Liverpool is located in south-western part of Sydney, and the population is characterised by its cultural diversity, with 55.3% of its residents born overseas (and 27.6% arriving since 2011). The main ethnic groups in our local government area came from Middle East, South Asia and East/South-East Asia. Our population growth rate is one of the fastest in the country, and the prevalence of gestational diabetes mellitus (GDM) is also one of the highest in the state. Clinicians at our institution had struggled with the management of diabetes in pregnancy, both in terms of the sheer number of women with diabetes during pregnancy as well as the extra challenges due to language barriers and varying health literacy. The number of women who failed to be managed on medical nutrition therapy at Liverpool Hospital had been consistently above 40%. In the past 10 years, the number of women with GDM seen at our service had risen from 420 in 2008 to 778 in 2018. Over time, there had been significant changes to the way we manage diabetes in pregnancy. With limited resources, we need to be flexible and have the courage to trial new models of care in order to meet these constant challenges.