I am a certified diabetes educator as well as a IBCLC and have worked with this issue.  The baby doesn't use synthetic insulin while in-utero.  The baby uses its own insulin.  If the mother is well controlled during pregnancy there is usually a pretty smooth adjustment for the baby after birth.  It's blood glucose levels will be carefully monitored and breastfeeding will be encouraged.  If mom's blood glucose (BG) levels are high prior to giving birth, the baby's natural insulin levels will also be high.  Once the baby is born and it is no longer receiving extra glucose via the mom, its BG's may drop very low until it adjusts its own insulin levels.  During that time it may receive IV glucose or oral glucose along with breastfeeding as needed.  The baby's BG's should be stable without need for extra glucose within 24 to 48 hours.  A motivated mom on an insulin pump is ideal for this situation and she should be able to breastfeed immediately and normally.  Her insulin needs will be much lower than her normal and her diabetes will be easier to control while breastfeeding.  She should be under the care of an endocrinologist during pregnancy and will probably be referred to a specialist who will monitor the baby in-utero.

Patty Usher

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Melissa Lactation
Sent: Friday, May 30, 2014 6:37 AM
To: [log in to unmask]
Subject: insulin pump/maternal diabetes

Good morning!  I have been searching the archives for information regarding initiating breastfeeding for an insulin dependent mother.  She uses an insulin pump and highly motivated.

She specifically wants to understand the baby's physiologic process in adapting  from in-utero synthetic insulin to producing his own insulin after birth.
Any information is appreciated.

Melissa Senf, RN, IBCLC in SC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome