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Will my baby be born with diabetes?
No.  The infant will not have diabetes at birth.  Your baby does, however, have the same genes as you, therefore, has an increased risk of developing diabetes.  Helping your child develop healthy eating habits, staying active, and breastfeeding, will help your child prevent or delay diabetes.

Will I automatically get a Caesarian Section?
Not usually, for the usual diabetes patient, a vaginal delivery is suggested.  If there are any complications, a C-Section may be suggested.  About 50-60% of women with diabetes have a C-Section.

Can I breastfeed?
Absolutely yes and it is encouraged.  Most women find that their diet is more easily managed if they breastfeed.  It is also better for your baby.  Bottle feeding is fine, too, if breastfeeding does not work out for you.  For women with type 2 diabetes, metformin ad glyburide seem safe for breastfeeding but some prefer to continue with insulin if breastfeeding.

What will happen to my eyes during pregnancy?
Generally, pregnancy may be associated with a 5-10% chance of diabetes related changes.  The more damage there is at the start, the more likely there will be changes throughout the pregnancy.  It is important that you see an ophthalmologist before and during the pregnancy.  There is a risk that the eyes may show changes up to a year after the baby is born so you should continue to see the ophthalmologist as often as recommended.

What will happen to my kidneys during the pregnancy?
Normally, your kidney function drops slightly and returns to normal after the baby is born.  However, if you have significant kidney disease at the start, your kidneys may show some deterioration and will not revert to their pre-pregnancy state.

What will happen to any nerve damage I have during the pregnancy?
Generally this stays the same.  Some women get tingling in the hand or carpal tunnel syndrome that improves after the birth.

If I took metformin or glyburide in the first trimester, is there a concern for the baby?
Although not formally approved for use in pregnancy, the general feeling is that no harm will come to a baby exposed to these tablets in the early pregnancy.  Less information is known about the newer medications such as pioglitazone (Actos)  or sitagliptin (Januvia).

Does the insulin go into the baby?
Insulin does not cross the placenta and thus will not harm the baby.  The high glucose if left untreated crosses the placenta and can harm the baby.  There are rare situations where antibodies to insulin can cross the placenta but the antibodies to the newer human insulins are usually very low and do not appear to cause problems.

Are analogue insulins safe?
The rapid acting insulins, Humalog and Novolog, are considered safe.  Studies are ongoing for the long acting analogue insulins, lantus and levemir.  Both of these long acting insulins have been used in Europe for pregnancy.

Should I test for ketones routinely?
Ketones are a sign of starvation.  If the body senses it is starving, it will break down body fat and these fats are converted into ketones (a weak acid substance) that are tested for in the blood or urine.  Ketones can cross the placenta.  Ketones should be specifically tested in two main situations:
  1.  Pregnancy needs extra calories for both mother and to feed the growing fetus.  If you are not gaining weight, it is worthwhile to check your blood or urine for ketones in the morning.  If you have ketones, it is a sign more calories are needed, particularly at bedtime.  Ketones in smaller amounts do not appear to harm the baby.
  2. If the glucose is uncontrolled in the mother because of lack of insulin especially in the presence of infection, the body senses this as starvation and breaks down fat at a rapid rate, forms ketones which in excess can build up as diabetic ketoacidosis (DKA), a very serious situation for the mother and baby.  This is much more of an issue for people with type 1 diabetes, but can occur in type 2.  Therefore, if the blood sugar starts to rise without a cause, such as during illness or if you have an infection, you should check your blood or urine ketones.  If you have moderate or large amount of ketones you need to call your doctor immediately and get instructions on additional amounts of insulin to take.  You should also drink large amounts fluids without sugar in them.  You may also be instructed to go to the emergency room, especially if you are vomiting and can’t keep fluids down for more than an hour.  In this situation, you will need intravenous fluids at the hospital.  Do not delay, this can be a harmful situation for you and the baby.

What are the target blood sugar goals?
Our program recommends the fasting blood sugar (when you first wake up) should be less than 95 mg/dl;  before meals less than 110 mg/dl; one hour after the start of meals should be less than 140 mg/dl; bedtime and 2 am blood sugar 80-120 mg/dl.

What  are the lower limits for my sugars?
As a general guide a fasting sugar below 63 mg/dl, a one hour after the start of the meal less than 81 mg/dl and a two hour after the start of the meal less than 72 mg/dl would be considered low and if on therapy would prompt a reduction in the medication dose.

If I get a low blood sugar, does this harm the baby?
Low blood sugars that are not severe do not seem to harm the baby.  Animal studies suggest the hypoglycemia has to be very severe and very prolonged before any harm could come to the baby.

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