I developed type 2 diabetes after giving birth to my son six years ago, and I am almost two months pregnant. I wish to seek advice on precautionary measures I need to take. Will appreciate advice as healthcare is limited in Samoa.

You have type 2 diabetes, and, now that you are pregnant there are several things that should be done. It is important that you maintain good blood glucose control either on diet or insulin. If you have been on an oral hypoglycemic agents, then ideally you should switch over to insulin at least until you are out of the first trimester. Your fasting blood sugar should be 60-90 mg/dl [3.3-5 mmol/L], one after a meal, it should be less than 130 mg/dl [7.2 mmol/L], and less than 120 mg/dl [6.7 mmol/L] two hours after a meal. If you have not done any blood glucose testing in a while, then you should see your doctor as soon as possible.

Since you are eight weeks pregnant, much of embryonic development has occurred. Now it is a matter of fetal surveillance. At 16-18 weeks you should have an ultrasound to look at the anatomy of the baby and again at 20-22 weeks to evaluate the fetal heart. Later in the pregnancy, the growth of the baby should be evaluated periodically by ultrasound. I like to get my patients as close to term as possible as long as the baby is not too big and is otherwise healthy. This way you are more likely to go into labor on your own and avoid an induction.

OWJ