.

However, you have a greater chance of developing type 2 diabetes later in life. Experts generally recommend that you get tested for diabetes about every 3 years after your baby is born.

Here are some commonly asked questions about gestational diabetes:

Did I cause my gestational diabetes?

Some factors do make you more likely to develop gestational diabetes, such as obesity or being overweight when you become pregnant, as you may already have some insulin resistance and not even know it. Having a family history of diabetes also seems to increase your risk.

However, some people develop gestational diabetes when pregnant without any known risk factors.

What happens if gestational diabetes isn’t well managed?

According to the Centers for Disease Control and Prevention, you’re at a higher risk for several things if you have difficulty managing your blood sugar levels with gestational diabetes:

• An extra-large baby
• C-section delivery
• High blood pressure
• Low blood sugar in your baby

What not to do with gestational diabetes?

You don’t want to ignore the importance of testing your blood sugar levels as your doctor recommends. If you don’t test your blood sugar levels, you won’t know if you need to take insulin to lower your blood sugar levels.

Whether you anticipated it or not, a gestational diabetes diagnosis can still come as a surprise. However, it’s a manageable condition. If you do receive a diagnosis of gestational diabetes, you can follow in the footsteps of many others who have managed with some lifestyle changes and possibly some insulin. Talk with your doctor about any concerns that you may have about managing gestational diabetes and keeping track of your chance of developing type 2 diabetes later in life.