Answer by Dr. Albana Greca, MD, MMedSc
Hi there,
Your concern is understandable. Because your sister has already needed hospital care for very high glucose and now feels tired and weak, she should contact her maternity or diabetes team today and follow their instructions. She should not skip insulin doses.
Gestational diabetes develops when pregnancy hormones make the body more resistant to insulin and the pancreas cannot produce enough extra insulin to keep glucose within the pregnancy target range. It is not caused by the baby “using up” the mother’s insulin.
It is often diagnosed between 24 and 28 weeks, although it may be recognized later. Our guide to gestational diabetes symptoms, testing, and control explains the condition in more detail.
Many women can manage gestational diabetes with a structured meal plan and appropriate physical activity. Others need insulin because pregnancy-related insulin resistance becomes stronger as the pregnancy progresses.
Insulin is commonly preferred when medication is needed because it can be adjusted to the glucose pattern and does not cross the placenta. Needing insulin does not mean that your sister failed. Read more about how it is used in our insulin treatment guide.
She should use the exact insulin type, dose, and timing prescribed. Insulin requirements can change quickly in late pregnancy, so her team may need to review her glucose log and adjust the plan.
Common targets for many women with gestational diabetes are 95 mg/dL or less before meals, 140 mg/dL or less one hour after starting a meal, and 120 mg/dL or less two hours after starting a meal. Her own obstetric team may set different targets.
She should record the reading, time, meal, insulin dose, activity, and symptoms. Our page on blood sugar levels after eating provides general background, but pregnancy targets must come from her maternity team.
She should not eliminate all carbohydrates, skip meals, or follow a weight-loss diet. Eating too little during pregnancy can lead to poor nutrition and ketone production. A pregnancy-trained dietitian can help divide carbohydrate foods across regular meals and snacks.
Our diabetic meal-planning guide gives general ideas, but her pregnancy plan should be individualized.
Two hours of exercise every day is not a standard recommendation. When her obstetrician says exercise is safe, moderate activity such as walking for about 30 minutes on most days—or a 10–15 minute walk after meals—may help. She should stop and contact her maternity team for bleeding, fluid leakage, painful contractions, dizziness, chest pain, severe shortness of breath, or reduced baby movement.
A spoonful of cinnamon cannot guarantee normal glucose, and concentrated cinnamon may cause side effects or interact with medicines. Alpha-lipoic acid and other supplements should not be started during pregnancy unless her obstetric clinician specifically recommends them.
Her safest treatment is the plan prescribed by her maternity and diabetes team—not herbs promoted for blood sugar control.
She should seek urgent maternity or emergency assessment for vomiting, inability to drink, abdominal pain, deep or difficult breathing, confusion, fainting, severe weakness, dehydration, moderate or high ketones, or glucose that remains very high despite following her prescribed plan.
Urgent obstetric assessment is also needed for vaginal bleeding, fluid leakage, painful regular contractions, severe headache, vision changes, sudden swelling, or reduced fetal movement.
Because insulin can cause low glucose, she and her family should also recognize the symptoms explained on our page about low blood glucose.
Your sister should take her insulin exactly as directed, check glucose at the times prescribed, keep every prenatal appointment, and contact her team promptly when readings remain above target. With close monitoring and treatment, many women with gestational diabetes have healthy pregnancies and babies.
After delivery, she will also need follow-up glucose testing because gestational diabetes increases the future risk of type 2 diabetes.
Hope this helps.
Dr. Albana Greca
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