This is my 6th pregnancy, and I have had gestational diabetes in two previous pregnancies, possibly three because one baby was large although I passed the 3-hour test.
I am 26 weeks pregnant and my fasting blood sugar levels have been creeping up, while my post-meal levels are perfect.
I was told that if more than half my fasting readings are over 95 mg/dL I may need medication. Right now about three a week are above that level.
I have tried protein snacks before bed, fruit with cheese, and peanut butter toast, but nothing seems to make a consistent difference. Is there anything I can do with diet or exercise to lower my fasting glucose without medication?
Answer by Dr. Albana Greca Sejdini, MD, MMedSc, Family Physician, IDF Fellow
Hello,
This is a very common and frustrating pattern in gestational diabetes: your after-meal readings can look excellent while your fasting glucose gradually rises.
I want you to know that this does not necessarily mean you are doing something wrong.
As pregnancy progresses, hormones produced by the placenta increase insulin resistance. Overnight, your liver also continues releasing glucose to provide energy between meals.
If your body cannot produce enough insulin to compensate, your morning glucose may rise even though you are eating carefully and your after-meal values remain within target.
This is why fasting glucose is sometimes the most difficult part of gestational diabetes to control.
For gestational diabetes, the usual fasting glucose target is below 95 mg/dL (5.3 mmol/L). Common after-meal targets are below 140 mg/dL (7.8 mmol/L) at 1 hour or below 120 mg/dL (6.7 mmol/L) at 2 hours.
Your maternity team may individualize these targets, so follow the numbers they have given you.
You can see the full pregnancy glucose ranges in our gestational diabetes monitoring guide.
Sometimes changing the evening meal or snack helps, but there is no single bedtime snack that works for everyone.
A snack containing protein, healthy fat and a modest amount of carbohydrate may work well for some women, while others may see no improvement or even a higher morning reading.
Rather than repeatedly changing foods from one night to the next, I would keep a short record of:
This can help your diabetes team see whether there is a reproducible pattern.
Regular pregnancy-safe activity can improve insulin sensitivity and is an important part of gestational diabetes treatment.
If your obstetric clinician says exercise is safe for you, a gentle walk after dinner can be useful for overall glucose control. However, even excellent exercise habits may not completely correct fasting glucose if pregnancy-related insulin resistance is increasing.
Your clinician will usually look at the pattern rather than one isolated reading. The exact number of elevated values that triggers medication can vary between practices and should be individualized.
If fasting glucose remains repeatedly above target despite appropriate nutrition and activity, medication may be recommended.
Current guidance prefers insulin when medication is needed for gestational diabetes. You can review the available options in our gestational diabetes treatment guide.
Glyburide has been used in pregnancy, but it is no longer preferred as first-line medication because it crosses the placenta and has limitations compared with insulin.
This point is important. If your fasting glucose continues to rise despite careful eating and activity, needing insulin does not mean you failed to control your diabetes.
Placental hormones become stronger as pregnancy progresses, and sometimes lifestyle measures simply cannot overcome that degree of insulin resistance.
The purpose of treatment is not to avoid medication at all costs. It is to keep glucose in a safer range for both you and your baby.
You are already doing many of the right things. I would continue your healthy eating pattern, avoid excessive carbohydrate restriction, remain active if your pregnancy care team says it is safe, and keep a consistent record of your evening meals and fasting readings.
If the fasting values continue rising, I would not keep experimenting indefinitely with different bedtime snacks. I would show the pattern to your diabetes team and discuss whether treatment is now appropriate.
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