How is gestational diabetes treated? Treatment aims to keep your blood sugar in a target range so you and your baby stay healthy. The American College of Obstetricians and Gynecologists (ACOG) says that for many women, a healthy diet and regular exercise control blood sugar, and some need medicine as well. The American Diabetes Association (ADA) says 70% to 85% of people diagnosed under a common set of criteria can manage gestational diabetes with lifestyle changes alone. When medicine is needed, insulin is the preferred choice.
Key takeaways
- Treatment usually starts with an eating plan made with a dietitian, regular activity, and checking your blood sugar at home.
- ADA lists these goals: fasting below 95 mg/dL, below 140 mg/dL 1 hour after a meal, or below 120 mg/dL 2 hours after a meal. Your care team sets your targets.
- ACOG says three meals and two to three snacks a day are often recommended, plus a 10 to 15 minute walk after each meal.
- ACOG says insulin is the recommended medicine in pregnancy and does not cross the placenta. ADA says metformin and glyburide are not first-line choices because both cross the placenta.
- You will have more prenatal visits and may have tests to check your baby's health.
The Goal of Treatment
MedlinePlus says the goals are to keep your blood sugar within normal limits during pregnancy and to make sure your growing baby is healthy. ACOG says tracking and controlling blood sugar reduces the risks to both you and your baby. ADA adds that gestational diabetes is treatable but can pose health risks if left unmanaged, so acting quickly matters.
Treatment usually has four parts: an eating plan, physical activity, blood sugar checks, and medicine if needed. Your care team also checks your baby more often.
Blood Sugar Targets for Gestational Diabetes
ADA's 2026 guidance lists these glucose goals for gestational diabetes:
| Check | ADA 2026 goal |
|---|---|
| Fasting | Below 95 mg/dL |
| 1 hour after a meal | Below 140 mg/dL |
| 2 hours after a meal | Below 120 mg/dL |
ADA says to use either the 1-hour or the 2-hour after-meal goal. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists 95 or less before meals, at bedtime, and overnight, 140 or less 1 hour after eating, and 120 or less 2 hours after eating. NIDDK says to ask your doctor which targets are right for you. Your care team tells you which after-meal time to use.
Checking Your Blood Sugar at Home
ACOG says you will use a glucose meter, which measures blood sugar from a small drop of blood. Keep a record and bring it to each prenatal visit. ACOG says logs can also be kept online, in phone apps, or emailed to your ob-gyn. Your log helps your team decide whether your plan is working.
ADA says continuous glucose monitoring (CGM) is recommended for type 1 diabetes in pregnancy and may help with other types, including gestational diabetes. Ask your care team whether CGM is an option for you. Learn more about blood sugar after eating.
Ketones. NIDDK says your body may make ketones if you are not eating enough or your blood sugar is too high. Your doctor might recommend testing your urine or blood for ketones daily or when your blood sugar is above a certain level. If ketones are high, NIDDK says your doctor may suggest changing the type or amount of food, or your meal and snack times. See ketones in urine.
Eating Plan
ADA's 2026 guidance describes nutrition therapy for gestational diabetes as a personal eating plan made with a registered dietitian who knows gestational diabetes. ADA's 2026 guidance also recommends an eating pattern with fruits, vegetables, legumes, whole grains, nuts, seeds, fish, and other lean protein. MedlinePlus says that in many cases, eating healthy foods, staying active, and managing weight are all that is needed to treat gestational diabetes.
What sources say about a gestational diabetes eating plan:
- Eat regularly. ACOG says to eat regular meals through the day, with small snacks if needed, especially at night. ACOG says three meals and two to three snacks a day are often recommended. Eating regularly helps avoid dips and spikes.
- Do not cut out carbs. ADA says all pregnant people need at least 175 grams of carbohydrate a day as a dietary reference intake. ADA says to avoid eating patterns that severely restrict any food group, including ketogenic diets that lack carbohydrates. MedlinePlus says carbs can come from fruits, vegetables, and complex carbohydrates like bread, cereal, pasta, and rice.
- Watch timing and amounts. NIDDK says food choices, amounts, and timing are all important for keeping blood sugar in your target range.
- Gain a healthy amount of weight. ACOG says to talk with your ob-gyn about how much weight gain is best. Too much weight gain, or gaining too quickly, can make blood sugar harder to control. The Centers for Disease Control and Prevention (CDC) says not to try to lose weight while pregnant.
Your dietitian adjusts the plan to your food preferences, culture, and blood sugar log. Talk with your provider if you are vegetarian or follow another special diet, as MedlinePlus advises.
Physical Activity
ACOG says exercise helps keep blood sugar in the normal range. In general, ACOG recommends 30 minutes of moderate aerobic exercise at least 5 days a week, or at least 150 minutes a week. ACOG says walking is a great exercise for all pregnant women. ACOG also suggests adding a 10 to 15 minute walk after each meal for better blood sugar control.
ADA's 2026 guidance cites research showing that exercise in gestational diabetes improved glucose results and reduced the need to start insulin. ADA's patient page says to work with your provider on the safest level of activity for you and your baby, and to start slow. Our guide to walking after meals explains why timing helps.
When Medicine Is Needed
ACOG says some women need medicine to reach normal blood sugar even with diet changes and exercise. ADA says insulin should be added if needed to reach blood sugar goals.
- Insulin. ACOG says insulin is the recommended medicine in pregnancy, and it does not cross the placenta. NIDDK says insulin will not harm your baby. Your care team will teach you how to give yourself insulin shots with a small needle.
- Diabetes pills. ADA says metformin and glyburide should not be used as first-line medicines in pregnancy because both cross the placenta and may not be enough to reach goals. ACOG says that in some cases your ob-gyn may prescribe a medicine taken by mouth. This is your prescriber's decision.
- Doses change. ACOG says your ob-gyn reviews your glucose log to check that the medicine is working, and changes may be needed throughout pregnancy.
Needing insulin does not mean you did something wrong. Insulin resistance rises as pregnancy goes on, and ADA says it drops quickly once the placenta is delivered. Our guide on whether people with type 2 diabetes need insulin explains how insulin works.
How Your Baby Is Checked
ACOG says you will need more frequent prenatal visits. Special tests may check your baby's well-being:
| Test | What it checks (ACOG) |
|---|---|
| Kick counts | How often you feel the baby move. Call your ob-gyn if you notice a change in activity. |
| Nonstress test | Changes in the baby's heart rate when the baby moves, using a belt with a sensor |
| Biophysical profile | Heart rate plus an ultrasound of amniotic fluid, breathing, movement, and muscle tone |
MedlinePlus says fetal monitoring checks the size and health of your baby.
Delivery
ACOG says most women with controlled gestational diabetes can complete a full-term pregnancy. If there are complications, labor may be started before the due date. ACOG says most women with gestational diabetes can have a vaginal birth, but they are more likely to have a cesarean birth. If your baby seems too big for a safe vaginal delivery, you and your ob-gyn may discuss a scheduled cesarean.
MedlinePlus says your baby is more likely to have low blood sugar in the first few days of life and may be watched in the neonatal intensive care unit (NICU) for a few days.
Taking Care of Your Mental Health
A new diagnosis plus daily checks can feel like a lot. CDC says gestational diabetes may raise the risk of postpartum depression. CDC advises talking to your doctor about depression before, during, or after pregnancy, even if they do not ask. If you or someone you know is struggling or in crisis, CDC lists 1-833-TLC-MAMA (1-833-852-6262).
When to Call Your Care Team
Call 911 for trouble breathing, confusion, a seizure, or fainting.
Call the same day for a change in how often your baby moves, blood sugar readings well above your targets that repeat, high ketones, vomiting that stops you from eating, or symptoms of low blood sugar if you take insulin.
At your next visit, bring your blood sugar log and any questions about your eating plan.
Frequently Asked Questions
Can gestational diabetes be controlled with diet alone?
Often, yes. ADA says 70% to 85% of people diagnosed under a common set of criteria can manage gestational diabetes with lifestyle changes alone. ACOG says some women need medicine even with diet changes and exercise. Your blood sugar log shows whether more help is needed.
What should my blood sugar be with gestational diabetes?
ADA lists these goals: fasting below 95 mg/dL, and either below 140 mg/dL 1 hour after a meal or below 120 mg/dL 2 hours after a meal. NIDDK lists the same numbers. Your care team sets the targets that are right for you.
Is insulin safe for my baby?
ACOG says insulin is the recommended medicine during pregnancy and that it does not cross the placenta, so it does not affect the fetus. NIDDK says insulin will not harm your baby. Your care team will show you how to use it.
Should I cut carbs if I have gestational diabetes?
Not completely. ADA says all pregnant people need at least 175 grams of carbohydrate a day and advises against ketogenic diets that lack carbohydrates. A dietitian can help you choose the type, amount, and timing of carbs that keep your blood sugar on target.
How much should I exercise with gestational diabetes?
ACOG generally recommends 30 minutes of moderate aerobic exercise at least 5 days a week, or at least 150 minutes a week. ACOG also suggests a 10 to 15 minute walk after each meal. Ask your ob-gyn what type and amount of activity is safe for you.
Will I need a C-section if I have gestational diabetes?
Not necessarily. ACOG says most women with gestational diabetes can have a vaginal birth, but they are more likely to have a cesarean birth. If your baby seems too big for a safe vaginal delivery, you and your ob-gyn may discuss a scheduled cesarean.
References
- American College of Obstetricians and Gynecologists. “Gestational Diabetes.” Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S321–S338. Accessed October 2026.
- American Diabetes Association. “Gestational Diabetes.” Accessed October 2026.
- National Institute of Diabetes and Digestive and Kidney Diseases. “Managing & Treating Gestational Diabetes.” Last reviewed May 2017. Accessed October 2026.
- MedlinePlus, National Library of Medicine. “Gestational diabetes.” Review date May 29, 2026. Accessed October 2026.
- Centers for Disease Control and Prevention. “Gestational Diabetes.” Accessed October 2026.
- Centers for Disease Control and Prevention. “Gestational Diabetes and Postpartum Depression.” Accessed October 2026.
Next Steps
Bring your blood sugar log to every visit and ask for a dietitian referral if you do not have one yet. For the bigger picture, see our diabetes and pregnancy guide, what causes gestational diabetes, and whether gestational diabetes goes away after pregnancy.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program organizes learning about meals, movement, sleep, and stress. It is not designed to manage gestational diabetes or pregnancy. It does not diagnose or treat diabetes, set blood sugar targets, interpret test results, change medicines, or replace your prenatal or diabetes care team.