To lower your blood glucose levels and minimize chances of complications to both you and your baby, you will need to make some lifestyle changes, including carefully watching what you eat and staying active.

Learning dietary control of GDM is a challenge because you have a short window of time to learn what you need to know, and you need to achieve good control fast. But pregnant women are what doctors like to call “highly motivated patients.” That means that like most mothers, you'll do just about anything to ensure your baby has the best possible start in life. So you start blood glucose testing in earnest, learning all about proper nutrition therapy, and read volumes on diabetes care.

Again, good CDEs and RDs are worth their weight in gold when it comes to learning about food and gestational diabetes. They will explain the basics of carbohydrates and other nutrients, and coach you on the intricacies of portion estimates, smart restaurant choices, your specific caloric and nutrient needs as a pregnant woman, and more. It also helps to have a good reference book or two around to refer to when you don't have your educator in front of you. Chapters 10 and 11 explain these issues and medical nutritional therapy (MNT) for diabetes in detail.

It's reassuring to know that many women with GDM are able to control their glucose levels through diet and exercise alone, but it's often that second word — exercise — that throws women into a panic. You should know that anything that gets your heart pumping and your body moving is good, and can lower blood glucose levels. That could be as simple as working in your garden or playing with your daughter at the park. If you need motivation, many health clubs, community centers, and hospitals offer prenatal exercise classes. Your health care provider can give you a referral.

And for those who like a more solitary form of fitness, walking is a good way to ease into a workout routine. It's cheap, easy, and always accessible. Even if you live in an inhospitable climate for outdoor walking, you can find a local mall or an indoor track to lap. If you've always been active, then you may be given the green light to do something a little more challenging. Always talk to your doctor first before starting any new fitness activity during pregnancy.

Tracking Your Blood Glucose

Checking your blood glucose levels frequently with a portable home monitor is also an important part of your treatment program. This quick and simple test involves pricking your finger with a fine needle, called a lancet, and placing a small blood drop on a test strip that is inserted into a blood glucose monitor, or meter. The monitor analyzes the amount of glucose in the blood sample and displays the reading. (Chapter 7 has more information on how and when to test your blood glucose levels.)

When you first get started, you may be testing more frequently as you try to get a handle on how different foods and activities affect your glucose levels. Testing is usually recommended early in the morning before breakfast (fasting test) and after meals (postprandial test). Post-prandial tests are taken one hour after the start of your meal, and can be taken again at the two-hour mark. You should keep a written log of all your results (see Chapter 7 for a sample log page). If you exercise regularly, test your glucose levels before and after your workout.

Blood Glucose Target Levels in Women with Gestational Diabetes

As recommended by the ADA

Ketone Testing

In addition to blood glucose monitoring, your doctor may ask you to perform ketone testing at home by dipping a test strip in a urine sample. Home monitors that check for blood ketones are also available. Ketones can be a sign that your blood glucose is too high and your body is breaking down fat stores for energy instead of glucose. They can also occur in cases of severe morning sickness if you aren't keeping adequate food down. If you test positive for ketones, call your health care provider.

When You Need Insulin

If you're unable to keep your blood glucose levels down to an optimal level with dietary and activity changes only, your doctor may suggest insulin therapy. Oral medications aren't typically recommended because of the possible risks to the fetus and a lack of long-term studies at this point in time, but insulin does not cross the placenta and is therefore considered safe for you and your developing baby.

Another trip back to the CDE may be in order to teach you how to take insulin and to learn the signs and symptoms of hypoglycemia (low blood sugar). He can also work with you to help you understand how to interpret your blood glucose readings and manage your insulin accordingly. Always bring your blood glucose log with you on both your ob-gyn and CDE appointments so you don't have to rely on your memory and your providers have a more accurate clinical picture on which to base treatment decisions.

And remember, needing to take insulin does not mean you've “failed” at managing your GDM. Consider it another method of ensuring your baby the best possible birth outcome.