Question from Hollywood, California, USA:

For two years prior to pregnancy I had an unexplained weight gain. For one year prior I had hypoglycemic attacks, during which, two hours after a heavy or starchy meal, I would have palpitations, sweating, anxiety and have to go to the ER.

When I became pregnant, it was suggested that I take the glucose test at six weeks, which was negative. At 30 weeks, I was diagnosed with gestational diabetes, and a very strict, specific diet in addition to two to three periods of exercise per day are not working. Although my pre- and post meal numbers are normal and in control, I cannot get my morning fasting numbers below 110-115 mg/dl [6.1-6.3 mmol/L]. I am going to need insulin and will go to the doctor tomorrow to start it

I have been spilling ketones in my urine for about five weeks now, at all times of the day. Until a week ago they were trace to small. Now they are moderate to large. No amount of food seems to help, although if I drink a gallon of water, they will disappear. My questions:

Have you ever heard of pre-existing, non-diabetic reactive hypoglycemia as being a risk factor for gestational diabetes?
I keep reading that a morning fasting number of 105 mg/dl [5.8 mmol/L] or over is the greater indicator of fetal or infant demise. I also read that ketones can cause instant fetal demise, and that women on insulin are at greater risk for stillbirth. I’m obviously extremely worried since I have three strikes against me and my baby. Why are morning numbers more important than any others? What are the ketones doing to my baby?
What would cause my baby to suddenly die in the womb or at birth? Also, does anyone know what causessuch an occurrence? How I might prevent it?
If I stay on my diet and exercise program, take insulin, and monitor my numbers eight times per day, keeping them normal, and if I deliver at 38-42 weeks, is there still a chance that my baby will be born with hypoglycemia, jaundice and/or breathing problems? What are all the precautions I can take to prevent this? Isn’t this the largest risk to the baby aside from weight gain? I know another woman whose baby was born with all these symptoms and she had hypoglycemia, not hyper. Any connection?
At my 21 week extensive ultrasound, and again last week, my baby measured 1.7 weeks ahead in size. Since my first ultrasound was so early on, and since my baby’s growth rate seems to have remained the same, does that indicate that his size is not connected to gestational diabetes? Does 1.7 weeks ahead in size indicate unreasonable growth, or are such variations normal? I want an unmedicated, vaginal birth. Does his present size indicate that it’s still possible?

I am seeing a dietitian, a diabetes educator, and soon, a high risk specialist. However, so far, I haven’t been able to get any real answers to these questions, and I’m pretty desperate. I am not asking for medical advice, but some type of overview of what’s going on here. I’ve spent exhaustive hours pouring through medical journals and can only find cursory or incomplete data. Any information you can give me would be greatly appreciated. It’s painful to be in the dark when it comes to the survival, health and safety of a baby we want so much.