Judy, 43 years old, was overjoyed to receive confirmation from her physician that she was indeed pregnant after three years of trying to conceive. After a prenatal exam that determined she was at 7 weeks gestation, blood was drawn as a routine part of the evaluation. Judy's physician told her she would have her nurse call Judy the next day with the laboratory results.

Judy found it surprising to hear her physician's voice on the phone the next morning at 8:15 a.m. instead of that of the physician's nurse. Her physician asked her if she had eaten or drunk anything yet that morning. When Judy said no, her physician ordered her to return to the clinic immediately to repeat her lab work in a fasting state. Judy rushed to her physician's office where she was informed that her random plasma blood glucose was 348 at 4 p.m. yesterday and a glycated hemoglobin of 12.3% indicated her blood glucose has been high for at least the past few months. A fasting plasma blood glucose, done immediately upon Judy's arrival at the clinic, showed a value of 235 mg/dL, confirming a diagnosis of type 2 diabetes. Diabetes didn't run in Judy's family and she had been in good health up until that point, as far as she knew. She acknowledged she hadn't had any blood work done in the past two years as part of her annual physical exams with her former primary care physician.

There were multiple questions swirling around in Judy's mind and she was extremely fearful of losing her baby. She begged her physician for help and her physician promptly introduced Judy to the diabetes management team at the clinic.

1. What type of diabetes would you suspect Judy has?

2. Based on a diagnosis of diabetes during pregnancy, what dietary modifications specifically regarding calories and carbohydrates might Judy need to make?

3. What factors make it likely that Judy will need insulin to manage her diabetes during her pregnancy?

4. Assuming that she was in poor glycemic control when she conceived, what are the risks to Judy and her unborn baby?

5. Could the results of Judy's elevated glycated hemoglobin be related to her three miscarriages in the past two years?