When Diet and Exercise Aren't Enough 

About 15-30% of women with GDM need medication. 

This does NOT mean you failed. It means: 

• Your placenta produces very strong hormones 
• Your pancreas can't keep up 
• You need extra help - and that's okay 

Medication protects your baby. Don't refuse it out of guilt or fear. 

Medication Options 

Insulin (most common): 

• Injected with small needle (less painful than finger pricks) 
• Types: Fast-acting (mealtime), long-acting (bedtime), or both 
• Doses adjusted frequently based on your numbers 
• Does not cross placenta - safe for baby 
• Stops immediately after delivery 

Oral medications (metformin or glyburide): 

• Some doctors prescribe instead of insulin 
• Taken as pills 
• May be combined with insulin 
• Effectiveness varies by person 

If prescribed medication: 

• Ask for training - you'll become comfortable quickly 
• Report all readings so doses can be adjusted 
• Never adjust doses yourself 
• Keep medication at correct temperature 
• Bring to all appointments 

Increased Monitoring in Third Trimester 

As you get closer to delivery: 

• More frequent ultrasounds (every 2-4 weeks) 
• Non-stress tests (monitoring baby's heart rate) 
• Amniotic fluid checks 
• Growth measurements 
• Possible early induction discussion (39 weeks vs. 40 weeks) 

This is precautionary monitoring, not evidence of problems. 

Planning for Delivery 

What to expect: 

• May recommend induction at 39 weeks (before due date) 
• Continuous blood sugar monitoring during labor 
• Possible insulin drip during labor 
• Baby's blood sugar tested after birth 
• Baby may need glucose IV or feeding support initially 
• You may need to stay extra day for monitoring 

C-section more likely if: 

• Baby measuring very large (>9-10 lbs) 
• Blood sugar poorly controlled 
• Other complications develop 

Discuss birth preferences with doctor early - some flexibility may be possible. 

Immediately After Delivery 

What happens: 

• Your blood sugar typically drops immediately after placenta delivery 
• Stop all GDM medications right away 
• Continue testing for 24-48 hours 
• Resume normal diet 
• Baby tested frequently for low blood sugar 
• Skin-to-skin and early breastfeeding help baby's blood sugar 

Most women can eat whatever they want after delivery (hospital cookie never tasted so good!). 

Breastfeeding with GDM History 

Benefits for baby: 

• Reduces baby's future diabetes risk 
• Helps regulate baby's blood sugar 
• Provides immune protection 

Benefits for you: 

• Lowers YOUR risk of developing Type 2 diabetes by 15-50% 
• Burns extra calories 
• Helps uterus contract 
• Delays return of period 

Breastfeeding is one of the best preventive measures for both of you. 

Postpartum Testing 

6-12 weeks after delivery: 

• Glucose tolerance test to confirm diabetes has resolved 
• Most women (85%) return to normal 
• Some (15%) have prediabetes or diabetes 
• This test is CRITICAL - don't skip it 

Annual screening thereafter: 

• Fasting glucose or A1C test yearly 
• Catch prediabetes early when reversible 
• Lifestyle changes prevent progression to Type 2 

Reducing Your Future Diabetes Risk 

You can cut your risk in half with: 

• Maintain healthy weight (lose pregnancy weight gradually) 
• Regular exercise (150 min/week moderate activity) 
• Healthy diet (continue GDM eating principles) 
• Breastfeed if possible (12+ months ideal) 
• Annual screening (catch problems early) 
• Manage stress (affects insulin resistance) 

GDM is a warning sign, not a life sentence. You have power to prevent Type 2 diabetes. 

Future Pregnancies 

If you get pregnant again: 

• 50-70% chance of GDM recurring 
• Earlier testing (16-20 weeks instead of 24-28) 
• May need to start diet/monitoring immediately 
• Each pregnancy is different - might be easier or harder 
• Consider working with high-risk OB from the start 

Planning ahead helps you feel more in control. 

Emotional Support 

Having GDM can feel: 

• Overwhelming and unfair 
• Guilty (even though it's not your fault) 
• Anxious about baby's health 
• Stressed by constant monitoring 
• Restricted by food rules 
• Isolated if others don't understand 

These feelings are valid. 

Find support: 

• Online GDM communities (Reddit r/GestationalDiabetes, Facebook groups) 
• Talk to your partner about how they can help 
• Ask healthcare team about counseling if needed 
• Connect with other GDM moms 
• Be honest with friends/family about what you need 

You're doing amazing work taking care of your baby. This is hard, and you're handling it. 

Course Summary 

The Five Key Lessons: 

1. Understand GDM - It's common, manageable, and not your fault 
2. Monitor blood sugar - Testing 4-7x daily guides all decisions 
3. Eat strategically - Right carbs, right portions, right timing 
4. Move your body - Post-meal walks are powerful medicine 
5. Plan ahead - Medication if needed, healthy delivery, prevent future diabetes 

Final Message: 

Gestational diabetes is a challenge, but thousands of women successfully manage it every day. You are capable of this. Every blood sugar test, every healthy meal choice, every post-dinner walk is protecting your baby and your own future health. 

Quick Reference Guide 

Daily Checklist 

• ☐ Test fasting blood sugar 
• ☐ Eat balanced breakfast (pair carbs with protein) 
• ☐ Test 1-2 hours after breakfast 
• ☐ Morning snack 
• ☐ Lunch with protein 
• ☐ Test after lunch + walk 10-15 min 
• ☐ Afternoon snack 
• ☐ Dinner with vegetables 
• ☐ Test after dinner + walk 10-15 min 
• ☐ Evening snack (if recommended) 
• ☐ Log all readings 
• ☐ Take medication if prescribed 
• ☐ Drink 8-10 glasses water 

When to Call Doctor Immediately 

• Blood sugar >200 mg/dL 
• Blood sugar <60 mg/dL 
• Ketones in urine 
• Decreased fetal movement 
• Severe headache or vision changes 
• Abdominal pain or contractions