Breastfeeding with Diabetes

I have type 1 diabetes. How does this affect breastfeeding?

Being informed how a medical condition could affect breastfeeding is so important. A woman with any type of diabetes can successfully breastfeed her baby.

Important Facts:

• Insulin plays a role in milk production. 
• Diabetes of any type is not transmitted through breastfeeding. 
• A mother taking insulin will not have an affect on baby. Insulin molecules do not pass into the breast milk.
• Diabetes is associated with a delay of the mature milk “coming in,” which usually occurs 3 days after delivery. Diabetic moms may not see this increase in volume until day 4. 
• Colostrum has countless benefits to babies and is usually all that is needed until the mature milk comes in.

Breastfeeding Benefits:

Breastfeeding benefits moms with diabetes and their babies! The longer and more exclusively moms breastfeed, the greater the benefit for both of them. Listed below are benefits specifically related to diabetes. (For a list of other benefits, see the image at the bottom of this article!)

For Moms: 

• • Increases insulin sensitivity, which leads to better health outcomes in breastfeeding moms. 
  • Causes sugars to be more controlled, which results in less insulin (about 27-50% less) being needed. 
  • Some breastfeeding moms report feeling better while they are breastfeeding, but there are also long-term positive effects on the metabolism for years after breastfeeding has ended. 
  • Breastfeeding helps with weight loss, delays the return of the menstrual cycle and promotes relaxation. The reduction in these stressors supports blood sugar levels too.

For Babies:

• • Reduces risk of developing type 2 diabetes later in life. The longer a baby is breastfed, the more their risk decreases.
  • Decreases chance of becoming overweight or obese as they age.

Digging Deeper:

Things to Consider Prenatally
After Delivery
If Baby Has Low Blood Sugar
Looking Ahead

Things to Consider Prenatally:

1.  Do you notice breast changes?
Changes are a good sign you will be able to breastfeed.

• • Growth
  • Tenderness
  • Darkening/enlarging of nipples & areolas
  • Darkened blue veins showing near the surface of the breasts
  • Nipples stick out more
  • Small bumps on the areolas (Montgomery Glands) become more noticeable
    

2.  Is your diabetes well controlled? 
Keeping blood sugar levels in a healthy range is vital to you and your baby’s health. There are benefits to milk production when blood sugars are in a healthy range. Most diabetes medications are safe to use while pregnant and breastfeeding. Work with your doctor to manage your diabetes, and inform them that you plan to breastfeed.

3.  Is it safe for you to hand express colostrum during your pregnancy? 
With your doctor's approval and guidance, you may be able to collect colostrum during pregnancy to supplement your baby after birth. Offering extra colostrum to your baby after breastfeeding can be beneficial, but it’s important that it doesn’t replace breastfeeding itself, which is key to maintaining future milk supply.

Do not attempt to express colostrum if:

• • • You have not gotten approval from your doctor
    • Your pregnancy is considered high risk
    • You are less than 36 weeks gestation

Collect colostrum through hand expression only- NO PUMPING. Expressing without the approval of your doctor puts you and baby at risk for preterm labor.

4.  What breastfeeding classes are available in your area?
For information on Zoom classes available through the Breastfeeding Peer Counselor Program, click here.

5.  Do you have a breastfeeding plan?
Preparing for your hospital stay, researching best practices for successful breastfeeding, and clearly communicating your wishes to both your support person and the hospital staff are essential. Click here for recommendations and a printable breastfeeding plan to share with the hospital staff.

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After Delivery:

Babies whose moms have diabetes are at greater risk for low blood sugar after birth. It’s very important to breastfeed EARLY and OFTEN. 

1.  Skin-to-skin contact immediately after birth offers many benefits. 
It stabilizes baby’s blood sugar levels! Uninterrupted skin-to-skin contact will also stimulate baby’s natural instinct to find the breast and latch. Colostrum (1st milk) is very effective at stabilizing baby’s blood sugar levels too.

2.  Nursing 8-12 times in 24 hours, while baby has a good, deep latch decreases the risk of delayed mature milk production. 
Delaying or limiting the first breastfeeding sessions can further postpone the milk from “coming in.”

If supplementation is needed, these are the alternative options:

1. 1. 1. Mother’s own colostrum, which is most effectively collected using hand expression.
      2. Pasteurized donor milk.
      3. Formula, if medically necessary.

To ensure breastfeeding is not affected, and a preference to a bottle nipple is not developed, consider giving supplements to baby using an alternative feeding method. Ask a lactation consultant about a supplemental nursing system that allows baby to suckle at the breast while receiving supplementation through a tube inserted into their mouth.

3.  During the first 5-7 hours after delivery, most moms (regardless of a diabetes diagnosis) experience low blood sugars. 
This is due to the rapid hormonal changes, which require the body to adjust.

Tips in the hospital and at home:

• • • Eat a snack before or while breastfeeding.
    • Keep something nearby to quickly boost your blood sugar if necessary.
    • Stay well-hydrated by drinking plenty of fluids.
    • Monitor your blood sugar levels before and after nursing.

4.  Add hand expression sessions.  
This will stimulate milk production and should be done in addition to regular feedings at the breast.

5.  Ask the nurse for baby’s 24-hour weight.  
This is more accurate to use when determining the percentage of weight loss. It’s normal for all newborns to lose weight after birth. Babies born to mothers with diabetes may be slower to regain their birth weight, due to fluids that need to be eliminated and factors related to the mother's abnormal blood sugar levels. Be sure to keep follow-up appointments with your baby’s doctor to monitor their growth.

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If Baby Has Low Blood Sugar:

1.  During the first 1-2 hours after birth, low blood sugar levels are common and occur in almost all babies.  
In healthy, full-term infants, low blood sugar is usually not a problem. While in the womb, baby is fully dependent on their mother for glucose. After delivery, because they are no longer receiving glucose through the umbilical cord, their blood sugar falls rapidly.

2.  Baby’s blood sugar should rise and stabilize by 3 hours after birth.  
They continue to rise up to 24 hours, and by 2-4 days, an infant’s blood sugar level is the same as an older child or adult.

3.  Because colostrum is so rich in nutrients, vitamins, antibodies, antioxidants, protein and growth factors, it is all baby needs for the first few days of life.
Studies show colostrum does a better job at stabilizing baby’s blood sugar levels than formula, resulting in less transfers to the NICU for more advanced interventions.

4.  Formula may be unnecessary. 
If supplementation is needed, work with hospital staff on the best way to continue breastfeeding, and come up with ways that don’t interfere/interrupt breastfeeding. To ensure breastfeeding is not affected, and a preference to a bottle nipple is not developed, consider giving supplements to baby using an alternative feeding method. Ask a lactation consultant about a supplemental nursing system that allows baby to suckle at the breast while receiving supplementation through a tube inserted into their mouth.

How it’s treated:
Your doctor will determine whether baby needs treatment for low blood sugar.

• • • Glucose gel (usually a better option than sugar water), along with breastfeeding and skin-to-skin contact, is the best option to try first. Studies show that this is the most effective treatment for stabilizing/maintaining baby’s blood sugar levels.
    • Being close to mom reduces infant stress. Stress hormones can cause baby’s blood sugar to go even lower. Room-in with baby during your hospital stay. Consider delaying baby’s first bath for at least 12 hours, as this can be another stressor for a newborn.

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Looking Ahead

1.  There are many benefits to long-term breastfeeding.
When a mother’s blood sugars are stable, long-term milk production is not a problem.

2.  When you’re ready to wean in the future, it is suggested to wean very gradually.
This will help maintain healthy blood sugar levels, while abruptly weaning can negatively impact blood sugars.

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Although breastfeeding with diabetes may present some challenges, being informed about potential issues increases your ability to overcome them. Breastfeeding and breast milk are essential to both your and your baby’s well-being! Reach out to your peer counselor for support. We can connect you with our breastfeeding specialist (IBCLC) for additional help.

SOURCES:
Mohrbacher, N. (2020). Breastfeeding Answers: A Guide for Helping Families (2nd Ed.) p. 199, 214, 409, 843-849
Marasco, L., West, D. (2020). Making More Milk (2nd Ed.) p. 154-158
Wight, N. E. (2021) ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021. Breastfeeding Medicine, 16(5), 1-13.
Stanford Medicine Children’s Health “Hypoglycemia in a Newborn Baby” 2022. https://www.stanfordchildrens.org/en/topic/default?id=hypoglycemia-in-the-newborn-90-P01961 
Newman, J., & Polokova, A. (2022). What Doctors Don’t Know About Breastfeeding. Praeclarus Press. 63-68. 
https://diatribe.org/lifestyle/breastfeeding-diabetes-benefits-challenges-and-recommendations 
https://www.sth.nhs.uk/clientfiles/File/pd3058_BreastFeedingMothersWithDiabetes[1].pdf