“Hello, I am in my 33rd week of pregnancy. I have a problem with my fasting blood sugar levels, which are always between 5.3 and 5.7 mmol/l. After meals, my readings are always below the threshold, but now my endocrinologist has advised me to start taking insulin. My average is also below the threshold, at 5.0. I’d like to know your opinion on my glucose levels and whether I should agree to insulin therapy?” — Amira A
During pregnancy, blood sugar levels tend to rise after the 20th week. Whether they’re already elevated on an empty stomach depends on two factors. First, blood sugar levels rise if you eat fruit or bread for dinner, which causes a significant spike in blood sugar by morning. If you choose salad, eggs, vegetables, etc., instead, your blood sugar levels are usually lower. The second reason is heredity: if several family members have high blood sugar, the increase in your levels will also be slightly higher. One solution, of course, is to start a very low dose of insulin (which won’t harm the child), but you could also try adjusting your diet first (eating only vegetable-based meals in the evening) and staying somewhat active in the evening as well. If you manage to take a one-hour walk after dinner, or if you find some household chores (ironing, tidying up) to “burn off” your dinner, then the likelihood of elevated blood sugar is lower. Try this for a few days, and perhaps your diabetes specialist will determine that this alone has already helped. By week 33, this might be enough on its own, without insulin therapy.