The Diabetic Breastfeeding Mother

Can You Breastfeed If You Have Diabetes?
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Whether you have just recently learned that you have diabetes, or you've had it for quite some time now, do not believe the myths that claim that you can't breastfeed your baby. It is still good for both of you. Here are the solid facts about diabetes and breastfeeding.

The 3 Types of Diabetes

Insulin-Dependent Diabetes Mellitus (IDDM, Type I, or Juvenile Onset Diabetes): IDDM is usually seen in people under the age of 25 and results in absolute insulin deficiency. Type 1 diabetics have to take insulin every day.

Non-Insulin Dependent Diabetes Mellitus (NIDDM, or Type II): Type 2 diabetes is mostly seen in adults. Type 2 diabetics can make enough insulin to prevent ketoacidosis but not enough to meet the total body needs. 

Gestational Diabetes Mellitus (GDM/GCI or metabolic stress of pregnancy resulting in reversible carbohydrate intolerance): Gestational diabetes develops during pregnancy and goes away during the postpartum period.

Most of what is discussed in this section pertains to women with pre-existing, not gestational diabetes. Once someone with gestational diabetes delivers their baby, they get routine postpartum care and are treated as if they are "cured" unless their 6- to 8-week postpartum glucose tolerance test proves otherwise.

Contrary to popular belief, breastfeeding is compatible with all of them. Breastfeeding:

  • May lower your baby's risk of getting diabetes
  • Helps you lose weight/prevent obesity
  • Helps your body use insulin in a positive way
  • Decreases your insulin need

Before Your Baby Arrives

It goes without saying that proper prenatal care is essential to ensure that your baby is healthy. Talk to your doctor, especially if you have Type 1 diabetes, about insulin dosages, caloric intake, and particular foods to eat. Many women find they have low blood sugar within an hour after breastfeeding, so eating something with a good balance of carbs and protein just before, or during, a nursing is key. Always keep a healthy snack in your bag when you go out, as well.

It is also important to choose a pediatrician before your baby is born so that you can discuss how to keep your glucose levels in check after delivery. Almost half of babies of mothers with diabetes have low blood sugar right after birth.

During this time, you should also prepare yourself for breastfeeding by speaking with a lactation consultant. Many times, breastfeeding may be delayed, and the baby may need a supplement in the hospital. The lactation consultant will teach you how to express colostrum from your breasts so you can use that as part of the supplement. She will also help you plan how you will feed your baby once you go home from the hospital.

After Your Baby Arrives

It is possible that your baby will have to go to the Neonatal Intensive Care Unit (NICU) for monitoring. If supplementation is necessary, request that the baby is fed your expressed colostrum before any formula is given. The formula that most hospitals use actually increases the risk for a baby to get diabetes. If an infant formula is necessary because you do not have enough colostrum or expressed milk is, you can request that they use hypoallergenic formula (Nutramigen, Alimentum) instead of the standard issue.

Hold your baby skin-to-skin to keep him warm, to interest him in breastfeeding, and to avoid crying. Skin-to-skin contact can also help to maintain your baby's blood sugar levels. 

Request to see a lactation consultant to make sure the baby's latch is correct to avoid sore nipples. The incidence of thrush or mastitis is significantly higher in diabetic mothers who have sore nipples.

Breastfeed as soon as you can after delivery and quite often. You want to begin to stimulate your supply of breast milk and keep your baby's blood sugar levels stable. If, for some reason, you are not able to breastfeed, make sure to express or pump every 2 to 3 hours until you are able to feed the baby so that you are stimulating your production and simulating what the baby would typically be doing.

If the baby is having a rough start at breastfeeding, just remember to look for your baby's hunger cues and stay relaxed and focused. He will learn. Don't forget to watch the sucking and swallowing pattern (suck-suck-swallow-pause) of your baby to make sure everything is going well.

Although it is recommended to feed one breast entirely before offering the other, it may be necessary to switch breasts often to ensure she is getting an adequate amount of colostrum. Switching breasts often is called switch nursing. It's a technique where the baby is taken off the breast when he starts to slow down and put on the other ... sometimes multiple times in a feeding period.

Your glucose levels will be watched very carefully in the hospital to ensure that they are steady.

You may need to eat more frequently than what is offered – the majority of hospitals only serve breakfast, lunch, and dinner. Ask to speak with a hospital dietician; s/he should give you at least three other snacks during each day of your stay. If not, ask a support person to bring something to you.

At Home With Your Baby

Don't be surprised if your breast milk has not come in by Day 3 as having diabetes may slightly delay the production of your breast milk. It is fair to say that you can expect to see your milk come in by Day 4 or 5 if you are breastfeeding at least 10 times a day. You will know the baby is doing well if he is having at least 6 wet diapers and 3 bowel movements every day after the first 3 days.

The pediatrician will also want the baby to come into her office for a weight check within the first few days after you come home to make sure everything is on the right track.

Even though it seems like years away, it is important to keep in the back of your mind that babies, especially those of diabetic mothers, should not be given any solid foods until 6 months of age. Their bodies are not ready to handle solids earlier than that point and waiting may stave off the disease.

What You Can Do for Yourself

Diabetic mothers should:

  • Monitor their blood glucose levels very carefully while they are breastfeeding, keeping in mind that their levels will vary during feedings
  • Avoid medicinal herbs, such as fenugreek, which can alter blood sugar levels.

You can breastfeed. It may be overwhelming to think about breastfeeding with diabetes, but with proper preparation and monitoring, you'll sail through the process.

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Article Sources
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  • Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby. 2011.
  • Riordan, J., and Wambach, K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning. 2014.