Gestational diabetes is treated with a combination of dietary changes, physical activity, blood sugar monitoring, and, when needed, medication. Most people manage it successfully with lifestyle changes alone, though up to 90% of those who can’t control blood sugar through diet and exercise will need insulin or an oral medication. The goal is to keep blood sugar within a specific range that protects both you and your baby through delivery and beyond.
Blood Sugar Targets
The foundation of gestational diabetes treatment is hitting specific blood sugar numbers throughout the day. The American Diabetes Association’s current targets are:
- Fasting: 70 to 95 mg/dL
- One hour after a meal: 110 to 140 mg/dL
- Two hours after a meal: 100 to 120 mg/dL
Your provider will typically ask you to check your blood sugar four times a day: first thing in the morning (fasting) and after each meal. Some providers prefer the one-hour post-meal reading, others the two-hour mark. Either works as long as you’re consistent and staying within range. These readings get logged so your care team can spot patterns and decide whether lifestyle changes are enough or medication is warranted.
How Diet Changes Work
Nutrition therapy is the first and most important intervention. The original approach to gestational diabetes was to sharply restrict carbohydrates to about 33 to 40% of total calories, but more recent evidence supports a wider range. Research now suggests that carbohydrate intake between 47 and 70% of daily calories can support normal fetal growth, especially when those carbohydrates come from high-quality sources with a low glycemic index and minimal added sugars. The Institute of Medicine recommends at least 175 grams of carbohydrates per day during pregnancy, so very low-carb diets are not appropriate.
In practice, this means spreading your carbohydrate intake across the day rather than eating large amounts at once. Most providers recommend three moderate meals and two to three snacks. Pairing carbohydrates with protein, fat, or fiber slows digestion and prevents the sharp blood sugar spikes that come from eating refined grains or sugary foods on their own. Choosing whole grains, legumes, vegetables, and fruit over white bread, juice, and sweets makes a measurable difference in post-meal readings.
Exercise and Timing
Physical activity is a powerful tool for lowering blood sugar, and the timing matters. Current guidelines recommend at least 150 minutes of moderate-intensity activity per week, spread over three or more days. That could look like 30 minutes at the gym five days a week, or something as simple as a 10-minute walk after lunch and dinner every day.
Walking immediately after a meal is particularly effective because it helps blunt the post-meal blood sugar spike. Even a short stroll can bring your one-hour reading down noticeably. Swimming, stationary cycling, and prenatal yoga are other common options. The key is consistency rather than intensity.
When Medication Becomes Necessary
If your blood sugar readings stay above target despite diet and exercise, medication is the next step. The threshold varies by provider, but one common approach is to start medication when 20 to 40% or more of your logged readings are above goal after about a week of dietary management. The American College of Obstetricians and Gynecologists recommends treatment “when target glucose levels cannot be consistently achieved through nutrition therapy and exercise.”
Insulin has long been the standard medication because it doesn’t cross the placenta in meaningful amounts. It’s given by injection, usually before meals or at bedtime depending on which readings are elevated. The dosage gets adjusted throughout pregnancy as your body’s insulin resistance naturally increases.
Oral medications, particularly metformin, have become a widely used alternative. Metformin is easier to take, costs less, and is better accepted by most patients. A recent randomized trial published in JAMA found results supporting metformin as a first-line option for gestational diabetes, and many providers now offer it before insulin. Glyburide is another oral option, though it has fallen somewhat out of favor compared to metformin. One trade-off: in the JAMA trial, 78% of people taking oral medications reported adverse effects (mostly gastrointestinal) compared to 56% of those on insulin.
Your provider may start with metformin and switch to insulin if blood sugar still isn’t controlled, or go straight to insulin if your readings are significantly elevated.
Weight Gain During Treatment
Weight gain doesn’t stop when you’re diagnosed with gestational diabetes, but the pace matters. Research on optimal weekly weight gain after a gestational diabetes diagnosis found the following ranges based on pre-pregnancy BMI:
- Underweight (BMI under 18.5): 0.37 to 0.56 kg per week (about 0.8 to 1.2 lbs)
- Normal weight (BMI 18.5 to 24.9): 0.26 to 0.48 kg per week (about 0.6 to 1.1 lbs)
- Overweight (BMI 25 to 29.9): 0.19 to 0.32 kg per week (about 0.4 to 0.7 lbs)
- Obese (BMI 30+): 0.12 to 0.23 kg per week (about 0.3 to 0.5 lbs)
Gaining too much weight increases the risk of a larger baby and delivery complications, while gaining too little can restrict fetal growth. Your provider will track your weight alongside your blood sugar readings.
How Gestational Diabetes Affects Delivery
Gestational diabetes influences when and how your baby is delivered. If your blood sugar is well controlled through diet and exercise alone (called class A1), delivery timing is typically closer to your due date. If you need medication to manage your levels (class A2), your provider may recommend delivery slightly earlier.
One reason for careful timing is that gestational diabetes can delay fetal lung maturation, with full maturity sometimes not reached until around 38.5 weeks. Inducing labor too early, particularly at 37 weeks, has been linked to higher rates of newborn complications in diet-controlled cases. Research comparing outcomes at different gestational ages found that well-controlled gestational diabetes with labor induced between 39 and 40 weeks produced outcomes comparable to pregnancies without diabetes.
Gestational diabetes does increase the likelihood of cesarean delivery and shoulder dystocia (where the baby’s shoulder gets stuck during delivery), primarily because of higher birth weight. Keeping blood sugar in range throughout pregnancy is the most effective way to reduce these risks.
After Delivery
For most people, blood sugar returns to normal shortly after the placenta is delivered, since the placental hormones driving insulin resistance are gone. But gestational diabetes is a strong signal that your body has difficulty processing sugar under stress, and up to 36% of people with gestational diabetes have persistently abnormal glucose levels after pregnancy.
Guidelines recommend a glucose tolerance test between 6 and 12 weeks postpartum to check whether your blood sugar has normalized. If it has, you should still be screened for type 2 diabetes every three years going forward. The long-term risk of developing type 2 diabetes after gestational diabetes is significant, but maintaining the same habits that controlled your blood sugar during pregnancy (balanced eating, regular activity, healthy weight) substantially lowers that risk.