What gestational diabetes is
Gestational diabetes is high blood sugar that develops during pregnancy in pregnant women who have never had high blood sugar before. Blood sugar usually returns to normal after the baby is born.
When you eat, some food is broken down into sugar, also called glucose. Sugar travels in your blood to all of your body's cells. Insulin helps sugar move from your blood into your cells. Insulin is a hormone made by the beta cells in your pancreas.
Your cells need sugar for energy. Sugar from food makes blood sugar levels rise. Sugar may come from sugar itself or from carbohydrates that the body turns into sugar. Natural insulin lowers blood sugar by helping sugar move from the blood into the cells.
During pregnancy, hormones that help the baby develop can cause insulin resistance. Your body tries to produce more insulin to handle the extra sugar, but it may still not be enough. Sugar then stays in the blood instead of moving into cells, causing blood sugar levels to become too high.
Risks and why control matters
If blood sugar levels are not managed during pregnancy, this can cause problems for both you and your baby. Your baby gets nutrients, including sugar, from your blood. If your blood sugar levels are high, your baby will get too much sugar, store extra sugar as fat, gain too much weight, and may become too large.
Higher risk for baby
- Injuries during delivery
- Low blood sugar after birth
- Breathing problems
- Jaundice
- Developmental problems, usually related to premature birth and not common
- Possibility of type 2 diabetes later in life
Higher risk for mother
- Type 2 diabetes
- High blood pressure during pregnancy
- Caesarean section
- Gestational diabetes in a future pregnancy
These problems do not have to happen. Managing blood sugar levels can help reduce the risk.
Managing gestational diabetes
The goal is to keep blood sugar levels as close to normal as possible. Your diabetes care team will help create a care plan to meet that goal.
- Eat meals and snacks according to your meal plan.
- Get regular physical activity.
- Take medicine as prescribed by your doctor.
- Check your blood sugar often according to your care plan.
- Bring your glucose log and meal questions to visits.
Carbohydrates and plate planning
Food groups that count as carbohydrates include beans, grains, pasta, breads, starchy vegetables, dairy products, milk alternatives, fruits, snacks, baked goods, condiments, and salad dressing.
Daily carbohydrate rhythm
30gBreakfast
2 servings
15gSnack
30-45gLunch
2-3 servings
15gSnack
30-45gDinner
2-3 servings
15gSnack
Vegetables
Make half your plate non-starchy vegetables. Try fresh, frozen, or low-sodium canned vegetables.
Protein
Examples include chicken, turkey, lean cuts of beef, eggs, nuts, fish, and tuna. Choose baked, boiled, sauteed, rotisserie, grilled, or roasted preparations instead of fried.
Carbohydrates
Consume recommended carbohydrate amounts as directed and choose whole grain products whenever possible. Remember to eat 3 meals and 3 snacks, add protein to snacks, and try to eat at the same times every day.
Sample one-day meal plan
Breakfast (30g carbs)2 scrambled eggs, 1 slice whole wheat toast, 1/2 cup berries
Morning Snack (15g carbs)1 small apple, 1 tablespoon peanut butter
Lunch (45g carbs)Grilled chicken salad, 1 whole wheat pita, 1 small orange
Afternoon Snack (15g carbs)Plain unsweetened Greek yogurt
Dinner (45g carbs)Baked salmon, 1/2 cup brown rice, roasted vegetables
Bedtime Snack (15-20g carbs)Whole grain crackers with cheese
Protein snack ideas
Protein snacks help fill you up just enough and provide longer-lasting energy than carb-heavy options.
- Cottage-style fruit: 1/2 cup cottage cheese with 1/2 cup fruit such as bananas, mixed berries, or melon.
- Beef or turkey jerky: choose low-sodium, natural, or lightly flavored brands; 1 oz has about 9g protein.
- Mixed nuts or trail mix with dried fruit.
- Pumpkin seeds: 1/2 cup has about 14g protein.
- Hard-boiled egg, alone or sliced on whole-wheat bread.
- Deli rollup: low-sodium turkey, chicken, or roast beef with low-fat cheese, pepper, tomato, or lettuce.
- Nut butter boat: celery or apple with nut butter, almonds, or raisins.
- Mini bean-and-cheese quesadilla with black beans, salsa, cheddar, and a small tortilla.
- Protein shake such as vanilla protein with orange juice and ice, or iced coffee with chocolate protein.
- KIND bar or KIND Plus protein variety.
- Easy oatmeal raisin microwave cookie.
- Tofu sticks, baked and served with tomato or teriyaki dipping sauce.
- Chunky Monkey shake: banana, peanut butter, low-fat chocolate milk, and ice.
- Edamame poppers; 1 cup of pods has about 17g protein.
- Hummus dippers with carrots, celery, or snow peas.
- Soy milk smoothie with frozen blueberries or raspberries.
- Portable cheese platter with reduced-fat cheese, whole-grain crackers, and almonds.
- Rice cake with nut butter, banana, and cinnamon.
- Silver dollar protein pancakes with egg whites, oats, cottage cheese, baking powder, and vanilla.
- Low-fat chocolate milk, especially after activity.
- Greek berry parfait with plain Greek yogurt, berries, and roasted almonds.
- Grape-and-cheese sticks.
- Whole-grain toast sticks with almond butter and cinnamon.
- Lentils; 1 cup has about 22g protein.
- Greek yogurt parfait with fruit, honey, and toasted oats.
- Mini black-bean mash taco with salsa and a small tortilla.
- Turkey sandwich with Swiss cheese, lettuce, tomato, mustard, and dried cranberries.
- Protein bar with attention to sugar, fat, and calories.
- Overnight chocolate oats with non-dairy milk, chocolate protein powder, and walnuts.
- Protein rice crispies.
- Blueberry flax microwave muffin.
- Glucerna Smart Shake, green top.
Insulin education
Insulin cannot be taken in pill form because digestive enzymes break it down. It is delivered into the layer of fat below the skin, called subcutaneous tissue. Common injection sites include the stomach, hips, thighs, buttocks, and backs of the arms. Because this layer has no nerve endings, injections are usually painless.
Syringes
Disposable insulin syringes vary by how much insulin they hold and by needle length and thickness. Syringes can deliver insulin directly under the skin or into a temporary port changed every 2-3 days.
Pens
Insulin pens are pen-shaped devices with insulin inside and a dial for setting the dose. They use disposable pen needles and are often convenient, accurate, and easy to use.
Pumps
Pumps are worn continuously and deliver insulin through a flexible tube. They require education and training and are usually considered after more experience with insulin.
Needles
Needles range from 4 mm to 12.7 mm. Higher gauge means thinner. Short, thin needles are generally preferred; a needle longer than 6 mm is usually not needed.
Drawing one type of insulin into a syringe
- Gather your insulin vial and a fresh syringe. Check the vial for correct insulin, no clumps or particles, and no expiration.
- Gently roll intermediate or premixed insulin between your palms. Clear fast-acting or long-acting insulin generally does not need mixing.
- Prepare the bottle. If new, remove the cap. Wiping with alcohol is not necessary if it is clean.
- Pull air into the syringe equal to your insulin dose.
- Inject air into the vial through the rubber stopper to help maintain pressure.
- Turn the vial and syringe upside down and draw insulin to the desired dose.
- Check for air bubbles, push air out if needed, and redraw to the correct dose.
- Remove the needle and avoid letting it touch anything before injection.
Hypoglycemia and the Rule of 15
Symptoms of low blood sugar may include shaking, sweating, dizziness, confusion, hunger, headache, or weakness. If symptoms occur, check your blood sugar. If it is below 70 mg/dL, follow the Rule of 15.
- Consume 15 grams of carbohydrates.
- Wait 15 minutes and recheck blood glucose.
- If still low, below 70 mg/dL, repeat until glucose is above 90 mg/dL.
- Once normal, eat a balanced snack with protein and carbohydrates if the next meal is more than one hour away.
A1C and eAG
The A1C blood test shows average blood glucose over the past two to three months by measuring how much sugar is attached to red blood cells. eAG means estimated average glucose and translates A1C into a number similar to home glucose readings.
| A1C | Average Blood Glucose (eAG) |
|---|
| 6% | 126 mg/dL |
| 6.5% | 140 mg/dL |
| 7% | 154 mg/dL |
| 7.5% | 169 mg/dL |
| 8% | 183 mg/dL |
| 8.5% | 197 mg/dL |
| 9% | 212 mg/dL |
| 9.5% | 226 mg/dL |
| 10% | 240 mg/dL |
| 10.5% | 255 mg/dL |
Both A1C/eAG and home meter checks are important. Meter results help with day-to-day decisions, while A1C gives a broader picture over time.
After delivery
Your doctor will check your blood sugar 6 to 12 weeks after the baby is born to make sure it is normal. Because gestational diabetes increases the risk of diabetes later in life, your doctor may recommend continued blood sugar checks.
You can reduce your future risk by continuing to eat a healthy diet, getting regular physical activity, and managing your weight.