All women who agree to participate in the study will have an ultrasound performed to confirm gestational age and rule out fetal anomalies, a serum glycosylated hemoglobin A1C to assist in excluding preexisting diabetes and a fasting insulin level to assist in determining degree of insulin resistance. A serum glycosylated hemoglobin A1C will be repeated upon admission for delivery. Subjects randomized into standard therapy insulin arm will have their insulin dose calculated by established standards. Dosing is based upon a 2 shot combined dose with long acting and short acting insulin given prior to breakfast and dinner. If the fasting glucose values remain elevated the dinner NPH will be moved to bedtime. Subcutaneous administration is recommended in a consistent anatomic region, preferably the abdomen.