How Is Diabetes in Pregnancy Treated? Diet, Insulin, and Medications Explained

Author: Amrutha Balagopal, PhD, Biotechnology

Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Diabetes in pregnancy can be pregestational or gestational diabetes
• Pregestational diabetes is a pre-existing condition that occurs before pregnancy, while gestational diabetes is diagnosed during pregnancy and resolves soon after childbirth
• Early diagnosis, healthy eating with portion control, and regular exercise can help manage blood sugar levels
• Sometimes medications such as metformin, glyburide, and insulin are required when lifestyle changes do not help
• Regular blood sugar monitoring and follow-up with your healthcare provider are necessary to keep both the mother and baby safe

Introduction

While pregnancy brings you joy, it can also come with complications, and diabetes in pregnancy is one such complication. You are more likely to develop this condition if you have a family history of type 2 diabetes, high blood pressure, and obesity, among others.This can lead to complications in both the mother and the baby.

 Possible effects on the baby include preterm birth, stillbirth, high birth weight, low blood sugar (neonatal hypoglycemia), and obesity later in life. The mother can develop high blood pressure and pre-eclampsia or type 2 diabetes in the future.

The good news is that extensive research has been done in this area. With a few dietary and lifestyle changes, and sometimes by the use of prescribed drugs, this condition can be effectively managed. Prevention, early diagnosis, and treatment are key to reducing the burden of adverse effects in women and children. This is why early and consistent monitoring in pregnancy is always recommended.

This article aims to educate you about the significance of diabetes in pregnancy and the various ways to manage the condition, including dietary and lifestyle changes, as well as the medications and therapies involved. You will also learn why it is essential to stay consistent with monitoring and follow-up appointments with your healthcare provider.

What is Diabetes in Pregnancy?

Diabetes in Pregnancy is of two types:

• Pregestational Diabetes

It is the type of diabetes that exists before pregnancy, typically type 1 or type 2. Evidence show that about 0.5-2.4% of women are affected by pregestational diabetes, depending on the geographical location. Type 1 diabetes occurs when there is insufficient production of insulin by the insulin-producing cells, leading to unregulated levels of sugar. Sometimes, even when insulin is present in the body, your cells do not respond to it as they should (insulin resistance), leading to type 2 diabetes. Some risk factors for pregestational diabetes include:

• Obesity
• Age
• Physical inactivity
• Ethnicity
• Family history

Gestational Diabetes (GD)

It is the type of diabetes that is diagnosed during pregnancy and usually resolves soon after childbirth. It can develop at any stage of pregnancy and is generally common in the second or third trimester.  GD occurs when the body produces hormones that interfere with the mother’s ability to use insulin effectively. This leads to unregulated levels of blood sugar (glucose) in the body, causing complications. Some of the risk factors for developing GD include:

• Gestational diabetes in a previous pregnancy
• Obesity
•  Advanced maternal age (>35 years)
•  Family history of type 2 diabetes
•  Polycystic ovary syndrome (PCOS)

GD is more common in certain parts of the world, such as Southeast Asia, parts of Europe, North America, including China, and Hong Kong, among others. GD is diagnosed by a glucose tolerance test, which is part of routine prenatal testing.

Management of Diabetes in Pregnancy

Dietary and lifestyle management

Healthy eating and portion control

This condition can impact both your health and that of your baby, but it can be managed with consistent care and attention.  Evidence shows that in most cases, a holistic approach combining a healthy diet, reduced sedentary lifestyle, and regular physical activity can effectively manage the condition [1]. Eating balanced meals in controlled portions can help regulate your blood glucose levels. Some helpful tips to keep in mind are:

• Divide your plate into portions of non-starchy vegetables, starchy vegetables, fruits, proteins, and whole grains
• Have smaller portions of carbohydrates spread evenly throughout the day, and aim for no more than one-quarter of carbohydrates at each meal
• Aim to have three full meals with 2-3 snacks a day
• Limit your intake of sweets and fruit juices with added sugars

Make sure you include foods with a low glycemic index and high fibre to prevent blood sugar spikes. It is always recommended to consult with your healthcare provider or a registered nutritionist or dietitian for the best results.

Exercise and physical activity

Another important lifestyle modification for managing gestational diabetes is engaging in regular physical activity. Exercising requires the use of energy and helps in the effective use of insulin, leading to lower levels of blood glucose in the body. Aerobic or resistance exercise, or a combination of both, is effective for the control of glucose, HbA1c, and insulin in the body. The Centres for Disease Control and Prevention (CDC) recommends at least 150 minutes of moderate-intensity aerobic activity a week during pregnancy and the postpartum period. A recent study reports that about 40-60 minutes of exercise, three times a week, starting early in pregnancy, helps lower the risk of GD [3].Here are some simple and safe exercises that can help:

• Brisk walking
• Swimming
• Yoga
•  Stationary cycling
•  Squats
• Pelvic tilts
•  Kegel exercises

Always consult your healthcare provider before starting an exercise program, especially if you have any health conditions or complications.

Medications for the treatment

Most often, the lifestyle modifications mentioned above help manage GD. Routine blood sugar monitoring is recommended. This helps ensure your blood sugar levels stay within a healthy range. This may require you to test your blood sugar four or more times a day, particularly soon after waking up and after meals. In cases where your blood sugar levels are high even after following the diet changes and regular exercise, you may need to take medications.

Insulin therapy

Insulin is the preferred treatment in cases where dietary and lifestyle modifications are unable to achieve pregnancy-specific glucose targets.

 Insulin is highly effective in managing the blood sugar levels and, more importantly, does not cross the placenta (keeping your baby safe). It is used in the case of both pregestational and gestational diabetes. Thus, insulin remains the gold standard in pregnancy. Insulin is usually administered using insulin pens or syringes. It can be tailored in type and dosage to maintain blood sugar effectively. Depending on your blood sugar levels, different types of insulin are prescribed. 

• Rapid-acting insulin includes NovoRapid or Humalog. These act quickly, within 20 minutes, and last up to 5 hours
• Regular/short-acting insulin takes about 30 minutes to act and lasts for 3-6 hours
• Intermediate-acting insulin includes Humulin I and Insulatard, which are slow in action (2-4 hours) but last longer, about 12-18 hours. 
• Long/ultra long-acting insulin takes 2-6 hours to act and lasts up to 24-36 hours
• Premixed insulin combines intermediate and short-acting insulin, acts within 60 minutes, and lasts from 10-16 hours

Even though insulin helps protect the mother and the baby, many women are still hesitant to take the insulin therapy. This stems from the fear of possible harm to their babies and discomfort from injections. Research shows that women face emotional challenges when starting insulin therapy for GD [5]. This calls for the need for more healthcare professionals to provide proper education, reassurance, and compassion to help them manage the condition with confidence. 

Drugs for diabetes in pregnancy

Sometimes, even insulin does not help maintain the blood sugar levels. In such cases, the commonly used drugs to treat diabetes are metformin and glyburide. These are oral glucose-lowering medications, popular alternatives to insulin, as they are easily administered (orally) and less expensive. A recent study reported that almost 59% of pregnant women in the UK resort to the use of metformin when medications are required in GD [4]. The table below will give you a better understanding of both drugs. 

*Dosage may vary depending on your condition. Consult with your healthcare provider first

Increasing evidence supports the safety and utilisation of these drugs, but long-term data are still limited when compared to insulin.

Monitoring and Follow-Up

Once you are diagnosed with diabetes, monitoring your blood sugar levels and consulting with your healthcare provider becomes very important. The most common approach is self-monitoring of blood glucose (SMBG), where you measure your blood sugar with a glucose meter to keep it as close to normal as possible. SMBG requires testing several times a day and may seem cumbersome, but it allows you to identify and prevent hypoglycemia or hyperglycemia, giving you peace of mind. 

It has been reported that testing blood glucose twice a day is the same as that obtained from four times a day in women with well-controlled diabetes. This can reduce the burden, cost, and inconvenience of frequent monitoring [6].

The recommended levels of blood sugar for diabetes in pregnancy include:

•  Fasting: (3.6 mmol -5.3 mmol/l
• 1-hour postprandial: <7.8 mmol/L
•  2-hour postprandial: <6.7 mmol/L

Hypoglycemia or low blood sugar levels is a dreaded complication in diabetes, especially in people using medications such as insulin.  Some common symptoms include:

• Sweating or chills
• Dizziness
• Trembling
• Slurred speech
• Blurred vision
• Loss of consciousness

The symptoms usually arise when the blood sugar falls below 3,6 mmol/LHypoglycemia can be life-threatening and needs immediate attention. Severe complications can lead to organ failure, coma, or even death. If you experience any of the symptoms listed above, make sure you act quickly or let your loved ones know. You can act by taking 1-2 tablespoons of sugar or some sips of a sugary drink when you feel your sugar levels are dropping. You should make efforts to get to the hospital as soon as possible.

Regular antenatal visits to your healthcare provider is necessary to manage your condition. These will help prevent complications and lead to a safe and healthy pregnancy.  In gestational diabetes, it is equally important to have your blood sugar levels checked 6-12 weeks post delivery, to ensure they are back to normal. 

Being diagnosed with GD can be emotionally challenging, but remember, you are not alone. Reach out to your family, friends, and other social support groups to receive all the help you need

Conclusion

Diabetes in pregnancy is a common yet manageable condition during pregnancy. While it can bring anxiety, timely interventions, including regular exercise, healthy eating, and proper monitoring, can help manage the condition. Insulin therapy and medications such as metformin are available to help maintain normal glucose levels. Consistent follow-up with your healthcare provider and a solid support team can greatly contribute to the well-being of both mother and baby. 

References 

1.  Taousani E, Papaioannou K-G, Mintziori G, Grammatikopoulou MG, Antonakou A, Tzitiridou-Chatzopoulou M, et al. Lifestyle Behaviors and Gestational Diabetes Mellitus: A Narrative Review. Endocrines [Internet]. 2025 [cited 2025 Oct 19]; 6(1):6. Available from: https://www.mdpi.com/2673-396X/6/1/6.

2.  Sun N, Wen S, Huo Z, He Z, Sun T, Hu J, et al. Association Between the EAT-Lancet Reference Diet and Gestational Diabetes Mellitus: A Mini-Review. Nutrients [Internet]. 2024 [cited 2025 Oct 19]; 16(23):4073. Available from: https://www.mdpi.com/2072-6643/16/23/4073.

3.  Lust O, Chongsuwat T, Lanham E, Chou AF, Wickersham E. Does Exercise Prevent Gestational Diabetes Mellitus in Pregnant Women? A Clin-IQ. J Patient Cent Res Rev [Internet]. 2021 [cited 2025 Oct 19]; 8(3):281–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297497/.

4.  Yu Y-H, Platt RW, Reynier P, Yu OHY, Filion KB. Use of metformin and insulin among pregnant women with gestation diabetes in the United Kingdom: A population-based cohort study. Diabet Med. 2023; 40(8):e15108. Available from: https://pubmed.ncbi.nlm.nih.gov/37029772/

5.  Düzgün G, Polat G, Ünsal Avdal E. Perspective on insulin use in gestational diabetes: A phenomenological study. Medicine (Baltimore) [Internet]. 2023 [cited 2025 Oct 19]; 102(49):e35831. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713104/.

6.  Bussière-Côté S, Sieffien W, Berger H, Park AL, Ray JG. Twice-Daily vs 4-Times-Daily Glucose Testing in Women With Gestational Diabetes Mellitus: A Pilot Study. Canadian Journal of Diabetes [Internet]. 2020 [cited 2025 Oct 19]; 44(3):274–9. Available from: https://www.sciencedirect.com/science/article/pii/S1499267119305970.

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published October 28, 2025