Breastfeeding

Breastfeeding with diabetes

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As a mom to be, we all want what is best for our baby. There is a huge amount of research that shows breastfeeding is best for baby and for mom. But, is this true when it comes to a mommy who is living with diabetes? The good news is, absolutely! 

Firstly, we know that breastfeeding can reduce the risk of the baby developing diabetes, as well as less likely to be overweight later in life.1It has been shown that breastfeeding protects against both Type 1 and Type 2 diabetes.2,3 Breastfeeding is also thought to play a role in reducing the risk of a mom developing Type 2 diabetes later in life.1

However, a mom already living with diabetes may be concerned that she may face different challenges when it comes to breastfeeding.

Mothers with gestational diabetes

When a mom develops diabetes during pregnancy (known as gestational diabetes mellitus), the impact can be a delay in her mature milk (growing milk baby needs until the day they wean) coming in.4 Under normal circumstances the mature milk comes in on day three. However, a mom who has developed gestational diabetes – her mature milk may only come in on day five to seven.

This means that baby gets colostrum (first stage of breast milk) for the extra few days, resulting in baby feeding often, or not settling after feeding. Although colostrum contains many nutrients, it isn’t really growing milk and some babies on colostrum will lose weight. Up to 10% weight loss is considered normal. Because of this, parents introduce formula top-up which can further delay the mature milk coming in. Formula top-ups can also result in lower milk supply long-term.

  • Differences in colostrum and mature milk

Mature milk and colostrum differ in the nutrient content. Colostrum being higher in fat and certain minerals whereas mature milk has a higher carbohydrate percentage. Colostrum comes in very small volumes with baby needing only about 5ml a feed whereas mature milk is found in much greater volumes.

On day 3, when the mature milk comes in, baby needs about 30ml per feed. However, a baby getting colostrum at this stage won’t be getting this volume from the breast. So, they don’t fill their tummy as easily. These babies need to eat more often to keep their tummy full on the smaller volume of colostrum.

Your body will provide what baby needs with slightly more frequent feeds and a mom who is aware of this will be happy to give baby the extra feeds needed. A mom not aware of this change may feel she is not making enough milk for her baby and may be tempted to give formula top-up. Working with a lactation consultant at this stage can help give mom peace of mind and a plan to ensure baby receives enough breast milk.

  • Caesarean section

Another challenge we see with moms who have gestational diabetes is that they are more likely to need a caesarean section birth. This can cause delays in initiating breastfeeding and contribute to a delay in the milk coming in. The good news is that this isn’t always the case, but it is important to be aware that it may happen.

To help with milk supply, mommy needs to feed baby often after birth, about every 2 – 3 hours. This will also help with the other challenge we find with baby after the birth if a mom has gestational diabetes: hypoglycaemia (low glucose levels).5

Feeding often will help to keep baby’s blood glucose levels up. When we look at a mom who had gestational diabetes, her post-birth glucose levels stabilise, and breastfeeding has an additional benefit in that it can help prevent the onset of Type 2 diabetes later in life. This is a known risk factor of gestational diabetes.6,7

Mothers with Type 2 diabetes

Studies have shown that mothers with Type 2 diabetes are more likely to experience low milk supply or at least a delay in increased milk volume.8 This is because insulin plays a role in milk metabolism.5,9

Breastfeeding, however, may help to stabilise a mom’s blood glucose levels. Mothers with Type 2 diabetes may be able to reduce their hypoglycaemic medication while breastfeeding. Most medication required to treat Type 2 diabetes is safe to take while breastfeeding.8

To be certain though, discuss this with your healthcare providers before your baby is born. Moms do need to monitor their glucose levels closely to start with, as breastfeeding can reduce maternal glucose levels which may in turn lead to mom experiencing hypoglycaemia.5As with gestational diabetes, we do find a delay in the onset of mature milk in moms living with Type 2 and Type 1 diabetes.10

Mothers with Type 1 diabetes

Breastfeeding rates in moms with Type 1 diabetes have been shown to be lower. The reasons are usually related to caesarean birth; delay in initiation of breastfeeding; and babies being born earlier in the pregnancy.

Earlier birth dates are associated with challenges with sucking coordination and latching issues.10 However, breastfeeding can assist in stabilising glucose levels in moms with Type 1 diabetes. These moms can then reduce the amount of insulin they are using.11

Managing milk supply with galactagogues

When looking at managing milk supply, many moms want to take medication to increase their milk supply. This is especially common when the milk is delayed as with diabetes. This medication is known as a galactagogue and it may be medical or natural.

Moms living with diabetes need to be particularly careful about taking galactagogues, unless guided by a healthcare provider. Many of the natural forms are readily recommended and easily available. However, some of them can impact a mom’s blood glucose levels.

Goat’s rue is an herbal medication used to increase milk supply, but it is also used to lower blood glucose levels. It may present as a benefit to moms living with Type 2 diabetes, but moms living with Type 1 diabetes should not use it. 12,13

Likewise, fenugreek, milk thistle and alfalfa to name a few have been used to increase milk supply and are also associated with reducing glucose levels. 14,15,16,17 It is strongly recommended that moms consult with their healthcare providers before taking any form of natural supplements to increase milk supply.

Lactation consultant

Working with a lactation consultant is important to rule out any other underlying issues that may cause low supply, such as a poor latch. Lactation consultants can also guide mothers with practical steps she can take to increase her milk supply, as well as assist in making sure baby is exclusively breastfed. Most importantly, moms living with diabetes can breastfeed and will reap the rewards of doing so.

References

  1. Erica P Gunderson. Breastfeeding and diabetes: Long-term impact on mothers and their infants. 2008 Aug: 8(4): 279-286 [NCBI]
  2. Gouveri E, Papanas N, Hatzitolios Al, Maltezos E. Breastfeeding and diabetes. Curr Diabetes Rev 2011 Mar; 7(2):135-42 [PubMed]
  3. Stage E, Hogardd H, Damm P, Mathiesen E. 2006. Long-term Breast-feeding in women with type 1 diabetes. Diabetes care 2006 Apr; 29(4): 771-774
  4. Wallenborn JT, Perera RA, Masho SW. Breastfeeding after gestational diabetes: Does perceived benefits mediate the relationship
  5. Diabetes and breastfeeding. https://www.laleche.org.uk/diabetes-and-breastfeeding/#gestational
  6. Diabetes and breastfeeding: what to know. https://www.webmd.com/diabetes/breastfeeding-and-diabetes#1
  7. Wein, H. Breastfeeding may help prevent type 2 diabetes after gestational diabetes. 2015. NIH research matters. National Institute of Health.
  8. Thursday’s tip: Breastfeeding if you are Diabetic or Insulin resistant. 2015. https://www.lllc.ca/thursdays-tip-breastfeeding-if-you-are-diabetic-or-insulin-resistant
  9. Factors leading to diabetes may contribute to milk supply problems for new mothers. 2014. https://www.sciencedaily.com/releases/2014/05/140505211037.htm
  10. Sparud-Lundin C, Weenergren M, Elfvin A, Berg M. 2011. Breastfeeding in women with type 1 diabetes. Diabetes Care 2011 Feb; 34(20): 296-301
  11. Breastfeeding with type 1 Diabetes. https://beyondtype1.org/breastfeeding-type-1-diabetes/
  12. Using Goats rue to increase your milk supply. Very well family. https://www.verywellfamily.com/goats-rue-and-increasing-the-supply-of-breast-milk-431841
  13. Goat’s rue. Drugs.com. https://www.drugs.com/npp/goat-s-rue.html
  14. Fenugreek and Diabetes. https://www.diabetes.co.uk/natural-therapies/fenugreek.html
  15. Ranade M, Mudgalkar N. 2017. A simple dietary addition of fenugreek seed leads to the reduction in blood glucose levels: A parallel group, randomized single blind trial. Journal List Ayu v.38(1-2); Jan-Jun 2017 PMC5954247
  16. Kazazis CE, Evangelopoulos AA, Kollas A, The therapeutic potential of milk thistle in diabetes. 2014. Rev Diabet Stud. 2014 Summer; 11(2): 167–174. Published online 2014 Aug 10. doi: 10.1900/RDS.2014.11.167
  17. Amraie E, Farsani MK, Sadeghi L, Khan TN, Babadi VY, Adavi Z. 2015. The effects of aqueous extract of alfalfa on blood glucose and lipids in alloxan-induced diabetic rats. Interv Med Appl Sci. 2015 Sep; 7(3): 124-128.
Laura Sayce

MEET OUR EXPERT

Laura Sayce is a certified lactation consultant (IBCLC) and doula in private practice. She is also the mom of two gorgeous girls. With both personal and professional experience, Laura has a passion to help moms meet their breastfeeding goals. She has been working in the birth and breastfeeding industry for 11 years.

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