This guide provides a step-by-step approach to explaining a diagnosis of gestational diabetes. You should also read our overview of how to effectively communicate information to patients.
Structuring your explanation
Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
Opening the consultation
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better understanding of their problem. After introducing yourself, it is important to take a brief history (this is the first part of the BUCES structure):
- What has brought the patient in to see you today?
- What are their symptoms?
- Are there any risk factors that can be identified? (e.g. lifestyle/family history)
Tip: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction and brief history between 1-2 minutes maximum.
What does the patient understand?
Following a brief history, it is important to gauge the patient’s knowledge of their condition. Patients may know someone who has had gestational diabetes, or this may be their first encounter with the disease. Be open with the patient and work to identify any misconceptions they may have. The patient sitting before you may not even know at this point that they have gestational diabetes – you may be the first person to inform them of the diagnosis.
Due to these reasons, it is important to start with open questioning. Good examples include:
- “What do you think is causing your symptoms?”
- “What do you know about gestational diabetes?”
- “Have you, or a family member, had gestational diabetes before?”
- “What has been explained to you about gestational diabetes so far?”
Open questioning should help you to determine what the patient currently understands, allowing you to tailor your explanation at an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks (i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal communication such as nodding).
Checking the patient’s understanding should not be solely confined to this point of the consultation but should be done throughout by repeatedly ‘chunking and checking’.
Tip: Try using phrases such as: “Just to check that I am explaining what gestational diabetes is clearly, can you repeat back to me what you understand so far?”. This is far better than only saying “What do you understand so far?” as the onus is placed upon the quality of your explanation rather than there being an issue with the patient’s ability to understand.
What are the patient’s concerns?
The patient’s concerns should never be overlooked. A diagnosis of gestational diabetes can be a significant event during pregnancy and provoke a variety of worries. Asking the patient if they have any concerns before beginning your explanation allows you to specifically tailor what is most relevant to the patient, placing them at the centre of the explanation. The ICE (ideas, concerns and expectations) format can provide a useful structure for exploring this area further.
ICE
Ideas
- What is the patient’s understanding of gestational diabetes?
Concerns
- What are the patient’s concerns about the diagnosis and its impact on them and their baby?
Expectations
- What is the patient hoping to get out of the consultation today?
Explanation
After exploring the patient’s current understanding and concerns, you should be able to explain the condition clearly. Avoid medical jargon where possible.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
“I’m going to start by explaining how the body controls blood sugar in pregnancy, then I’ll explain what gestational diabetes is, why it matters and how we can manage it together.”
In preparation for your OSCE, practise your explanation in patient-friendly terms. Consider using visual aids (e.g. diagrams or simple drawings) to support understanding.
Tip: Use the mnemonic “Normally We Can Probably Manage” to help you remember the structure of explaining a disease.
Normal anatomy and physiology
The control of blood sugar can be explained using the analogy of insulin as a key to the cell:
“Carbohydrates we eat are broken down into sugar and released into the bloodstream. This sugar is fuel for the body’s cells, and it needs to move from the blood into the cells for them to work properly.”
“A chemical called insulin acts like a key that unlocks the cell and lets sugar in. Insulin is made in an organ called the pancreas.”
In the second and third trimesters of a normal pregnancy, insulin resistance increases to allow more glucose availability for the developing baby. The body usually compensates by producing more insulin to maintain normal blood sugar levels.1
“In pregnancy, the body’s cells respond less well to insulin. You can think of it as the key being a bit rusty, so it doesn’t open the lock as easily. This helps make more sugar available to support the baby’s growth. To stop sugar levels rising too high, the body usually makes extra insulin to keep things in balance.”
What is gestational diabetes?
Gestational diabetes is diabetes that is first diagnosed during pregnancy.
“If the body can’t keep blood sugar within the target range during pregnancy, and this is picked up for the first time in pregnancy, we call it gestational diabetes.”
For further information, see the Geeky Medics guide to gestational diabetes.
What are the causes of gestational diabetes?
Gestational diabetes is most commonly caused by beta cell dysfunction on a background of chronic insulin resistance, which is exacerbated by the increased insulin demands of pregnancy.1,2
- Genetic: family history of diabetes, polycystic ovarian syndrome, ethnicity (South Asian, Black, African-Caribbean, Middle Eastern)2,3
- Environmental: obesity, physical inactivity, advanced maternal age, diet high in saturated fats and refined sugars, low fibre intake, previous gestational diabetes or previous macrosomic baby1
“Most cases are due to not being able to produce enough insulin when the body needs it most during pregnancy. This is more likely in women who already have risk factors for diabetes.”
“Some risks are related to things like family history and ethnicity. Lifestyle factors can also play a big role, such as not getting enough exercise, being overweight and having a diet high in certain carbohydrates.”
“If you had gestational diabetes in a previous pregnancy, or you previously had a larger than average baby, you are also more likely to develop gestational diabetes in a later pregnancy.”
Problems/complications of gestational diabetes
It is important to explain the significance of gestational diabetes, as it can affect both the woman and their developing baby. A good explanation can encourage patients to engage with monitoring and treatment, so issues are identified early and addressed promptly.
Avoid alarming the patient, but explain that you are outlining potential complications so they understand why management is important and how this reduces risk.
“Higher sugar levels during pregnancy can affect both you and the baby. It can influence how the baby grows and can make the pregnancy and delivery higher risk, which is why we monitor it closely.”
Fetal and neonatal complications may include:
- Macrosomia
- Neonatal hypoglycaemia
- Polyhydramnios
- Neonatal jaundice
- Stillbirth
- Increased future risk of metabolic disease
Maternal complications may include:
Macrosomia
“Extra sugar can cross to the baby. With more available energy, the baby can grow larger than ideal.”
Stillbirth
“Poorly controlled gestational diabetes can increase the risk of stillbirth. The important thing is that good monitoring and management can greatly reduce this risk.”
Neonatal complications
“Gestational diabetes can lead to low blood sugar or jaundice in the baby shortly after birth. This is one reason we usually recommend giving birth in hospital, so the baby can be monitored and treated if needed.”
Pre-eclampsia
“The risk of a serious condition called pre-eclampsia is increased in women with gestational diabetes. This can have serious effects for both you and your baby.”
For further information, see the Geeky Medics guide to pre-eclampsia and eclampsia.
Delivery complications
“A combination of factors means that labour and delivery can come with increased risk. A larger baby may increase the chance of needing help with delivery, such as instruments, or an emergency caesarean section.”
Future maternal risks
“Having gestational diabetes increases your risk of gestational diabetes in future pregnancies and your risk of developing type 2 diabetes later in life. That’s why the lifestyle changes we discuss are important both during pregnancy and after the baby is born.”
As most people return to normal blood sugar levels after delivery, the long-term complications of diabetes are not covered in detail here. For further information, see the Geeky Medics guide to type 2 diabetes.
Management
After diagnosis, an individual care plan is usually set up by the diabetes specialist team and reviewed regularly. Normal blood sugar levels can often be achieved with lifestyle changes and, if needed, medication.
Because the aim is to reduce risks for both mother and baby, escalation to pharmacological treatment may be more proactive than in type 2 diabetes.
“Our goal in managing your gestational diabetes is to keep your blood sugar within a target range to reduce risks for you and your baby.”
Explain that there are steps the patient can take, and actions you and the team will take to support them:
“We recommend a combination of healthy lifestyle changes and, if needed, medications during pregnancy. I can talk you through these options so you understand how they help.”
Non-pharmacological
All women with gestational diabetes should be encouraged to adopt lifestyle changes. If fasting glucose is <7 mmol/L at diagnosis, lifestyle interventions are usually trialled first before medical treatment.2
Start by explaining what the patient can do to help control blood sugar levels, including:
- Following dietary advice (e.g. high fibre, low glycaemic index carbohydrates, low fat dairy products)
- Aiming for at least 150 minutes of moderate physical activity each week2,3
“Regardless of whether you need medication, lifestyle changes can make a big difference. For some women, these changes alone are enough to keep blood sugar in the target range.”
It can be helpful to signpost patients to resources such as NHS Better Health for support with lifestyle changes.
Pharmacological
Commonly used medications in pregnancy include metformin and insulin. Decisions are based on blood sugar readings and whether targets are being met.
- Metformin: may be started if fasting glucose is <7 mmol/L at diagnosis and targets are not reached after 1-2 weeks of lifestyle interventions
- Insulin: may be started if fasting glucose is ≥7 mmol/L at diagnosis, there are complications, or targets are not met with metformin2
“At diagnosis and throughout pregnancy, we will check your blood sugar regularly. Depending on the results, treatment may involve tablets such as metformin or insulin injections to keep your blood sugar in the target range.”
For further information, see the Geeky Medics guides to gestational diabetes and insulin prescribing.
Monitoring
Routine reviews are a crucial part of gestational diabetes care, involving blood glucose monitoring and screening for complications. This may include:
- Foetal monitoring: anomaly scan at 20 weeks, with additional growth scans every 4 weeks from 28-36 weeks
- Blood glucose monitoring: regular self-monitoring, regardless of whether management is lifestyle-based or includes medication2
“It’s very important that we work together to manage your gestational diabetes. This involves regular reviews, extra scans to monitor your baby’s growth and checking your blood sugar at home several times a day to make sure it stays within the target range.”
Closing the consultation
Summarise the key points back to the patient.
“We’ve covered what gestational diabetes is, why it matters, how we monitor it and how we manage it. I know that’s a lot of information, so I can give you a leaflet summarising what we’ve discussed. I’ll also refer you to the diabetes specialist team to support you during your pregnancy.”
Ask the patient if they have any questions or concerns that have not been addressed.
“Is there anything I’ve explained that you’d like me to go over again?”
“Do you have any other questions before we finish?”
Offer leaflets and signpost to reliable sources of information such as Diabetes UK, RCOG and NHS conditions.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Editor
Dr Chris Jefferies
References
- Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. International Journal of Molecular Sciences. 2018;19(11):3342. Available from: [LINK].
- NICE. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). 2025. Available from: [LINK].
- NHS. Gestational diabetes. 2025. Available from: [LINK].
- Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes: Systematic Review and Meta-analysis. BMJ. 2022;377:e067946. Available from: [LINK].
- Sheiner E. Gestational Diabetes Mellitus: Long-Term Consequences for the Mother and the Child Grand Challenge: How to Move on Towards Secondary Prevention. Front Clin Diabetes Healthc. 2020. Available from: [LINK].
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