Home > Health conditions > Diabetes > Diabetes in pregnancy (gestational diabetes) >

Online education for diabetes in pregnancy (gestational diabetes)

You are viewing this page because you have recently been diagnosed with gestational diabetes. This was following a positive glucose tolerance test or blood glucose monitoring at home for 1 week.

Or you may be pregnant and have prediabetes, diagnosed by checking your HbA1c (glycated haemoglobin) via a blood test.

Gestational diabetes is more fully known as gestational diabetes mellitus (GDM).

Your LMC (midwife) or diabetes midwife has sent a prescription to your pharmacy. This includes a glucose meter (CareSens N), a lancet (finger pricking device) and a 3-month supply of testing strips.

To help you manage your gestational diabetes, there are three videos to watch:

What is gestational diabetes?
The dietary management of gestational diabetes.
How and when to test your blood glucose levels.

Please watch all three videos (see below), including the video about testing your blood glucose level.

It is important to test your blood glucose levels and record your food intake during your pregnancy. See the section below about Testing your blood glucose level.

Diabetes and prediabetes

Glucose (sugar) enters the bloodstream after we eat foods that contain carbohydrates. It is released from the liver during times of fasting.

Diabetes is a condition where glucose levels in the blood remain too high for too long.

Prediabetes is also known as impaired glucose tolerance. Glucose (sugar) levels in the blood are higher than normal, but not high enough to be diabetes. The treatment for prediabetes in pregnancy is similar to gestational diabetes.

Gestational diabetes

Gestational diabetes can occur in late pregnancy. This is when changing hormone levels increase your body's requirements for insulin.

At this time, you need extra insulin to maintain your blood glucose level within the normal range. With gestational diabetes, your pancreas cannot produce enough extra insulin.

The main treatment for gestational diabetes is eating well and keeping active. But you might also need tablets or injected insulin.

See the following video, What is gestational diabetes (5 min 43 sec).

The effect of gestational diabetes on your baby

If your blood glucose is high during pregnancy, there are increased risks for your pēpi (baby). These include:

your pēpi may grow too big, which can cause problems during birth
your pēpi may have low blood glucose levels after they are born (hypoglycaemia).

The effect of gestational diabetes on you

When you have had gestational diabetes, you have a high risk of developing type 2 diabetes in the future. Your pēpi does not have an increased risk of diabetes as a pēpi, but they may have an increased risk of type 2 diabetes as an adult.

Your whānau (family) should continue the healthy eating and other lifestyle changes suggested to you in pregnancy. This will allow you to work together towards a healthy future and reduce your risk of diabetes.

You will need to have a blood test to check for type 2 diabetes 3 months after you have your pēpi, then yearly. Your diabetes team will talk to you more about this when you are closer to giving birth.

Managing gestational diabetes

The main ways to treat gestational diabetes are:

Eating well for the whole whānau (see the video below).
Keeping physically active. Aim for at least 150 minutes of moderate intensity activity per week, for example 30 minutes, 5 days a week.
Monitoring your blood glucose. Do this 4 times a day (see the video and instructions below).
Medication. Sometimes people cannot meet the target blood glucose levels. This is even when eating well and staying active. In this case, you may need metformin tablets or injected insulin (or both) to help you reach the targets. For more information about medication options, see Treatment options for gestational diabetes.

Eating well with gestational diabetes

The most important part of treating gestational diabetes is eating the right amount of healthy food and being active.

This video explains the types of food that will help you manage your gestational diabetes.

Dietary management of gestational diabetes (21 min 4 sec).

Also, see Shopping guide for diabetes in pregnancy and Snack ideas for diabetes in pregnancy.

Testing your blood glucose level

Your Diabetes in Pregnancy team will help you select the best treatment option for you and your pēpi.

We would like you to start testing and recording your blood glucose levels and food intake. Use this Food and blood glucose level diary to record these details.

Email your results to the Diabetes in Pregnancy team at diabetesinpregnancy@cdhb.health.nz on Sunday evening. Include your name and NHI number in the email so we can identify you.

One of the diabetes dietitians will call you or email you the following week. They will discuss your food intake and blood glucose levels. They will also tell you about the plan for your diabetes management.

Continue testing and recording your blood glucose levels 4 times a day and recording your food intake. Email your results through every Sunday evening or every second Sunday, depending on what the diabetes dietitian has agreed with you.

See the following video, Blood glucose testing (21 min 50 sec).

The video shows you how to test your blood glucose levels and use your meter (CareSens N).

Make sure you hold your meter above the drop of blood and allow the testing strip to suck up the blood.
Ensure that you change the needle in the lancet (finger pricking device) every 1 to 2 days.
Your meter comes with 50 needles. If you need more needles, you can buy them from your local pharmacy (you will have to pay for these yourself).

Please test your blood glucose (sugar) levels 4 times a day.

Your 1st blood glucose test should be as soon as you wake up in the morning – this is your fasting level.
Your 2nd test should be 1 hour after you start eating your breakfast.
Your 3rd test should be 1 hour after you start eating your lunch.
Your 4th test should be 1 hour after you start eating your dinner.

Tip: It can be difficult to remember to test after meals, so set an alarm on your phone when you sit down to eat.

Target blood glucose levels

Your ideal blood glucose levels are:

fasting (when you wake up) – 5.0 mmol/l or less
1 hour after your meals – less than 7.5 mmol/l.

Troubleshooting raised blood glucose levels

If your fasting (waking up) blood glucose level is over the target level most days, your diabetes specialist may prescribe medication. Food and activity have little effect on the fasting level.

If you have a high glucose level after meals, you may be able to minimise the chance of it happening again.

Below are some questions you can ask yourself to try to work out why your blood glucose levels may be high.

Were my hands clean?

Hand lotion or food on your hands can affect the blood glucose test result.

Wash your hands in warm water and repeat the test if you think this may be the case.

Was the test after breakfast high?

Carbohydrate at breakfast can often be poorly tolerated, especially breakfast cereals.

Try grainy breads with a protein topping (for example, peanut butter, egg or cheese) or avocado.

Am I unwell, stressed, less active or sleeping poorly?

All these things can affect blood glucose levels.

Did I eat more carbohydrate or a different type than usual?

Did I have a larger serving size of carbohydrate, or did I have several carbohydrate foods in one meal? For example, fruit with my usual meal or potato and rice.

Try to choose carbohydrate foods that are fibre-rich, less processed and slow release (low glycaemic index). For example, grainy breads, whole fruits, high-fibre cereals or long grain rice.

Did I wait long enough after eating before my blood glucose test?

Wait an hour after eating to do your test and avoid snacks until after testing.

Was I active after the meal?

Sitting down after a meal can cause a higher blood glucose reading than if you are active and on your feet.

Have I been taking the diabetes medication as prescribed?

Have you missed a tablet or insulin? Remember you need to take insulin before the meal.

Collecting colostrum before you give birth (I kohi ai te waiū motuhake i mua o te whānautanga)

Sometimes, there are concerns that a pēpi may have difficulty maintaining their blood sugar levels or experience significant feeding challenges. This includes when the mother has diabetes in pregnancy.

Expressing colostrum before birth means you will have a supply of your milk available if your pēpi needs extra. This may reduce or even eliminate the need for infant formula use.

This factsheet has information about how to collect, store and use colostrum.

This video explains why and how to do hand expressing of colostrum.

Contacting the Diabetes in Pregnancy team

You can contact the Diabetes in Pregnancy team by email or by phoning (03) 364-4420. Please leave a detailed message with your name and contact number.

The team's days of work are Monday, Tuesday and Thursday.

Written by dietitian, Te Whatu Ora Waitaha. Adapted by HealthInfo clinical advisers. Page created April 2022. Last updated August 2024.

Sources

Page reference: 963751

Review key: HIHCP-311277