Dear Linda,
About the mom who has had sore open cracked nipples since the first week of
breastfeeding, I have had similar experiences with the diabetic women I have
worked with.  Dr. Lawrence on p. 503-504  (of her 4th edition) has solid
background information as to what to expect.  The diabetic mother is more
prone to infection including breast infections and fungal infections. If a
fungal infection can be identified as the cause of the sore nipples then
treatment for mother and baby needs to be maintained for at least two weeks
past the absence of symptoms.  A maintenance regimen may need to be worked
out. A great source of treatment ideas is Lactation Consultant Series Unit
18 Candidiasis & Breastfeeding.  I have had to teach such mothers to be
super careful with latch-on and positioning. Using positions with minimal
drag on the nipples seem to work the best such as various positions with the
baby prone to the mother. Extreme care in drying and avoiding excess nipple
moisture seems to also help.  The diabetic mother needs to be especially
careful to avoid fatigue. Rest is essential.  In extreme cases, I have
worked out care plans where the mother would breastfeed only several times a
day and rest the nipples with pumping, if the pump was caused less friction
than the baby.  I would then teach the mother to fingerfeed with a
periodontal syringe.  Sometimes optimizing the suck of the baby by
fingerfeeding and consequently suck training would make a difference.
Sometimes fingerfeeding just a bit prior to latch-on would take the baby's
hunger edge off and relax the breast latch-on. The mothers with these
chronic problems need lots of support.  Hope this helps.
Joanne Burke Snyder, MA, CLE, IBCLC
Latch-On Services:  A private practice in Indianola, Iowa