Estimated reading time: 7 minutes
Emma Gardner, Northampton, UK
Photo: Freya & Leo courtesy of The Sandwell Baby Cafe
Diabetes and breastfeeding?
Diabetic mothers may be concerned about whether they can breastfeed their babies. The good news is that yes they can. In fact, breastfeeding reduces the impact of the metabolic and hormonal changes following birth for all mothers and all babies benefit from breastfeeding.
Insulin is a naturally secreted hormone that the body needs in order to use glucose for energy. In diabetes insulin is depleted, impaired or destroyed and glucose builds up in the blood, which can cause significant complications. Diabetes is treated with medication or insulin injections, to keep the blood sugar levels under control. For all diabetic moms good blood glucose control is key to avoiding problems in pregnancy labor and birth.
I’ve had diabetes for 24 years and have gained a lot of experience in that time, as well as giving birth to three babies. I have had the good fortune of suffering no diabetic complications (so far!), have had problem-free pregnancies and, somewhat amazingly, two home births.
During pregnancy, diabetic mothers-to-be receive a lot of attention from their health care providers (HCPs). In my experience, this felt intrusive at times but I can’t fault the quality of care I had from my diabetes and obstetric consultants. Having diabetes can increase the risk of your baby being born prematurely and of your having a cesarean birth. It is always well worth getting a good dialogue going with your HCPs about how you monitor and control your glucose levels. Discuss with them how best to manage your changing needs for insulin.
Some expectant mothers have gestational diabetes, which develops during pregnancy. This is a not uncommon but temporary condition, in which the body fails to produce enough insulin to meet increased needs while pregnant. It is usually diagnosed from the fourth month of the pregnancy and can come as a shock. Women suffering from gestational diabetes will need to manage their blood glucose levels and will require extra medical care, just as those with long-term diabetes do, but diabetes treatment following the birth is usually unnecessary.
After the birth of my babies, I felt pretty much on my own as regards diabetic care. The body’s insulin need goes back to pre-pregnancy levels quite quickly. My HCP gave me some guidelines for reducing my insulin, and I made an occasional phone call to the clinic for support. But I had to figure out for myself how to manage my day-to- day diabetes care while mothering a newborn.
Insulin treatment is compatible with breastfeeding. The molecules of insulin are usually too large to pass into your milk. Even if there were any insulin present in your milk, it would be destroyed in your baby’s stomach.
Fluctuations in blood glucose levels affect milk production, so seek skilled help to get breastfeeding established. La Leche League is a good place to start. Having now read the information provided by LLL, I can see how much things will vary with each baby and at every feed. When my first baby was born, no one could tell me how a single breastfeed would affect my blood glucose level. Managing diabetes while breastfeeding is very much trial and error, but each individual diabetic with a breastfeeding baby will gradually work it into her daily life.
Insulin treatment is compatible with breastfeeding. The molecules of insulin are usually too large to pass into your milk.
Diabetics soon come to realize that there will always be unexpected highs and lows of blood glucose—we don’t live in laboratory conditions! But with time and experience even these can become more predictable. Having a newborn is yet another learning curve in handling your diabetes.
Have your blood and urine testing equipment examined to check it is not affected by lactose, the milk sugar that circulates in the blood while you are pregnant and breastfeeding.
I found that once I had a tiny baby in my arms, whose needs were urgent, my diabetes became less of a priority, especially compared to the priority diabetes had assumed during my pregnancy. But for long-term health it is vital to be in control and a step ahead whenever possible.
Once breastfeeding and your baby’s rhythms are worked into daily life, you can either have less insulin at mealtimes or eat a bit extra. I found that during the early weeks of breastfeeding when my babies were growing and changing so quickly I experienced more hypoglycemic episodes. I would test my blood glucose, work out the carbohydrate value of my meal, inject my insulin accordingly and eat my dinner. Then my baby would settle down for a nice long cluster feed, which literally took energy from me and lowered my blood glucose. Time for a hypo! (a hypoglycemic episode). My remedy for this is a 200ml carton of fruit juice that will bring my blood glucose up to normal levels in around ten minutes. (Chocolate is a poor choice for this job because fat slows down the absorption of sugar and it’s not one of your five fruits and vegetables a day!) It was well worth having a small snack as well to help maintain blood glucose at this point. Getting it right does become easier with practice.
Babies of diabetic moms risk becoming hypoglycemic in the hours following birth. This is likely to happen if the mom has had high blood glucose readings in the weeks leading up to the birth and during labor itself. Even with good control, your baby will have been used to relatively high levels of glucose before he was born. The extra insulin he produces can lead to a drop in blood glucose after birth. Skin-to-skin contact and early frequent feeds of colostrum are particularly important for babies of diabetic moms because colostrum will help regulate the baby’s blood glucose.
After giving birth there are a lot of hormonal changes, not just insulin, each of which can affect the others. I found that during the first few months maintaining decent blood glucose results was a bit haphazard—not impossible but not consistent. Less insulin and/or more food is needed while breastfeeding so that takes a few adjustments and days/weeks to get just right. Frequent feeding and growth spurts, in turn can affect diabetic control.
Hypoglycemia (a hypo) is triggered when blood sugar levels fall under 4 mmol/L.
The most common symptoms of a hypo include:
- Feeling dizzy
- Feeling hungry
- A change in mood
- Feeling sweaty
- Finding it hard to concentrate
Hyperglycemia occurs when people with diabetes have too much sugar in their bloodstream.
The main three symptoms of high blood sugar levels are:
- Increased urination
- Increased thirst
- Increased hunger
High blood sugar levels can also contribute to the following symptoms:
- Weakness or feeling tired
- Loss of weight
- Vision blurring
Some moms will express colostrum in the last weeks of pregnancy to ensure that their baby gets plenty in the hours/days after the birth in case there are problems with breastfeeding. A few drops or a teaspoon of colostrum can make a huge difference and help avoid the need for any supplements.
It can be easy to forget or lose track of your monitoring when emotional, tired or overwhelmed.
It is really helpful to have family and friends around in the first few weeks with a new baby, not only to keep the house in order and cook many delicious meals, but to fetch your insulin and blood glucose tester when you have a sleeping baby on you, or simply to remind you to inject your insulin or do a test. It can be easy to forget or lose track of your monitoring when emotional, tired or overwhelmed. I find a change in routine, when on holiday, for example, is enough to put my diabetes all over the place—from forgetting to inject to even doing the same injection twice!
Difficulties of diabetes and mothering
Having a hypo when your baby needs you. For this period of time you are the priority and, in my opinion, it is impossible to be the mother you want to be at this time.
Having a hyper can make you feel tired, sick and irritable, too.
Forgetting to inject because your baby needed you and upset your routine. Hyper!
Injecting before eating and not being able to finish eating because your baby needs you. Hypo! Wearing your baby in a sling may help here. Eating a whole meal becomes easier as your baby gets older. Probably crawling stage to early toddlerhood is the trickiest period.
Diabetic moms are more at risk of thrush, which can infect the nipples, causing pain and itchiness. Seek medical help and the support of your LLL Leader.
As always, eat healthily, get outside, take exercise, ask for help. Be as healthy as you can!
Advantages of breastfeeding for diabetic mothers
Diabetes carries more health risks and breastfeeding reduces many of these.
Breastfeeding can help you control your blood glucose levels as your body adjusts after the birth of your baby.
Depending on the type of diabetes you have, you may need less insulin or other medications when breastfeeding. I still have to inject insulin, though.
Breastfeeding suppresses your periods (lactational amenorrhea) and monthly hormonal changes
When breastfeeding, oxytocin and prolactin hormones are calming and help reduce stress.
There is research evidence that being breastfed reduces the risk of your child developing diabetes later in life.
Breastfeeding is biologically normal and our bodies expect this to happen when we have a baby. There are long-term health benefits for all moms and babies.
Always have a 200ml carton of juice, or other preferred hypo remedy, by your bed, nursing chair, in your bag and in your car.
Keep some carbohydrate and non carb snacks by your nursing chair with your tester and insulin. And a bottle of water.
Keep your regular appointments at the diabetes clinic and keep a contact number with your liaison nurse handy.
Enlist support from family or friends to help on appointment days, especially if you are having your eyes tested, when you might possibly need their assistance for the rest of the day until your eyes have settled from the eye drops.
Emma Gardner is an LLL Leader, married to Ru, and has three children, Bryn, Erin and Hetty. She runs Toddler Meetings and moderates LLL GB’s Facebook page and that of her local group. She is a contributing editor in LLL GB’s national magazine and she responds to Help Forms.