Factors delaying breast feeding as the first feed are the major determinant of breast feeding on discharge. Strategies to increase breast feeding as the first feed among women with Type 2 diabetes, and those having a Caesarean section, may be useful in increasing the uptake of breast feeding in the longer term.

OBJECTIVE -To describe the use of insulin pump therapy in women with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite multiple injections of subcutaneous insulin.RESEARCH DESIGN AND METHODS -As part of a service audit, deliveries to women with diabetes at a single South Auckland hospital were reviewed from 1991 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-control study, pregnancies complicated by GDM/type 2 diabetes with use of an insulin pump were compared with those without insulin pump therapy and peak insulin requirements of 100 -199 units/ day, matched for ethnicity and type of diabetes.RESULTS -A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An additional two women with high insulin requirements discontinued pump therapy. None of the women with GDM/type 2 diabetes experienced severe hypoglycemia, whereas 79% of the women had improved glycemic control within 1-4 weeks. Mothers using a pump had greater insulin requirements (median maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienced greater hypoglycemia than control subjects.CONCLUSIONS -Insulin pump therapy seems to be safe and effective for maintaining glycemic control in pregnancies complicated by GDM/type 2 diabetes and requiring large doses of insulin. Diabetes Care 24:2078 -2082, 2001G estational diabetes mellitus (GDM) is associated with important perinatal and long-term health risks for both mother and child (1). Type 2 diabetes in pregnancy is associated with an increased risk of operative delivery, and the risk of perinatal mortality may even be higher than that in type 1 diabetes (2). A study of women with GDM, in which a significant proportion had type 2 diabetes after pregnancy, clearly showed that tight glucose control, particularly of postprandial glucose, is associated with less neonatal hypoglycemia, macrosomia, and caesarean delivery (3). In that study, 88% of women achieved target glycemia using a three-times-per-day, split-evening-dose insulin regimen. Although reduced adherence to such regimens and dietary indiscretions can contribute to difficulties in glycemic control, some women need, but do not always receive, large amounts of insulin to achieve euglycemia. Achieving optimal glucose control is not always possible with a four-times-per-day insulin regimen.New Zealand Polynesians (both indigenous Maori and those from the South Pacific) have a high prevalence of GDM (4), type 2 diabetes diagnosed at a young age (5), and obesity (6). Compared with European women with GDM, Polynesians with GDM are older, heavier, have worse hyperglycemia at diagnosis, are more likely to have type 2 diabetes postnatally, and are prone t...

This study shows that there is poor awareness of brain complications of diabetes among individuals with diabetes and the general population in Ireland. The results suggest a need for expansion of public awareness campaigns and diabetes education programmes to promote awareness of the brain complications of diabetes and of the modifiable risk factors for dementia, as part of a life-course approach to dementia prevention.

Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.