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.
There are 3 types of diabetes: Insulin Dependent Diabetes Mellitus (IDDM, Type I, or Juvenile Onset Diabetes), which usually has its onset prior to age 25 years, results in absolute insulin deficiency; Non-Insulin Dependent Diabetes Mellitus (NIDDM, or Type II), occurs predominantly in adults where the insulin produced is sufficient to prevent ketoacidosis but it is insufficient to meet the total body needs; and Gestational Diabetes Mellitus (GDM/GCI, or a metabolic stress of pregnancy resulting in reversible carbohydrate intolerance). 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
- lowers your insulin need
Note: Most of what is discussed in this section pertains to women with pre-existing, not gestational diabetes. Once Gestational Diabetics have delivered, they get routine post partum care and are treated as if they are "cured" unless their 6- to 8-week post partum Glucose Tolerance Test proves otherwise.
Before 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 proper snack in your bag when you go out, as well.
It is also important to choose a pediatrician prior to your baby's birth 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 to be supplemented 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 Baby Arrives
It is possible that your baby will have to be monitored in a Neonatal Intensive Care Unit (NICU). If supplementation is necessary, request that the baby be fed your expressed colostrum before formula is given. The formula that most hospitals use actually increases the risk for a baby to get diabetes. If formula is necessary because your colostrum or expressed milk is insufficient, you should request that they use hypoallergenic formula (Nutramigen, Alimentum) instead of standard issue.
Hold your baby skin-to-skin to keep him warm, to interest him in breastfeeding, and to avoid crying. Separation of a dyad can drop blood sugar levels in the baby. Skin-to-skin contact maintains those 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 are able to after delivery and quite often. You want to begin to stimulate your milk supply 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 observe for hunger cues and stay relaxed and focused. He will learn. Remember to observe 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 (Often called "super-switch nursing" -- 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 3 other snacks during each day of your stay. If not, ask a support person to bring something to you.
Don't be surprised if your milk has not come in by Day 3 as having diabetes may slow milk production slightly. 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 breastfeeding, keeping in mind that their levels will vary irregularly 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.