In the past, generally after pregnancy, insulin therapy was necessary and the only treatment option. In recent years studies have confirmed that glibenclamide, metformin, is also available for women with diabetes during pregnancy. One study compared the evidence of effectiveness of glibenclamide or standard insulin in the treatment of gestational diabetes. Glibenclamide has similar effects to insulin in controlling blood glucose. The incidence of hypoglycemia, neonatal ICU stays, and fetal malformations was similar. And cord blood insulin concentrations were similar in the treatment groups, but glibenclamide was not monitored in infant cord blood. Studies have shown that glibenclamide is safe and as useful as insulin in the treatment of patients with gestational diabetes. The currently recommended starting dose of glibenclamide is 2.5 or 5 mg/day or twice/day (with a maximum daily dose of 20 mg). Second, metformin has been used for decades in early pregnancy and other indications during pregnancy, such as establishing normal ovulation and reducing the risk of early spontaneous abortion in women with polycystic ovary syndrome. Metformin has also been shown to be similar to insulin in neonatal hypoglycemia, rostral distress, need for phototherapy, birth trauma, 5-minute Apgar score < 7, or preterm infants. An additional advantage is that women on metformin weigh significantly less during pregnancy compared to insulin, and neonates are less likely to have significant hypoglycemia. Current data suggest that metformin is an acceptable alternative to insulin and is most likely to be effective in controlling blood glucose, especially in normal or slightly overweight women or women with mildly elevated fasting blood glucose. The currently recommended starting dose is 500-800 mg/day, with a maximum daily dose of 2000-2500 mg/day (divided doses).