When I began my own breastfeeding with type 1 diabetes journey, I was pleased to find that my milk production came easily, often referring to myself as a Vermont Creamery. And I was relieved to see that I wasn’t going to need nipple shields or nipple lubricants for cracked or bleeding or sore nipples. Nor would I struggle for weeks while my little Lucy figured out how to latch properly. After having her very sturdy tongue-tie snipped when she was two days old, our feedings were mostly effortless, that is, except for their impact on my blood sugar levels.
After I’d spent 9 months aiming for near-perfection, in my first few months postpartum my blood sugar swung between 40 and 200 mg/dL once or twice a day. Perhaps I was too hard on myself and my blood sugars weren’t as wild as I felt they were. They just seemed “awful” in comparison to my tight pregnancy blood sugars. However, since the lows didn’t necessarily correlate with nursing, I often felt like it was just me failing at smooth blood sugar management.
It wasn’t until I stopped breastfeeding 3 months after Lucy was born that I saw just how tremendous an impact breastfeeding (and more specifically: producing milk) had on my blood sugar management—and how much more stable my blood sugar was when I was no longer breastfeeding.
The reality is that every woman is different, and on top of that, every woman’s diabetes is going to be different, too. It’s only natural to assume, then, that every woman’s experience of breastfeeding is also going to be different. But there are some basic facts every woman with diabetes who wants to breastfeed should know. I talked to Jennifer Smith, mother, person with diabetes, CDE & RD, who works with women across the globe via Skype at IntegratedDiabetes, to help you better understand the truth about breastfeeding with type 1 diabetes.
1. Milk production relies heavily on insulin production, so women with type 1 diabetes often have trouble producing enough milk.
“Unless your blood sugars are well over 200 mg/dL for days on end, there’s no reason a woman with type 1 diabetes will have any more difficulty producing breast milk than a non-diabetic woman.” Smith explains, “Diabetic or not, there are certainly women whose bodies struggle to produce enough milk for unknown reasons that are completely out of their control, but in a woman with reasonable well-managed blood sugar levels, diabetes shouldn’t be the problem.”
2. If your blood sugar is higher before you nurse, you’ll have to pump and dump that milk because too much sugar in your breast-milk will be bad for your baby
“Although it isn’t great to have consistently high blood sugars while nursing, breast-milk contains a great deal of sugar to begin with and very little of the sugar in the mother’s bloodstream actually makes its way to the breast-milk,” explains Smith. “The main sugar in a mother’s milk is lactose, which is made up of two basic sugars: glucose and galactose. Glucose is the sugar that is in excess in the bloodstream of people with diabetes. Although some of the excess glucose in the bloodstream of a mother with consistently high blood sugars will get into the milk, most of it gets used in producing lactose.”
“For the occasional high blood sugar in a new mother with otherwise well-managed blood sugars levels, the actual amount of glucose in the breast-milk is minimal and insignificant. To tell a mother with type 1 diabetes to ‘pump and dump’ is incredibly shortsighted and even greater pressure on the mother. The benefits of breast-milk for your baby certainly outweigh the rather insignificant amount of extra glucose in the breast-milk.”
3. Breastfeeding will definitely make blood sugar management a nightmare. I’ll always be low.
“During the first three months of breastfeeding, your basal rates will need to be gradually reduced and adjusted as your milk production reaches its peak and eventually regulates,” explains Smith. “Nursing sessions could be every 2 to 3 hours during the first month, and your baby might nurse for 10 minutes at one feeding and 20 minutes at the next. This can make it tricky to predict just how much glucose you’ll need consume to prevent a lowballed sugar.”
“But you’ll also find that you won’t need to eat extra glucose for every feeding session. There will likely be times of day you won’t need extra glucose and times of day when you do, for instance, morning feedings may require extra glucose, daytime feedings may not, and overnight feedings may require extra glucose again. You may find that you can simply reduce your meal bolus by anywhere from .5 to 2 units for whatever meal you eat following a breastfeeding session. In the end, breastfeeding is not simple nor necessarily predictable, and all of our bodies are different, so our response to breastfeeding will differ slightly, too.”
Like all things in life with diabetes, your diabetes may vary. Making slight adjustments to your insulin doses or eating 10 to 20 grams of carbohydrates after each feeding may keep your blood sugar steady. Or for you, the stress of being a new mother combined with having a very high-maintenance chronic illness may be enough to say, “Okay, I gave my child a few weeks of breast milk—which is a wonderful gift and will benefit their health—and now, for the sake of my own needs, it’s time to begin using formula.”
The decision is yours, and yours alone, and should always be made in consultation with your health care provider.