When you are pregnant, your body needs more insulin than before because of the increased production of hormones that lead to insulin resistance. In gestational diabetes, the pancreas is unable to produce enough insulin to overcome this resistance. Gestational diabetes is treated much like type 2 diabetes. Most women start with meal planning and regular exercise. But, if diet and exercise do not keep blood glucose levels very close to normal, insulin is the next course of action. Diabetes pills are not prescribed during pregnancy because of the risk to the baby. Blood glucose goals are tighter for pregnant women than for most people with type 2 diabetes. This is because of the harmful effects that too much glucose in the mother’s blood can have on the growing baby, as well as on the mother. The last half of the pregnancy is when the baby grows larger. Too much glucose in the mother’s blood during the last half of pregnancy can lead to a baby that is too large to be delivered safely. This condition is called macrosomia. Because of macrosomia, women with gestational diabetes have a higher risk of delivery by cesarean section. Also, the baby may need to be delivered early if he or she grows too large too fast. An early delivery puts the baby at a higher risk for respiratory distress because the lungs are about the last organ to mature. For women who have type 1 or type 2 diabetes before becoming pregnant, keeping blood glucose levels low even before pregnancy decreases the risk of birth defects. Birth defects occur early in pregnancy as the baby’s organs are being formed. But gestational diabetes does not usually occur until more than halfway through the pregnancy. By the halfway mark, the baby’s organs are already formed. Women with gestational diabetes are also at higher risk for toxemia, a condition in pregnancy in which blood pressure is too high. Swelling of legs and arms commonly goes along with toxemia. Toxemia can be dangerous for the mother and baby and can mean bed rest for the mother until delivery. Treatment for gestational diabetes is based on the results of your 3-hour glucose tolerance test. If your fasting blood glucose level (taken at the start of the test) was normal (under 105mg/dl) but your glucose tolerance test results were in the range for gestational diabetes, you may start with nutrition therapy and perhaps with exercise, if you are able. If your fasting blood glucose was over 105 mg/dl, you will probably start with metformin or insulin therapy, too. Because of the emphasis on keeping blood glucose levels close to normal, you will need to monitor frequently, perhaps four or more times a day till sugars are under control. later on every alternate day can work. Note that these goals are considered normal for a person without diabetes and are general goals for women with diabetes during pregnancy. Your goals need to be individualized.