Welcome back to our Saturday diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois — where myths get busted and unseemly topics sometimes see the light of day.  Hey, where else ya gonna turn?

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}


First things first this week:

Exercising over 250 mg/dL CORRECTION:

Last week we talked about how it's generally considered unsafe to start exercising when you're over 250 mg/dL, due to the risk of ketones and possible diabetic ketoacidosis (DKA).

It has come to our attention, however, that some experts, including famous diabetes educator and author Gary Scheiner, believe it can be safe as long as NO ketones are present. "It's fine to exercise with high BG as long as you are not ketotic," Gary writes us.  "Just drink lots of water and take a small dose of insulin (typically 50% of the usual correction dose) to deal with the high. It is extremely rare to generate ketones if you have at least a basal level of insulin in your body."

For my part, my worry remains that 1) pumpers may not have a sufficient basal level of insulin present in their bodies, and 2) most folks check urine ketones, not blood ketones, and the urine test produces three-hour old news. If you do check blood ketones and get zero, working out would probably be fine.

 And now on to our regularly scheduled programming:


Janine from Missouri, type 2, asks: Is it true that if a diabetic gets pregnant, the baby will also be a diabetic? I keep hearing this, so just confirming...

Wil@Ask D'Mine answers: Nope. Not true. Not true at all. Well... not true for the most part. Ah, well, actually... not true most of the time. Well... that is to say, not true in the majority of cases.

Oh. Wait a sec. That's a lie.

I can think of one case when it's true exactly half the time.

You know what? It depends. It depends on who you are. It depends on who your partner is. It depends on what type of diabetes you are talking about.

Welcome to Diabetes Vegas, baby. Let me give you a quick run-down on your odds.

So, briefly we gotta talk genetics here: how the DNA blue-print that makes you who you are contributes to your odds of say, having blue eyes, a keen brain, brown hair, stubby fingers, or diabetes. When it comes to eye color, you pretty much come out of the uterus with that set in stone. With disease risk, on the other hand, it's never that simple. There are no guarantees, either positive or negative. Many other things come into play, from the environment that may or may not trigger disease to a genetic blue print for diabetes. So remember, even if the odds favor you getting diabetes, that doesn't mean that you necessarily will.

With that in mind, the scientific odds makers tell us that:

If you, as a type 2 woman, have a child with a man who doesn't have diabetes, the odds that your baby will develop diabetes is 1 in 7. Before you freak out on me, bear in mind that if neither of you had diabetes, your odds of having a child who'll develop type 2 diabetes is 1 in 9 in the first place. So the risk is only slightly higher. Oh, and those odds are the same regardless of whether it's the man or the woman who has diabetes. It gets more complicated with type 1s, as you'll soon see.

If you were a magically converted to a woman with a type 1 diabetes (arguably somewhat of a curse) and had a baby with a non-diabetic man, your odds of having a baby who develops type 1 is 1 in 25; up a fair bit from the 1 in 100 odds of two non-type 1 parents having one of us. Now, oddly, this risk drops if a type 1 woman has her baby later in life. And the numbers slide around a bit depending on your own age of diagnosis.

Now, if you not only had a conversion to type 1, but also a sex change and had a baby with a woman who doesn't have diabetes, you'd have a 1 in 17 chance of siring a new member of our club. If both parents are type 1s, the odds they'll create a family tradition are 1 in 10. Still, that's only a 10% risk. Do you take your umbrella with you if there is a 10% chance of rain? Read more about the odds at Joslin.

So up to this point, the odds are against you having a child who will get diabetes, even though you have diabetes yourself. But I've been ducking the odds that might affect you the most, Janine. If you, as a type 2, have a child with a type 2 man, what are the odds?

1 in 2.

Yeah. Sorry about that. A pair of type 2s has a 50% chance of creating a new family tradition.

Does that mean if both you and your partner have type 2 diabetes that you should abstain from having children? No! That's crazy talk! At least it would be crazy if that was the only reason you chose not to have children.

Here's how I look at it: If the odds are that it will rain, you should probably take your umbrella. Maybe you'll get wet and maybe you won't, but you'll be prepared.

But remember, as a type 2, many of the risk factors for triggering the body's genetic time bomb for diabetes are well understood, and eating too much and moving too little are chief among them. If your baby has high odds of type 2 diabetes, keep the little tyke in motion and keep the table light and healthy.

And you know what? Even if your baby doesn't turn out to have any risk for diabetes in the DNA after all, lots of action and not too much food is still good!

Bottom line: Don't let diabetes risk step into the equation of whether or not to have children. As a father, I speak with great authority here. Kids rock the house. (In a good way).


Tim, also from Missouri, type 1, writes: I take Novolog 70/30 insulin daily but I am overweight so my doctor has prescribed Victoza. After reading your article, my question is, is it OK to take the Victoza along with the mixed insulin that I'm taking now?

Wil@Ask D'Mine answers: The lawyers are out in the hall wringing their hands, so I have to remind everyone that I'm not a doctor and can't give medical advice. That said the answer is yes.


That was the sound of a lawyer falling onto the floor in a dead faint.

OK, here's the deal, for quite a while now, Victoza has been used "off label" with various insulins to very good effect. I use it myself with insulin.


The second lawyer just fainted.

Off label generally means that a medication is being used for something other than its FDA approved use, hence being used "off" the FDA "label." Lots of meds are used off label. It doesn't necessarily mean it's unsafe, or even that it's un-studied. It simply means that no one has jumped through the FDA hoops yet to get the drug approved for this particular use.

Of course, the real effect of off label use of a medication is that it gives insurance companies a simple way to say "no" when they don't want to pay for something.

But here's the good news. Victoza's competitor Byetta has just been FDA approved for use with Lantus insulin. Granted, Lantus is a whole different kettle of fish from your Novolog mix, but the stage is set for GLP-1 meds like Byetta and Victoza and insulins to not only be used together, but to be covered in tandem by insurance.

So I think you'll be fine.  But of course, talk to your doc about how to adjust your insulin dosage before you start, as both the Victoza and the "fast" portion of your mixed insulin impact your after-meal blood sugar numbers, and the insulin might need to be reduced.

Now, I gotta go run and find some smelling salts for the lawyers. Huh... I wonder if smelling salts are FDA approved for fainting? I wouldn't want to use them off label or anything...

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.