Dear Robin:

I don't know about how one would tell exactly what kind of control this
mother will require after her baby is born.  If her blood sugars cannot be
controlled with diet and exercise, then, my guess is that she would need
insulin.  The side effects of the oral hypoglycemic agents would probably
contraindicate them if they get into the milk. (I don't have my references
here now)  Insulin that gets into the milk is degraded in the gut as a
protein, so would not affect the baby's metabolism.

Many women require insulin in pregnancy and are able to maintain normal blood
sugars afterwards with no other medication.  The problem in pregnancy is the
pregnancy hormones which make mothers insulin resistant.  During lactation,
the synthesis of lactose pulls sugar from the maternal blood supply, so
should actually help to decrease blood levels of glucose. (I tell mothers
that every pound their baby gains is one they didn't.  The same would be true
for lactose. Every gram of lactose that the baby eats is one that is not
circulating in the mother's body-- not as lactose but as precursors)

Who is this diabetes educator, anyway.  Doesn't the mother have a physician.
 She is entitled to an opinion of an endocrinologist if the physician
managing her care isn't up on  diabetes as well as he/she should be (it's
downright apalling to see how some diabetics are medically handled).  Also
diabetes educators (generic term, here) are not necessarily qualified to do
nutrition education.  Many only have a passing knowledge of diabetic diet.  A
good RD probably will be able to help this mother very much, if the diabetes
educator is not an RD.  I am aware of some nurses who try to do diets, but
usually they do not do as good of a job as a dietitian.

Martha Brower RD LD IBCLC