by Shamaila
(Saint Paul)
Question: I am 24 weeks pregnant and was diagnosed with gestational diabetes three weeks ago. I failed my first test so badly that my doctor did not proceed with a second test.
I have followed a strict diet—sometimes eating fewer carbohydrates than suggested—and use the treadmill for 30 minutes five days a week. My fasting readings are fine, but my readings after breakfast, lunch and sometimes dinner are often high and unpredictable.
My doctor started insulin two weeks ago. As the dose increases, it feels as though my insulin resistance also increases. I feel frustrated, helpless and worried that the stress may harm my baby. Please help.
You are not failing. Insulin resistance normally increases during the second and third trimesters because of placental hormones, so insulin doses often need repeated adjustment as pregnancy progresses. This does not mean insulin is causing resistance or that you have done something wrong.
Do not cut carbohydrates below your pregnancy meal plan or increase insulin by yourself. Send your glucose and food log to your obstetric or diabetes team now. Repeated above-target readings usually mean the meal plan, carbohydrate distribution, insulin type, dose or timing needs prompt review.
Call today or follow the team’s reporting schedule if readings repeatedly exceed your targets despite following the prescribed plan. Seek urgent care for vomiting, inability to keep fluids down, moderate or high ketones, abdominal pain, deep or difficult breathing, confusion, severe weakness, or persistently very high glucose. Pregnancy can increase the risk of ketosis, sometimes at glucose levels lower than expected.
At about 24 weeks, placental hormones increasingly oppose insulin. This physiological insulin resistance often becomes stronger through the later second trimester and third trimester. Therefore, needing more insulin over time is common in gestational diabetes and does not mean that insulin is making the condition worse.
| Testing time | Common pregnancy target |
|---|---|
| Fasting | Below 95 mg/dL (5.3 mmol/L) |
| 1 hour after the beginning of a meal | Below 140 mg/dL (7.8 mmol/L) |
| 2 hours after the beginning of a meal | Below 120 mg/dL (6.7 mmol/L) |
Use the exact target and testing time given by your obstetric team. A reading taken one hour after the first bite cannot be compared with a two-hour target.
Reviewing a structured log is more useful than simply removing more food. Record the time of the first bite, glucose testing time, food and portions, insulin dose and time, activity, illness and any low-glucose symptoms.
Pregnancy requires adequate calories and nutrients. Current nutrition guidance recommends avoiding severely carbohydrate-restricted or ketogenic eating patterns during pregnancy. The general dietary reference intake is at least 175 grams of carbohydrate per day, but your personal distribution should be set by a registered dietitian or pregnancy diabetes team.
Eating too little, skipping meals or exercising without enough food can cause hypoglycemia and ketone production. A safer approach is usually to spread measured portions of higher-quality carbohydrates across three meals and two or three snacks, paired with protein, vegetables and healthy fats. See our gestational diabetes diet and treatment guide.
Possibly—but only by the clinician following your pregnancy or according to a written titration plan they already gave you. The team may adjust breakfast insulin differently from lunch or dinner insulin, review injection technique and sites, or change when insulin is taken relative to meals. Insulin is the preferred glucose-lowering medicine for gestational diabetes when lifestyle measures are insufficient and does not cross the placenta.
Do not repeat or add doses to correct an unexpected reading unless your pregnancy diabetes team has provided specific instructions. Unplanned insulin stacking can cause delayed hypoglycemia.
Stress can influence glucose and deserves support, but it is not the main explanation for repeated post-meal elevations at this stage of pregnancy. You should not be blamed or told that relaxing alone will normalize the readings. Ask for help from your obstetrician, diabetes educator, dietitian or mental-health professional if anxiety is becoming overwhelming. Do not start anti-anxiety medicine during pregnancy without an obstetric review.
Reassurance: Most people with gestational diabetes can have a healthy pregnancy when glucose is monitored and treatment is adjusted. Needing insulin or a higher dose is not a failure; it is a response to changing pregnancy hormones.
Answered by: Dr. Albana Greca Sejdini, MD, MMedSc
Medically reviewed by: Dr. Ruden Cakoni, MD, Endocrinologist
Last reviewed: July 2026
Medical disclaimer: Educational only—not personal medical advice. Diagnosis and treatment should come from a qualified clinician who knows the patient’s medical history.
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