Breastfeeding With Diabetes: Your Questions Answered

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If you have diabetes, you might be worried that breastfeeding with diabetes will be risky, difficult, or even impossible. But it’s not! Many parents are able to successfully breastfeed with diabetes, and you can too. Here’s what you need to know:

If you’re reading this, you probably already know about how diabetes affects pregnancy. Your doctor has probably reminded you of the risks one too many times. You understand how important it is to keep your blood sugar under control while pregnant. And you know from experience how difficult it can be to do so.

As a result, you might also be wondering if breastfeeding with diabetes is going to be just as risky and difficult. Because nothing is “easy” about diabetes, right?

I get it. I get you. I was you. 

How to successfully breastfeed with diabetes

I was diagnosed with type 1 diabetes when I was 18, and even at that relatively young age, it didn’t take long for me to wonder if I would ever be able to have a healthy pregnancy. I didn’t think about breastfeeding much at first. But after learning about it in college—and how it can offer the baby a measure of protection against developing diabetes later—I knew it was something I really, really wanted to do.

But I didn’t know if I would be able to. I had heard about how breastfeeding can cause scary low blood sugars, and I was worried about something happening to me while I was alone with baby during the day. I wasn’t sure if my diabetes medication would pass through breastmilk, and I was concerned that diabetes would keep my milk from coming in at all!

Fast forward 6 years: I’m now an International Board Certified Lactation Consultant (IBCLC). And I’m here to tell you: You can do this. 

At the very least, diabetes doesn’t have to stop you. And there is no guarantee that any of the things you might be concerned about will even affect you in a meaningful way. 

Here’s what you need to know:

Medical Disclaimer: The content of this blog post is not medical advice nor is it a substitute for medical advice, diagnosis, treatment, or professional lactation care. This post is for educational and informational purposes only. It is the reader’s responsibility to review all information regarding any medical condition or treatment with a healthcare provider.

CAN YOU BREASTFEED WITH DIABETES?

Absolutely. 

Diabetes alone doesn’t prevent someone from making breastmilk. And many, many people successfully breastfeed with diabetes, even through toddlerhood! 

But there are some things about having diabetes that can, for some, make breastfeeding a little more challenging.

The good news is, most of these are things you are already familiar with and will have managed during pregnancy anyway. For example, breastfeeding can cause blood sugar changes, and you may need to adjust your insulin or medication doses (I’ll address this in more detail in a moment). Realistically, you will need to do this after birth anyway, regardless of whether or not you choose to breastfeed. 

Breastfeeding with diabetes will require insulin adjustments, something you'll be used to after pregnancy.
Breastfeeding can affect your blood sugar, but not usually nearly as significantly as pregnancy does.

How do diabetes-related birth complications affect breastfeeding?

Some pregnancy/birth complications can make breastfeeding more challenging by interrupting the period after birth when breastfeeding is normally established.  

While these complications tend to happen more often in parents with diabetes, there is no guarantee that any of them will happen to you. And it’s important to remember that many of these complications are not even unique to parents with diabetes. C-sections, premature births, inductions, neonatal hypoglycemia, jaundice—these things happen frequently when parents don’t have diabetes, too. 

I won’t waste time listing all the things that could possibly happen at birth that might somehow affect breastfeeding. In my opinion, there is already too much fear-mongering in the world of diabetic pregnancies. And again, just because these things can happen doesn’t mean they will. Furthermore, even when they do happen, many people go on to successfully breastfeed regardless. 

Instead, you should know that there are things you can do to set yourself up for breastfeeding success in the event your birth is complicated or you have to be separated from baby after birth. In fact, I wrote an entire post on this topic, which I encourage you to read here.

The most important thing to remember is this: If you wind up separated from baby after birth for any reason, you can protect your milk supply by hand-expressing and pumping milk early and often (every 2-3 hours) until you can be reunited with baby. 

High risk pregnancies can complicate breastfeeding with diabetes, but they don't have to keep you from meeting your breastfeeding goals.
Having a “high risk” pregnancy with diabetes means it’s a little more likely that breastfeeding right after birth might be interrupted or delayed. Fortunately, there are things you can do to help promote and protect breastfeeding if this happens.

Will diabetes delay my milk coming in?

You have actually been producing milk (“colostrum” is just a fancy name for early milk) since you were 10-14 weeks pregnant! It’s already there, even if it’s not leaking or never leaks in pregnancy. 

When your placenta is removed at birth, a resulting drop in pregnancy hormones triggers increased milk production (your milk “comes in”). This typically happens 3-4 days after you have your baby, but it’s not unusual for your milk to increase in volume at any time between 2-5 days after birth. Effectively nursing or pumping frequently (10+ times in 24 hours) can help your milk come in sooner compared to if you don’t nurse or pump as often (source).

If you have good glucose control, your milk will increase in volume around the same time that it would for someone without diabetes. If your glucose control isn’t as good, it’s possible your milk might “come in” about a day later than it otherwise would have (source). 

But this doesn’t necessarily mean you will have breastfeeding issues. 

The truth is, there are a lot of factors that can affect when your milk increases in volume, and diabetes is only one of them. Having diabetes—or even a complicated birth—is NOT a guarantee that your milk “coming in” will be delayed. I had a Cesarean birth with type 1 diabetes, and my milk increased in volume on the evening of day 2!

Some experts recommend parents with diabetes be encouraged to express colostrum before baby is born. This way if you need to supplement, you can do so with your own milk. I wrote a full blog post on there, which you can read here.

You can express colostrum before birth to protect baby from low blood sugars after birth
I expressed this colostrum before my second baby was born. It had to be collected one drop at a time for several weeks. I never leaked during pregnancy. Ask your doctor about antenatal milk expression. This colostrum can be given to baby in the event that baby has a low blood sugar after birth, or if baby needs to be supplemented.

Are diabetes medications safe to use while breastfeeding?

Although medications aren’t studied in breastfeeding parents for ethical reasons, we know that most diabetes medications are considered safe to take while breastfeeding. 

However, some brands or types of diabetes medications may be safer to take while breastfeeding than others. For example, medications that have a proven track record of being safely used by breastfeeding parents might be preferable to medications that are newly on the market. 

Rapid-acting insulins like Novolog and Humalog are considered compatible with breastfeeding, as are long acting insulins like Lantus. 

If you have a question about the safety of your medications while breastfeeding, I encourage you to contact the Infant Risk hotline. Infant Risk specializes in helping parents determine the safety of medications while breastfeeding. Unfortunately, doctors and pharmacists often recommend parents quit breastfeeding when taking certain medications that are in fact safe to use while breastfeeding. Contacting Infant Risk can help you avoid this problem. 

Most diabetes medications are safe to use while breastfeeding
Generally speaking, most diabetes medications are compatible with breastfeeding, but some are safer than others.

You can also ask your lactation consultant to help you look up your medications in a medical reference book called Medications and Mothers Milk by Dr. Thomas Hale. This reference book is the most current and up-to-date resource available on medication use while breastfeeding. You can then discuss this information with your prescribing doctor. 

What can I expect in the early months of breastfeeding with diabetes?

Breastfeeding with diabetes, practically speaking, is very similar to breastfeeding without it. The biggest difference is that you are more likely to experience blood sugar swings—especially low blood sugars—in your first few months of breastfeeding. 

These swings are due in part to postpartum hormones and hormones associated with breastfeeding, both of which tend to make most parents more sensitive to insulin (source). In other words, there is a good chance you will need less insulin than you were used to needing pre-pregnancy (source).

Breastfeeding with diabetes is easier with a continuous glucose monitor to alert you when you have a low blood sugar.
Both the Medtronic and Tandem insulin pumps can use continuous glucose monitoring sensor data to reduce the amount of basal insulin you receive. These safety measures can be helpful when breastfeeding.

If you find yourself experiencing frequent low blood sugars, speak to the provider who manages your diabetes immediately. Have them help you adjust your medication doses. If you’re on insulin, you should not have to eat more carbs to match the amount of insulin you’re taking (sometimes called “feeding” your insulin). It is better to simply take an appropriate amount of insulin and avoid unnecessary overeating. 

To protect yourself from low blood sugars while breastfeeding in the early months, keep a basket of juice boxes and fast acting glucose nearby when you breastfeed. You may not necessarily have a low blood sugar after breastfeeding (source) but it’s good to have snacks on hand just in case.

If you have hypoglycemia unawareness (you can’t feel low blood sugars) a continuous glucose monitor can be a life-saving investment (even if you’re not breastfeeding!). 

Pro-Tip: If you are new to having diabetes or never received formal “diabetes education” at diagnosis, ask your doctor to refer you to a diabetes educator. A diabetes educator can teach you how to calculate how much insulin you need and how to safely make adjustments to your doses. This is good knowledge to have even if you plan to let your doctor continue to make your insulin adjustments. If you’re a reader, you might like the book Think Like A Pancreas by Gary Scheiner. 

Diabetic mother breastfeeding her baby

Can I breastfeed if my blood sugar is high?

The short answer is definitely yes. But for your own health, you’ll want to bring your blood sugar down. Furthermore, prolonged high blood sugars can cause dehydration, and dehydration can impact your milk supply. 

The long answer is that the amount of lactose in breastmilk is the same in parents with and without diabetes (lactose is the main source of sugar/carbohydrates in human milk made of glucose and galactose [source]). But it’s not as clear if the overall glucose content of breastmilk is affected by diabetes. Some studies have found that diabetes does impact the glucose content of breastmilk, while other studies reached the opposite conclusion (source). These studies examined breastfeeding parents with A1Cs of about 8.1%. This means that researchers haven’t able to firmly establish a clinically significant difference in the milk of breastfeeding parents with diabetes, even when their glucose control is less than ideal.

In other words, your milk is NOT going to be meaningfully different because you have diabetes. You do NOT need to pump and dump your milk if your blood sugar is high, and your milk is NOT harmful to baby. In fact, breastfeeding may lower your child’s risk of developing diabetes later (source, source, source).

Breastmilk is recommended over formula, even when the breastfeeding parent has diabetes. Breastmilk is preferred even if your diabetes is not perfectly controlled, and even though formula is also a healthy choice. 

Your blood sugars do not have to be perfect when breastfeeding with diabetes.
Your blood sugar does NOT affect your breastmilk in a meaningful way, especially if it is well controlled.

Is breastfeeding with diabetes difficult?

Breastfeeding can be challenging in the beginning if only for the simple fact that most new things are challenging at first. But it does get much easier

Most challenges you might experience breastfeeding aren’t unique to having diabetes. Be prepared to fine-tune your insulin or medication doses after birth, and keep snacks or glucose on hand in case you experience a low blood sugar. Otherwise, breastfeeding with diabetes isn’t much different from breastfeeding without it. 

Unfortunately, diabetes is always going to be something we have to manage on top of our other responsibilities. It’s annoying, and it’s not fair. But it doesn’t have to keep us from doing the things we want to do, including meeting our breastfeeding goals. 

One of the best things you can do to minimize breastfeeding difficulty is to learn about breastfeeding in advance. And get help from qualified support early! Don’t wait until you’re ready to quit.

You can do this. 

If you enjoyed this post, be sure to check out our digital library of helpful resources that quickly teach how to avoid common breastfeeding problems and give you the peace of mind and confidence you need to meet your breastfeeding goals.

You Might Also Enjoy:

How to express breastmilk before birth and why you might want to
How to successfully breastfeed after a C-section or induction

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How to successfully breastfeed with diabetes