INS and gestational diabetes: GDM is thought to develop as a result of the inability of pancreatic β cells to overcome the natural insulin resistance created by placental hormones in the second half of pregnancy as well as a loss of first phase insulin secretion.3 Healthy pregnant women adapt to this demand by increasing insulin secretion through β cell hyperplasia and hypertrophy and, as shown in animal models, when this fails to occur, GDM ensues.4–7