Diabetes and Breastfeeding

Breastfeeding is the normal and natural way to feed and nurture a baby. If you have diabetes you may be concerned about whether you can breastfeed. The answer is yes. All mothers experience metabolic and hormonal changes after giving birth. A mother with diabetes who breastfeeds has an advantage as breastfeeding reduces the impact of these changes. When you breastfeed, your body continues to support you and your baby, making your diabetes easier to manage in the days after birth. Later on, gradual weaning helps you to maintain control of your diabetes.

Gestational diabetes
Benefits of breastfeeding
What about medications?
Be prepared
Blood glucose control
Babies can have a hypo after birth
Antenatal expression of colostrum
Get breastfeeding off to a good start
Looking after yourself
Adjusting your diet

Gestational diabetes

It can be a shock if you are diagnosed with gestational diabetes during your pregnancy. This is usually a temporary condition in which your body fails to produce enough insulin to meet your extra needs while you are pregnant. It is usually diagnosed from the fourth month of pregnancy. Just like mothers who are on long-term treatment for diabetes, good control of blood glucose levels will minimise any problems for you and your baby. You may not need any extra medical care during labour and delivery. Diabetes treatment is usually unnecessary once you have given birth.

Benefits of breastfeeding

For you as a mum with diabetes
• It is easier to 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.
• Breastfeeding suppresses your periods and monthly hormonal changes.
• Oxytocin and prolactin hormones are calming and help to reduce stress.

For your baby
You will want your baby to have the best start possible—all babies benefit from exclusive breastfeeding. There is also some evidence that being breastfed reduces the risk of developing diabetes later in life.

What about medications

Many mothers with diabetes have breastfed: 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. Check with your doctor for up-to-date information on any other medications you take. If there is any concern over safety, an LLL Leader can obtain information on named medications for you.

Be prepared

Having diabetes can increase the risk of certain problems during pregnancy and after birth for you and your baby:
• Premature birth
• Caesarean birth
• Newborn hypoglycaemia (low blood sugar)
• Newborn jaundice.
Since any of these can have an impact on breastfeeding, it can help to find out how to avoid unnecessary problems and overcome difficulties. You may also like to find out about local hospital policies on the management of these and care of diabetic mothers during and after pregnancy. Do ask if the hospital has an Infant Feeding Advisor who will be well informed about breastfeeding and a source of support in those early days.

Blood glucose control

This is the key to avoiding problems in pregnancy, labour and after birth. If you are still planning a pregnancy, practise good diabetes management before you conceive too.
• Frequent antenatal and diabetes medical care will allow you to address any problems quickly.
• Discuss with the doctors, nurses and dieticians in your diabetes team how to control your changing needs for insulin, other medication and food while pregnant and after birth.
• Check at your diabetic clinic that your blood and urine testing equipment is not affected by lactose (milk sugar), which circulates in the blood of mothers who are pregnant and breastfeeding.
• Monitor your blood glucose levels closely, so you can adjust your insulin, other medication and food intake. You may need to eat frequent smaller meals a day to avoid hypos (hypoglycaemia or low blood glucose levels) and peaks in blood glucose levels.
• Even with excellent control, diabetic mothers tend to have larger than average babies. Good blood glucose control will help limit how large your baby grows, making birth easier and reducing the risk of complications.

Babies can have a hypo after birth

Your baby will be prone to hypoglycaemia (low blood glucose levels) during the first 12 hours after birth, particularly if you have poor blood glucose control in pregnancy. 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 breastfeeding will help avoid problems. Wherever you give birth, there should be a policy for testing blood glucose levels and treating a baby’s hypo. Your colostrum (first milk) is the best food for your baby if he has a hypo.

Antenatal expression of colostrum

In the last few weeks of pregnancy you can express some colostrum (early milk). This can be given to your baby if he can’t breastfeed after birth, or he needs supplements for any reason eg hypoglycaemia. Our information sheet Antenatal Expression of Colostrum explains how to do this before birth so you have some of your milk immediately available for your baby should he need any supplement.

Get breastfeeding off to a good start

The first few days
For many mothers with diabetes, milk ‘comes in’ later than for mothers who don’t have diabetes. You can help your milk production increase normally on the third or fourth day with good control of blood glucose. Fluctuations in insulin levels will affect milk production, and increase the risk of your baby needing supplements. Get skilled breastfeeding help sooner rather than later to reduce the need for supplements. Your baby will need to stay in hospital for at least 24 hours after birth, until he is feeding well and maintaining blood glucose levels.

Breastfeeding basics
• Hold your baby against your skin after birth so he can breastfeed as soon as possible.
• Keep your baby with you unless separation is medically necessary.
• Breastfeed frequently, at least 8–12 times in 24 hours.
• Spend as much time as you can in close contact—your baby will be encouraged to breastfeed often and this will help your milk ‘come in’ or increase normally.

Separation and supplements
Take action if you and your baby are separated or if your baby needs supplements for any reason.
• Hand express small amounts of colostrum frequently to give to your baby. This will also help you establish milk production.
• Once you can express larger amounts, you can use a hospital-grade pump.
• Your baby can be given your milk with a syringe, cup or spoon.

Being separated from your new baby will be hard for you. As soon as you can, spend as much time as possible with him to help make up for lost time. Even visiting him in the neonatal intensive care (NICU) or special care baby unit (SCBU) will help, as you will be able to touch, stroke and talk to him and take over some of his care. You can ask to give him kangaroo mother care, in which a baby is snuggled skin-to-skin against mum’s chest. Kangaroo care helps to stabilise a baby’s heartbeat, temperature and breathing, and encourages breastfeeding. The hormones produced will help you express your milk, even if you can’t breastfeed straight away.

Look after yourself

After birth
Be aware that your blood glucose levels can change rapidly and you are at increased risk of having a hypo. Take suitable snacks into hospital so you have something readily available —and watch out for early signs of hypos. You’ll have to manage your own health while caring for your baby.

Keep suitable snacks and drinks within arms reach in all the places you are likely to breastfeed your baby to treat hypos at the first signs. Many women have a favourite chair to sit in whilst they breastfeed their baby. It can be especially inconvenient to have a content baby feeding or sleeping and need a hypo remedy which is just out or reach or in another room. Some mums like to keep low/no carb snacks with a bottle of water by their seat as well as their hypo remedy. It can be helpful to not have to inject while holding a feeding/sleeping/wriggling baby. Or for those times when you leave your insulin in the other room!

Take up offers of practical help with household jobs so you can concentrate on caring for yourself and your baby.
Seek skilled help straight away if you experience sore nipples or breasts, to reduce the risk of an infection. Be aware that thrush can also infect the nipple area, causing itchiness and pain. You are more at risk of this if you have diabetes. There may be so much to take in during the first few days you might find it hard to remember everything. It can help to ask for important points to be repeated or written down.

Adjusting your diet

Breastfeeding helps your body adjust gradually to the metabolic and hormonal changes all mothers experience after birth. Monitoring your blood glucose levels, consulting with your diabetic support team and adjusting your diet and medication will all help you to readjust your blood glucose levels. You may need to eat as many as 400 extra calories a day while breastfeeding, eating regularly to maintain blood sugar levels. This will allow you to use your fat stores without the risk of ketones in your blood and urine.

Further support
You can contact an LLL Leader by calling our Helpline. You may also find it helpful to meet with other mothers at your local LLL group. You will be able to share practical tips on breastfeeding and mothering and find out what is normal for a breastfed baby.

Written by Karen Butler and mothers of LLLGB

Further Reading
Positioning & attachment
Positioning & Attachment (Kindle publication)
Antenatal Expression of Colostrum
Birth & Breastfeeding
Beginning Breastfeeding
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk?
Jaundice in Healthy Newborns
My Baby Won’t Breastfeed
Sleepy Baby – why and what to do
Thrush
Skin-to-skin

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing 2010.

Benefits of skin-to-skin contact www.kangaroomothercare.com

References
Cox, SG. An ethical dilemma: should recommending antenatal expressing and storing of colostrum continue? Breastfeeding Review 2010; 18(3):5–7. http://pages.ca.inter.net/~jfisher/docs/ Ethical_BFR_-Sue_Cox.pdf Cox, S.

Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review Nov 2006. Oscroft, R.

Antenatal expression of colostrum. Pract Midwife 2001;4 (4): 32–5.

NICE Clinical Guideline 63: Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. National Collaborating Centre for Women’s and Children’s Health March 2008 (revised reprint July 2008): www.nice.org.uk/CG063

You can buy this information in printed form from our shop

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