Borderline Sugar in Pregnancy: Do You Need Insulin or Just Diet Changes?

ByHemali Ramchandani
Updated: 11 Sept 2025, 12:30 pm
Medical Reviewed by Dr. Kabita Kovi

Being told you have borderline gestational diabetes can leave you confused. Are you already “high risk,” or can you still manage without medication? For many women, diet and lifestyle adjustments are the first line of treatment. But insulin may be recommended if sugar levels stay above safe limits. The key lies in understanding how gestational diabetes is diagnosed, when lifestyle is enough, and when insulin becomes necessary.

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Pregnancy changes the way your body uses sugar. Hormones released by the placenta make it harder for insulin to work effectively. Most women adjust by producing more insulin, but sometimes, the body struggles, leading to raised blood sugar. This is gestational diabetes (GDM). If your results fall in the “borderline” range, you may not need medication right away. Instead, careful monitoring, dietary planning, and lifestyle support may keep levels within target.
In this article:

What Does Borderline Gestational Diabetes Mean?

When your blood sugar levels are higher than normal, but not severely high, doctors often call it “borderline.” In India, the DIPSI test (single-step 75g glucose tolerance test) is widely used.
  • Normal: Fasting blood sugar under 92 mg/dL, 1-hour post-load under 180 mg/dL, 2-hour post-load under 153 mg/dL (as per IADPSG/WHO guidelines).
  • Borderline: Values slightly above normal, but not consistently high.
  • Gestational diabetes requiring treatment: When values remain above target on repeated tests, or diet changes fail to control them.
Your doctor may recommend repeating the test, home monitoring with a glucometer, and dietary modifications before deciding on insulin.

Why Blood Sugar Control Matters in Pregnancy

Even borderline high sugars can affect pregnancy. Possible complications include:
  • For the baby: Higher birth weight (macrosomia), breathing difficulties at birth, and risk of low sugar after delivery.
  • For you: Increased chance of C-section, high blood pressure, and developing type 2 diabetes later in life.
  • During pregnancy: Excess amniotic fluid (polyhydramnios), premature labour, or infections.
Good sugar control lowers these risks, whether achieved by diet or insulin.

Causes and Risk Factors

Some women are more prone to gestational diabetes:
  • Family history: Type 2 diabetes in parents or siblings
  • Weight before pregnancy: Overweight or obese
  • Age: Pregnant women above 30 have a higher risk
  • PCOS (Polycystic Ovary Syndrome): Linked to insulin resistance
  • Previous pregnancy history: Having had a large baby, stillbirth, or gestational diabetes before.
  • Lifestyle: Low physical activity and a high refined-carb diet
Even if you don’t fit these categories, pregnancy hormones alone can tip the balance.

How Doctors Decide on Insulin vs. Diet

Doctors usually recommend a stepwise approach:
1. Diet and Lifestyle First
  • Follow a diabet ic-friendly diet: balanced meals with complex carbs, high fibre, and protein.
  • Eat smaller meals every 2–3 hours to avoid sugar spikes.
  • Limit sweets, sugary drinks, and refined flour products.
  • Choose traditional foods wisely: idlis, dosas, roti, dal, and vegetables can be balanced with portion control.
2. Add Activity
  • Walking 20–30 minutes after meals can significantly lower post-meal sugar.
  • Gentle yoga or prenatal stretches are safe with doctor approval.
3. Regular Monitoring
  • Most women with borderline GDM are asked to check fasting and post-meal sugars at home.
  • Targets are usually fasting <95 mg/dL and 2-hour post-meal <120 mg/dL (NHS/ICMR).
4. Insulin Only if Needed
  • If your sugars remain above target despite diet and activity, insulin may be prescribed.
  • Tablets like metformin are used in some countries, but in India, insulin is the safer choice during pregnancy.
  • Insulin doesn’t harm your baby. It doesn’t cross the placenta.

What a Pregnancy-Friendly Diet Looks Like

Indian women often worry they’ll have to give up all carbs. That’s not true. You need balanced energy for yourself and your baby.
  • Breakfast: Vegetable upma with sprouts, or 2 idlis with sambar.
  • Mid-morning: A handful of roasted chana or fruit like guava/papaya.
  • Lunch: 1–2 phulkas with dal, sabzi, salad, and curd.
  • Evening: Buttermilk, boiled corn, or dhokla.
  • Dinner: Brown rice with dal and green vegetables, or a light roti-sabzi meal.
  • Bedtime snack: A glass of warm milk (if tolerated) or a handful of nuts.
Avoid fruit juices, sweets, deep-fried snacks, and white bread. Choose whole grains, pulses, and fibre-rich vegetables.

Emotional and Practical Support

Hearing “gestational diabetes” often causes guilt or fear. Remember:
  • This is not your fault. It’s largely due to pregnancy hormones.
  • With monitoring, most women deliver healthy babies.
  • In India, diet-related advice can feel confusing when families insist on “eating for two.” It’s okay to say no to excessive sweets or fried foods offered by relatives.
  • A dietician or diabetes educator can help you plan meals that fit Indian cooking styles.
Support groups (both online and local) can also help you share experiences with other expecting mothers.
Borderline gestational diabetes doesn’t always mean insulin. For many women, diet, activity, and regular monitoring are enough. But if your sugar levels remain high, insulin is a safe and effective option. The focus is not on avoiding insulin at all costs. It’s on protecting both you and your baby from complications. With awareness, meal planning, and medical guidance, you can carry your pregnancy safely and confidently.
Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.

FAQs on Borderline Sugar in Pregnancy: Do You Need Insulin or Just Diet Changes?

  1. Can borderline diabetes go away with diet alone?
    Yes. Many women manage their sugar levels through diet and exercise without insulin.
  2. If I take insulin, will I need it after delivery, too?
    Not usually. Most women stop insulin after birth, as blood sugar returns to normal once the placenta is out.
  3. Can gestational diabetes affect my breastfeeding?
    No. In fact, breastfeeding helps reduce your risk of type 2 diabetes later.
  4. Will my baby develop diabetes if I had GDM?
    Not directly, but your child may have a slightly higher lifetime risk of obesity or diabetes. Encouraging healthy eating habits from childhood helps.

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