Category: 2019 Winter – Diabetes Focus eMag

Vaccines

Vaccines – pneumococcal and influenza

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Dr Louise Johnson educates us on winter vaccines – pneumococcal and influenza – for people living with diabetes.

What is pneumococcal disease?

Pneumococcal disease is caused by the bacterium Streptococcus pneumonia (S. pneumonia). This can cause infection in the respiratory tract i.e. lung, sinus or ears.

In vulnerable people, such as children, the elderly, and people living with diabetes, these bacteria can invade the bloodstream and cause meningitis and septicaemia. This may lead to deafness, mental disability and even death. People at extreme ages (younger than two years or older than 65 years) are particularly susceptible to the complications because of their underdeveloped immune system or aging immune system.

Pneumococcal bacteria are spread from person to person through close contact with respiratory secretions (sputum or saliva).

Why immunise?

It is estimated that immunisation approximately prevents 2,5 million deaths a year due to infections. It is also cost-effective to the health system and has saved more lives than the development of antibiotics.1

Antibiotic-resistance is a reality, and resistance to commonly used antibiotics is becoming a serious threat to medical treatment of infections.

In the age of antibiotic-resistant bugs, the prevention of disease through vaccines has become essential. It not only helps prevent infections in vaccinated people, but also prevents a “herd immunity” by helping to prevent transmission of the bug to close contacts of the sick patient.

Types of vaccines:

There are two different types of pneumococcal vaccines available:

  1. PPV23 (Pneumovax 23)

Pneumococcal polysaccharide vaccine is made from polysaccharide (sugar like) capsule of 23 different strains of S. pneumonia.

This capsule is the main target of the body’s immune response during pneumococcal infection. The body produces antibodies when exposed to the capsule (acts like an antigen).

The next time the immune system is exposed to the same antigen, the immune system is prepared and can rapidly produce killing-antibodies. This is due to the body having a “memory” of the antigen via specially produced immune memory B-cells.

Children younger than two years of age have an immature immune system and cannot produce memory cells to the capsule. Therefore, they should not get this vaccine.

  1. PCV13 (Prevenar 13)

Pneumococcal conjugate vaccine is like PPSV23. Though, a protein that induces memory cells, even in young children, joins the capsular polysaccharide.

Who should be vaccinated with which vaccines?

Pneumovax 23:

Persons older than 65 years.

People older than two years with chronic heart and lung disorders, diabetes, chronic liver disease, COPD, alcoholism, spleen dysfunction, asplenia (spleen removed), cancer, organ transplantation, HIV infection and smokers.

Prevenar 13:

Children aged: six weeks, four months, and 12 months.

Children with underlying medical conditions should get an extra dose at six months. This is part of the South African Immunisation Programme.

How to vaccinate?

South African guidelines to CAP (community acquired pneumonia)2

Vaccination is the key pillar of antibiotic stewardship.

  • All patients older than 50 years who are vaccine naïve should receive a single-dose of PCV13.
  • Every adult older than 50 years who have received PPV23 should receive a single-dose of PCV13 one year later.
  • All adults older than 65 years of age who are vaccine naïve should receive a single-dose of PCV13, followed a year later by PPV23.
  • Every adult older than 65 years of age who have received PPV23, should receive a single-dose of PCV13 at least one year later.
  • Younger adults (>18 year) who are vaccine naïve with severe underlying comorbid or immunocompromising conditions, including HIV infection, should receive a single-dose of PCV13, followed at least two months later by PPV23.
  • Younger adults (> 18 years) who have previously received PPV23 and have severe underlying comorbid or immunocompromising conditions, including HIV infection should receive a single-dose of PCV13 one year later.
  • All women who are pregnant in the period of influenza vaccine availability, should be offered vaccination with influenza vaccination of that year.
  • Adults older than 65 years of age should receive the annual vaccination for influenza.
  • Individuals with chronic diseases (diabetes, lung disease, heart disease, HIV infected individuals and morbidly obese (BMI>40kg/m2) are at high risk and should be vaccinated.
  • All healthcare workers should be offered annual influenza vaccination.

Who should not be vaccinated?

Pneumovax 23 should not be given to children younger than two years. Hypersensitivity to the products in the vaccine.

What are the side effects of the pneumococcal vaccine?

Side effects are very uncommon. Local side effects to the injected area: redness, soreness, or rash. Also fatigue, headache, chills and diffuse achiness.

What is influenza?

Influenza (also known as flu) kills between 6 000 and 11 000 South Africans per year. These deaths are 50% in the elderly and 30% in HIV infected people.

The highest rate of hospitalisation is in people older than 65 years of age, HIV-infected people, and children less than five years of age.

Patients with chronic diseases, such as diabetes, heart and lung disease and tuberculosis are also at higher risk of contracting influenza.3

Flu is a virus and is spread from person to person. It causes many different symptoms from headache, fatigue, muscle pain, shivers, vomiting and diarrhoea.

It spreads mainly by droplets when people cough, sneeze, or talk. You can also get flu by touching a surface or object that has flu virus on it and then touching your mouth, eyes or nose.

What is in the flu vaccine?

The flu vaccine contains three different types of inactivated flu viruses. This mean the virus is dead and can’t make you sick. The viruses in the flu injection are named for the year they were found and the place they were found. This year’s vaccine (2019) was updated with two new viruses. The current vaccine contains:

  1. A/California/7/2009(H1N1) pdm09 like virus
  2. A/HongKong/4801/2014(H3N2) like virus
  3. B/Brisbane/60/2008 like virus

Who should get the flu vaccine?

  • Pregnant and post-partum women (anytime during pregnancy).
  • People who are infected with HIV.
  • Healthcare workers.
  • People with chronic diseases (diabetes, lung, heart, kidney, liver, etc.)
  • People older than 65 years of age.
  • Residents of old age homes, chronic care and rehabilitation centres.
  • Children older than six months.
  • Adults and children in close contact with high-risk individuals.
  • Anyone wishing to reduce the risk of getting flu or spreading flu to others.

Who should not get the vaccine?

Anyone who had a severe allergic reaction to the vaccine, such as drop in blood pressure and difficulty in breathing.

Can I get the flu vaccine when I am sick?

Yes. You are safe to get the vaccine with mild cold or flu-like symptoms even if you have a fever. Though, if you are very ill (need to be admitted to a hospital) you should rather wait.

How effective is the flu vaccine?

The flu vaccine prevents only influenza and no other viruses. It is 60% effective in healthy individuals. The elderly and children younger than two years may not respond as well due to weaker immune system.4

Therefore, when looking at the bigger picture of population and personal health: be wise and vaccinate.

References:

  1. Plotkin SA, Mortimer E.A, Vaccines 2ndedition, Philadelphia:Wb Saunders, 1994
  2. J Thorac Dis 2017; 9 (6):1469-1502
  3. (nicd.ac.za) (www.cdc.gov/flu)
Dr Louise Johnson

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Dr Louise Loot is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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donate blood

Can people living with diabetes donate blood?

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National Blood Donor Month was in June; with that we chat to Dr Nolubabalo Makiwane, from the South African National Blood Services (SANBS) about whether people living with diabetes can donate blood.

  1. Can diabetes patients using insulin (injection or pump) donate blood?

Yes, we accept donors who are using insulin to control their diabetes. Both those using injections or pumps. The most important factor is that their diabetes must be controlled and they must be well on the day they present to donate.

Insulin users should also not have any skin complications associated with using injections/pumps. We won’t allow a donor to donate blood, if they have a skin infection at the injection site, for example.

  1. Can diabetes patients using oral diabetes medication donate blood?

Yes, persons using oral medications and diet to control their diabetes are welcome to donate. Again, their diabetes must be well-controlled and they must be well when presenting to donate blood.

Most medication used to treat diabetes are classed as category B drugs. Therefore, are considered safe if one should opt to become a blood donor.

  • Understanding the categories of medication

Medications are assigned to five letter categories based on their level of risk to foetal outcomes in pregnancy. It can give one a good idea on the level of safety of a drug at a glance. This is of importance in transfusion as a fair percentage of SANBS blood products are used by pregnant women, women in labour or who are post-partum, and, of course, we also supply blood products for use in babies and children.

So, category A is the safest category of drugs to take. Category B medications are medications that are used routinely and safely during pregnancy. The C and D category drugs have shown positive evidence of human foetal risk but potential benefits of the drug may warrant use in pregnant women. Category X is never to be used in pregnancy. This is a classification based on the safety of a drug in pregnancy and lactation.

Pregnancy Category

Description
A No risk in controlled human studies: Adequate and well-controlled human studies have failed to demonstrate a risk to the foetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
B No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the foetus in any trimester.
C Risk not ruled out: Animal reproduction studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
D Positive evidence of risk: There is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
X Contraindicated in pregnancy: Studies in animals or humans have demonstrated foetal abnormalities and/or there is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
N FDA has not yet classified the drug into a specified pregnancy category.

  1. What are the medications that if taken, a person can’t donate blood?

Generally, SANBS doesn’t accept donors who are using medication that is classified as teratogenic. These drugs would fall into category X. These medications are known to cause malformations in unborn babies, or miscarriages. These include a lot of dermatological agents, like Roaccutane, Neotigason and etretinate.

Some anticonvulsant medication has been found to have teratogenic effects, such as valproic acid, phenytoin and phenobarbitone.

Some antibiotics and male hormonal medications are also classed as teratogenic. The list of teratogenics is, of course, much longer than this. However, what is of note is that there are no hypoglycaemic agents listed as teratogenic.

  1. Diabetes, unfortunately, has many side effects, such as heart problems, neuropathy, slow-healing, etc. Will any of these side effects stop people living with diabetes from donating blood?

Most definitely. If donors are people living with diabetes and they develop a complication due to their diabetes, we defer them until the complications are resolved, and until good control of the donors’ blood glucose level is re-established.

Persons who suffer from a hypoglycaemic coma (due to low blood glucose levels) are deferred for four months from the time of the episode. This is to ensure that their glucose control is adequate.

SANBS also doesn’t accept donors who develop diabetes as a complication of another disease process. For example, a donor who develops diabetes as a complication of acromegaly (a disorder caused by excessive production of growth hormone by the pituitary gland and marked especially by progressive enlargement of hands, feet, and face) would not be accepted for the procedure.

  1. Does SANBS encourage people living with diabetes to donate blood?

We encourage people living with diabetes to donate blood only if they are well enough to tolerate the procedures. At SANBS, the health of our donors is of very high importance. We do not collect blood from a donor if it would be detrimental to the health of the donor at all. This applies to our diabetic donors, even more so as they are at a slightly increased risk of developing infections and other complications.

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Dr Nolubabalo Makiwane is a registered medical practitioner working in the transfusion medicine field. She is part of the medical team at the SANBS where she works to ensure that donor care is at its best.

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CBD regulation

Change in CBD regulation in South Africa

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Regulatory experts at Webber Wentzel educate us on the recent change in CBD regulation: if CBD products contain less than 20mg for a daily dose, they will be considered over the counter products.

Constitutional Court ruling

Since the Constitutional Court, in September 2018, effectively decriminalised the possession, use and cultivation of cannabis in private dwellings in South Africa, there has been a rapid surge of cannabidiol (CBD)-containing products on the South African market.

CBD is an active non-psychoactive ingredient within cannabis which cannot make users of the product “high” as is the case with THC. THC is the other ingredient found within cannabis. The reported therapeutic benefits of CBD have resulted in it being featured in products, ranging from wellness, to dog treats and even in your morning smoothie.

The surge in CBD products was also spurred on by the uncertain and difficult regulatory regime that suppliers and distributers found themselves navigating.

Change in CBD regulation: from scheduled substance to OTC

CBD was considered a scheduled substance in terms of the schedules to the Medicines Act. This meant that products that contained CBD and were intended for therapeutic purposes could only be sold by pharmacists to consumers who held a prescription. This view was emphatically publicised by the South African Health Products Regulatory Authority (SAHPRA) in the media.

The Department of Health has since made a turnaround, by creating a significant space for CBD products to be sold to consumers. As of 23 May 2019, all products that contain a maximum daily dose of 20 mg of CBD, and are intended for general health enhancement or relief, are exempted from the operation of the schedules to the Medicines Act.

Arguably, products that fall within this threshold that are intended for therapeutic uses may still be required to register as complementary medicines with SAHPRA. But, once registered, will be capable of being sold directly to a consumer. In other words, CBD products which contain less than 20mg for a daily dose will be considered over the counter (OTC) products and may be sold openly in pharmacies, wellness stores and other outlets.

All products that contain a daily dose of more than 20mg of CBD will still be considered a scheduled substance in schedule 4 of the Medicines Act and would require a prescription to be sold.

Implications for commercial use of new CBD regulation

Notably, all processed products that contain naturally occurring CBD and THC (provided that no more than 0,0075% of the product contains CBD and not more than 0,001% of the product contains THC) may now be sold to consumers without any restrictions.

This change in the CBD regulations has implications for the commercial use of CBD in the manufacture of other products, including foodstuffs and alcohol. Before the recent amendment, consumer products, such as beer brewed from hemp seeds; hemp seed protein; hemp cooking oil; and even flax seeds were classified as scheduled substances by the authorities due the presence of trace amounts of CBD in these products.

The Department of Health’s announcement changes the legal status of these products and removes them from the strict regulation of the Medicines Act. These products may still, however, be subject to other regulatory regimes that govern foodstuffs and liquor.

These changes in the CBD regulations are exciting to the consumer sector and are music to the ears of suppliers of CBD products giving them scope to introduce their products into South Africa more easily. It will be interesting to keep an eye on SAHPRA’s attitude to the changes given that they will no doubt be flooded with registration applications in the coming months.

Exemption applies for one year only

While these changes signify the Department of Health’s relaxation of the regulation of CBD, the exemption applies for one year only. This signals that government is adopting a wait-and-see-approach before committing firmly to a policy position on CBD.

After last year’s Constitutional Court ruling, cannabis will also be squarely on Parliament’s agenda as they have been ordered to make changes to the laws regulating the private use of cannabis. This presents an opportunity for the public’s voices to be heard, not only regarding the private use of cannabis but also in shaping the approach to the commercialisation of cannabis derived products in South Africa going forward.

The recent change to the legal status of CBD, together with the issue of the first three licences to cultivate cannabis for medical use earlier this year by SAHPRA, signals a shifting perspective on the role of cannabis which will hopefully pave the way for the expansion of the cannabis market in South Africa in the near future.

MEET OUR EXPERT

Megan Adderley has experience in judicial review proceedings in the High Courts and litigation relating to municipal powers and functions, providing strategic advice to private sector clients in negotiations with organs of state, preparing and presenting training workshops for local government officials, assisting in drafting the legal aspects of various government policies, advising on co-operative governance responsibilities of various organs of state and conducting due diligence investigations on potential projects and developments. She advises a wide range of clients including all spheres of government and private sector on the administrative and criminal enforcement of environmental, heritage and planning laws. Megan also advises non-profit clients on a wide variety of administrative appeals and reviews, and industry associations on the constitutionality of proposed amendments to legislation.

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Rodney Africa specialises in all matters relating to procurement, local government and general administrative law. He also practices constitutional, public private partnership and general regulatory and compliance law. Rodney has advised clients from both the public and private sectors, and has been involved in various matters relating to procurement, access to information, public decision making, public finance management, the valuation and rating of properties, and all aspects of land use planning and development law. He is an expert in matters involving the public sector and has advised on regulatory matters in a variety of industries. Rodney has extensive experience in litigation in respect of the above areas of law, with a specific focus on judicial review and mandamus applications, tender disputes, interdicts and declaratory relief. He has been a member of the audit committees of various local government departments.

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Deerah Pillay-Lungoomiah focuses on of public and regulatory law, administrative and constitutional law. She also has experience in advising on procurement law related matters. From a regulatory perspective, she has particular expertise in transport, renewables, tourism, tobacco and fishing.

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Adriano Esterhuizen is an expert in procurement, local government law, administrative law and constitutional law. He has extensive experience in dealing with matters relating to property rights, procurement, environmental law, land use planning law, legislation relevant to municipal governance, as well as general statutory and regulatory compliance matters. His services are open to public and private sector clients. He regularly litigates in both the Magistrates’ and High Courts and is able to assist clients with specialist review applications, tender disputes, interdicts and declaratory relief.

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Somogyi effect and dawn phenomenon

Understanding the Somogyi effect and dawn phenomenon

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Diabetes nurse educator, Christine Manga, explains the causes behind elevated fasting blood glucose readings in the morning: Somogyi effect and dawn phenomenon.

Both the Somogyi effect and dawn phenomenon will lead to elevated fasting blood glucose (glucose level after an overnight fast) readings in the morning. The target for fasting blood glucose levels is <= 7mmol/L. This said, the causes are very different.

Dawn phenomenon

The dawn phenomenon occurs in everyone. However, people without diabetes will not notice it because their body is able to counteract the effects. It is caused by natural body changes during sleep.

During the night, less insulin is produced and in the early hours of the morning, hormones, such as cortisol, growth hormone, epinephrine and glucagon, are all released. These hormones all act in the opposite way to insulin, resulting in elevated blood glucose levels.

Towards the early hours of the morning, the body releases stored glucose from the liver into the bloodstream to provide energy for the coming day. This will cause a further rise in blood glucose levels. According to the American Diabetes Association, the dawn phenomenon occurs between 5:00am – 8:00am. The dawn phenomenon is a natural phenomenon.

Somogyi effect

The Somogyi effect is usually management related and is a rebound hyperglycaemia (high blood glucose). It happens in response to a nocturnal hypoglycaemia (low blood glucose).

This hypoglycaemia can be caused by giving too much insulin at night, not having an evening snack, or from doing vigorous exercise in the evening hours. In response to the hypo, the body releases hormones to raise the blood glucose levels. These include cortisol, growth hormone, glucagon and adrenaline. When you wake, you will have elevated fasting blood glucose level.

So, which one do you have: Somogyi effect and dawn phenomenon?

Due to the causes being different, the management will also differ. To establish what is causing your elevated fasting reading, you will need to do some extra blood glucose testing.

Testing your blood glucose levels between 2:00am – 3:00am on a few consecutive nights will give you an answer. If you are experiencing hypos at this time of night, then you are experiencing the Somogyi effect.

If on the other hand, your blood glucose levels are normal at this time, then you are experiencing the dawn phenomenon.

The use of continuous glucose monitoring (CGM) would be extremely useful in detecting the cause of your elevated blood glucose readings. CGM is now becoming more affordable, but definitely is still not cheap. Speak to your doctor about wearing a sensor to assist you in making management decisions.

Prevention

Dawn phenomenon

To prevent the dawn phenomenon, you could:

  • Increase the amount of vigorous physical exercise in the evening hours.
  • Wear an insulin pump to administer extra insulin in the early morning hours. This would work well.
  • Reduce the amount of carbs and evening snacks.
  • Change insulin formulations to more concentrated ones. This can lead to improved fasting blood glucose levels.
  • Administer insulin later at night. This may also be beneficial.
  • There may be a need to change some of your diabetes medications, or possibly even add more.

Somogyi effect

Here are ways to prevent the Somogyi effect from occurring:

  • Reduce the amount of insulin given in the evening.
  • Once again, changing your insulin to a stronger concentration can prevent nocturnal hypos.
  • Giving the insulin earlier may also prove helpful.
  • Getting assistance with carb counting will help you to match the amount of insulin to the amount of carbs you eat, preventing overdosing of insulin.
  • Your doctor may need to assess your medication and reduce, or discontinue some.
  • Try to reduce the amount of vigorous physical activity in the evening.
  • It may also be necessary to have an evening snack before bedtime. The down side to this is that it may cause long-term weight gain.

The most important thing is that you know which one, the dawn phenomenon or the Somogyi effect, is causing your elevated fasting readings. You can only manage what you know.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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highs and lows

Highs and lows of diabetes

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Aiden Nel, a teenager living with Type 1 diabetes, tells us about the highs and lows with diabetes.

The highs and lows of diabetes is a well-known term for any household that houses a person living with diabetes.

How many times have you, as a person living with diabetes, heard, “Is your reading high or low?” from a member of your family or friends. Yes, we have all experienced this at some stage and will continue experiencing it.

Well, the term ‘highs and lows of diabetes’ is not only associated with the blood glucose readings. To me, the highs and lows of diabetes can also be associated with experiences of living with diabetes but have the opposite meaning.

The ‘highs’ of living with diabetes can include the attention and concern that you receive from family and friends. It is a good feeling when your family and friends check on you and show concern. However, a ‘low’ would be when this is overdone and you feel that your family and friends don’t trust you.

Another ‘high’ is that you can control what you eat as a meal. If you don’t like the food that is being served then you can always say that you should not be eating that particular food. (Sneaky I know!)

The ‘low’ is that there are food items that you really want to eat, but these are the food items that you should not eat.

Though, regardless of how we feel about the highs and lows of diabetes, it’s a very important part of living with diabetes. If we are experiencing a high or a low in our readings or experiences, this statement of highs or lows will not change or disappear from our lives. Therefore, embrace this statement and live your life to the fullest.

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Aiden Nel lives in Port Elizabeth. He is 15 years old and has Type 1 diabetes.

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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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