Carrying a Baby and a New Diagnosis: Practical Tips for Managing Gestational Diabetes

Becoming pregnant brings a swirl of feelings. Then learning that gestational diabetes (GDM) has appeared can add fear, guilt, confusion, and a lot of “what is this and what should I do next?”

What is GDM – in plain language?

While the medical term “gestational diabetes” may sound scary, simply put, it means glucose levels are higher than normal during pregnancy. GDM is brought on by the placental hormones. They interfere with insulin, a natural hormone your body makes to help regulate glucose levels. When this occurs, you become resistant to insulin, and it can’t work well to regulate glucose.  This is called “insulin resistance”. At around 16 weeks, insulin resistance begins to increase on a steady climb each week into pregnancy. Thus, glucose becomes more challenging to manage as pregnancy progresses.

How to know if you have GDM

The 2025 Standards of Care evidence-based guidelines for diabetes care recommend that pregnant women without prior diabetes be routinely screened for GDM at 24-28 weeks. Most commonly, this is done via a “one-step” 75-gram oral glucose tolerance test (OGTT). Blood glucose is checked fasting, then you drink a very sweet beverage (although some care teams use alternatives). Glucose checks are done 1 and 2 hours after to see how you respond. There is also a less common “two-step” approach that may be used. Routine screening and diagnosis allow you to begin management, get support early, and keep both you and your baby well. Diabetes Journals

Why GDM is not your fault

While risk for GDM can rise with age, polycystic ovary syndrome (PCOS), family history of diabetes, overweight, prior pregnancy with a baby weighing >9 pounds, or a past GDM pregnancy, GDM is NOT your fault. Many women without any of these risk factors still develop GDM. Blame the pregnancy hormones. GDM CAN be managed, and you CAN have a healthy delivery.

Why healthy glucose is the top priority

Glucose goals are tighter in pregnancy to promote healthy growth and development. According to the 2025 Standards of Care, blood glucose monitoring is recommended fasting and after meals.  The fasting target is 70-95, and targets after each meal are either <140 after 1 hour  OR <120 after 2 hours. It’s nice to have a couple of options for after-meal checking because sometimes “life happens” and you can’t catch a 2-hour check. The more time spent with elevated glucose can increase a baby’s future risk for obesity, high blood pressure, and type 2 diabetes. Staying close to your glucose targets is protective both now and for the future.

Newborn note you need to know

After birth, the care team will likely check your baby’s glucose. This is common practice with GDM pregnancies, as the newborn may experience low glucose (hypoglycemia) while adapting to being outside of your body. If the baby’s glucose drops low, treatment typically involves administering a fast-acting source of glucose, such as oral dextrose gel or IV dextrose. For mild hypoglycemia, breastfeeding, donor milk, or formula can raise glucose. Nature+4BMJ Medicine+4PMC+4

Take charge through the ADCES7 self-care behaviors 

The ADCES7 is a proven framework for diabetes self-management. Many women can manage GDM through healthy eating, physical activity, and weight management. If extra help is needed to keep glucose in range, insulin is the preferred medication. The pills metformin and glyburide can also be used individually or in combination, though they often are not the first choice because both cross the placenta and aren’t as powerful as insulin.

The following are a variety of practical tips around each of the 7 self-care areas that can help you navigate pregnancy with GDM. 

#1 – HEALTHY COPING.

It’s OK and normal to feel overwhelmed, angry, fearful, and a range of other emotions. After all, GDM is not the kind of surprise any woman wants

• Share your feelings and challenges with your healthcare team and trusted people in your life. Tell them how they can support you.
• Know that you are not alone. DiabetesSisters hosts monthly virtual support groups for women who are expecting a baby and navigating GDM. These groups offer expert guidance, peer connection, and practical strategies to support a healthy pregnancy. Talking with other women shrinks fear. 

#2 – HEALTHY EATING.

A healthy eating pattern in pregnancy includes fruits, vegetables, legumes, whole grains, nuts, seeds, fish, and other lean protein. This provides a balance of nutrients to promote healthy growth. 

• Eat adequate carbohydrates. Now is NOT the time to restrict carbs. For growth and brain development, your baby needs carbohydrates. The dietary reference intake (DRI) recommendation for pregnant women is a minimum of 175 grams of carbohydrate daily, plus a minimum of 71 grams of protein and 28 grams of fiber daily. 
• Spread carbs throughout the day. Spreading carbs throughout the day helps keep glucose steady. To meet the 175-gram minimum, try 30 grams for breakfast, 45 grams for lunch, and 60 grams for dinner, with a 15-gram carb snack mid-morning, mid-afternoon, and at bedtime. Insulin resistance is stronger in the morning, improving as the day goes on – thus, try having fewer carbs in the morning and more as the day passes. 
• Use the simple and effective Diabetes Plate Method to manage carbs and eat a balanced meal. A standard 9-inch plate is just the right size. Use smart portioning to fill 1/2 of your plate with non-starchy vegetables, 1/4 of your plate with lean protein, and 1/4 with carby foods. Given that a woman’s fist is typically about 1 cup (equal to 30 carbs), you can quantify carbs quickly using your fist. Round out the meal with water or another calorie-free drink, and a small amount of healthy fat if you want (such as avocado, nuts, or olive oil).
• Familiarize yourself with the carb content of foods you eat. Use Nutrition Facts labels, Google, or one of many available apps to build carb awareness.
• Manage glucose more easily by eating fewer processed carbs. For instance, go for brown rice, whole-grain bread, and fiber-enriched pasta instead of white processed versions.
• Avoid sugary drinks. They spike glucose quickly.
• Include protein in your bedtime snack to help improve fasting glucose. Two favorites are peanut butter with a small apple or nuts/cheese with whole grain crackers.

#3- BEING ACTIVE.

Physical activity is powerful in lowering glucose and reducing the need to start insulin with GDM. For those who do require insulin, physical activity can lower the amount required. Other benefits include strengthening in preparation for delivery, managing pregnancy weight gain, improving energy, and reducing stress and anxiety. The 2025 Standards of Care recommend that healthy women get at least 150 minutes of moderate-intensity low-impact activity each week (such as walking).  Generally, no lifting, bouncing, or straining.

• Aim for 30 minutes most days. As pregnancy progresses, some find walking uncomfortable. Chair exercises or chair yoga are great options. There are many pregnancy yoga and chair exercise ‘workouts” on YouTube. 
• Get benefits in 10 minutes. Did you know that taking a 10- to 15-minute walk after meals helps lower glucose spikes?  

#4- TAKING MEDICATION.

If medication is recommended, it’s simply another supportive tool for your pregnancy journey. The ever-changing requirements of pregnancy call for dose adjustments along the way.

• Know the symptoms of hypoglycemia and how to treat it if you take insulin.
• Women with GDM usually don’t require diabetes medication after delivery. Insulin requirements quickly decrease because insulin resistance decreases dramatically postpartum. Insulin sensitivity returns to prepregnancy levels within 1-2 weeks after delivery. 

#5- MONITORING.

Glucose checks provide you with a wealth of feedback to learn what foods, portions, and physical activity work for you, and if or when medication changes are needed. Continuous glucose monitoring (CGM) may be a beneficial alternative. Beyond monitoring glucose, your provider will likely have you monitor your baby’s movement and possibly your blood pressure. 

• Make sure your fingertips are clean before checks. This is not only to prevent infection, but to remove any food residue. Several women have shared that after eating a piece of fresh fruit, they checked their glucose and noted a higher-than-expected result. They actually had dried fruit juice on their fingertips, which was sampled with the blood and resulted in a false elevation. 
• Safely dispose of sharps (needles). Use a sharps container or check with your local trash collection for guidelines to safely dispose of them in the trash. Do not put sharps in recycling.. 

#6- REDUCING RISKS.

It’s important to know that GDM can bring some health risks, but there are many ways to lower them. For women, these include high blood pressure (pre-eclampsia), more prevalent urinary tract or vaginal infections, early induction, and potential for Caesarean section (generally linked to baby’s size). For the baby, risks can include large-for-gestation weight, shoulder injury during birth, low glucose after delivery, lung development, jaundice, and increased future type 2 risk. For both mother and baby, risk is largely related to the degree of glucose elevation.  

• Keep prenatal appointments and ultrasound checks.
• Strive for your glucose goals to help minimize many of the above risks. 
• Breastfeed if possible for multiple benefits. Breastfed babies not only get immediate nutritional benefit, but they are also less likely to develop overweight, type 2 diabetes, asthma, respiratory disease, and other serious health problems. For women, breastfeeding helps to process insulin and glucose better, as well as reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. If breastfeeding is difficult or not possible, many well-baby units offer donor milk, which can provide the health benefits. 
• Get screened at 4-12 weeks postpartum. This is recommended by the 2025 Standards of Care to make sure glucose has returned to normal. 
• Stay on top of your health. Lifelong screening for prediabetes and type 2 diabetes is recommended. It’s as simple as an A1C or fasting glucose added to your annual blood work. Or, doing a 75-gram OGTT every 3 years (not the most popular screening among women!) This includes getting screened prior to a future pregnancy.
• Continue with your healthy lifestyle habits. After delivery, to help hold off prediabetes or type 2 diabetes, continue to eat healthy, maintain a healthy weight, and get regular physical activity.

#7 – PROBLEM-SOLVING.

You can’t plan for every situation you’ll encounter. Be patient with yourself. Lean on your care team. They help others like you every day to solve problems around healthy eating, being active, taking medications, monitoring, and reducing risks. The following are 8 steps to take in preparation for your next appointment:

• Make a list of questions or put them in your phone’s Notes.
• Ask how often you will be seen and what each visit is checking.
• Request a referral to a registered dietitian and/or a diabetes care and education specialist if you have not met with one yet to discuss carb goals and the best eating plan for you.
• Ask how often you should check your glucose and what your personal glucose targets are.
• Ask what type and amount of physical activity is safe for you.
• Set up a simple glucose log on paper, electronically, in your phone, or using an app.
• Plan one balanced breakfast.
• Identify one support space, such as a peer group or trusted friend.

You don’t have to navigate gestational diabetes alone. DiabetesSisters offers a safe, inclusive space where women share experiences, ask questions, and learn from both peers and experts. 

Join our Gestational Diabetes Virtual Support Group to connect with other women who understand this journey. You can also visit our Living with Gestational Diabetes and Beyond Hub for trusted resources and compassionate guidance.