Breastfeeding your child is natural and will give your infant a head start on a healthy life. Breast milk contains all of the vitamins, minerals, enzymes, antibodies and other nutritional elements that your baby needs.

Note: Breastfeeding and diabetes as discussed here pertains to women with pre-existing diabetes, either Type 1 diabetes or Type 2 diabetes. Gestational diabetes occurs during a pregnancy due to the additional body stressors of the pregnancy increasing body needs. Once the baby is born, gestational diabetes abates.

Contrary to popular belief, people with diabetes can and do breastfeed very successfully. The stress-busting hormone oxytocin that a woman’s body releases during feeding can also help you feel better physically and emotionally and will improve your overall diabetes control.

Advantages of breastfeeding for the mother;
• Lowers your risk of bleeding in the few days after birth
• Helps you lose weight/prevent obesity
• Lowers your insulin need and makes injected insulin more efficient
• Reduces the risk of premenopausal breast cancer and ovarian cancer

Advantages of breastfeeding for your baby;
• Colostrum i.e. first milk your baby takes, helps to stabilize a baby’s blood sugar levels after birth
• Colostrum has immunological properties that help to protect you baby against all the germs that he is suddenly exposed to.
• Colostrum lines and protects your baby’s stomach and helps to create the right mix of bacteria in the gut.
• Breastfed babies are at a lower risk of getting ear infections, respiratory problems and intestinal upsets
• Breastfed babies are less likely to need speech therapy or orthodontics when they are older. When feeding from the breast, the muscles around the jaw are worked in such a way that causes the bone structure of the face and jaw to develop more fully than when feeding form a bottle.

Ensure a good experience of breastfeeding baby
Before baby arrives – educate yourself and your family. Many mothers find that attending a support group before the birth can give them greater confidence in their ability to breastfeed. Seek out your nearest Cuidiú or La Leche League or check out your locality for a private breastfeeding class with an IBCLC lactation consultant. Talk to your diabetes team and review your medication/dietary and exercise plans.

Consider expressing colostrum before giving birth and store so that after birth, feeding can be supplemented if needed with this colostrum rather than formula. NOTE- All maternity units would be expected to have supplies of milk from the donor milk bank in the freezer for infants of mothers if additional milk is needed.
Know what to do if you do not get to feed your baby in the first few hours after delivery – express and give to your baby or store for when you baby is able to take feeds. Learn to hand express during pregnancy as this is more effective for colostrum than a pump. Skin to skin contact immediately at birth can stabilse baby and mother, keep baby warm, as well as assisting early feeding.

Be aware that some babies of mothers with diabetes have low blood sugar right after birth. Don’t panic and let the medical team deal with this. The best way to treat a baby with low blood sugar is to feed and maintain lots of skin to skin contact.

After baby arrives:

• Maintain contact and feed as early as possible
• Get help to ensure the baby is latched properly and feeding effectively as soon after birth as possible
• Monitor your blood sugar level
• If your baby has a medical need for additional milk and your expressed milk or milk from the donor bank is not available, formula may need to be used. Ideally this would be given by a cup feed or spoon rather than by bottle
• Each maternity unit has an International Board Certified Lactation Consultants (IBCLCs) available

Know that for every breastfeeding problem there is a breastfeeding solution. It’s just a matter of finding the right help and support. In addition to the support you can get from your medical team, there are voluntary breastfeeding support organisations such as Cuidiú and La Leche League which run breastfeeding support groups and have trained breastfeeding counsellors who can give you support and information when you need it.

Are there specific problems with breast feeding because of my diabetes?
There are no specific problems because you have diabetes but unsupported practices can cause issues. Maintain lots of skin to skin contact with your baby to trigger the hormones that produce milk. Breastfeed baby as soon as possible after delivery and feed on demand which may be at least 10-12 times in any given 24 hr period. Tune in to your baby’s needs rather than focusing on the clock. The more your breasts are stimulated the more milk they will produce.
If you chose to express, don’t replace breastfeeding with pumping sessions. You could pump in between breastfeeding sessions, or pump on one breast while your baby is feeding from the other breast. Bear in mind that the amount of milk that you express with a pump is not necessarily a good indicator of how much milk you are making. Your baby will always get more from the breast than you will express using a pump. Talk to a midwife and lactation consultant if you are having difficulty.
Use protective breast pads to keep your nipples dry between feeds. Examine your nipples daily and seek advice if they get sore as infections and thrush can develop quickly.

The key points to consider are:

• Stabilize your sugar levels through healthy eating and medication adjustment.
• Your insulin requirement may drop by a much as 25% when breast feeding is established
• Talk to your diabetes midwife specialist before leaving hospital and make a plan
• Eat before feeding – Always eat something that contains a combination of protein and carbohydrates before feeding. A glass of milk per feed may be sufficient. Many women find they have low blood sugar within an hour after feeding
• Monitor your daily dietary intake – You will need frequent snacks. Plan to have 40-50 grams extra starchy carbohydrate spread over the day
• Always keep a proper snack in your bag when you go out e.g. yogurts, fruit, and cereal bar etc. 

Talk to your diabetes team about when you can resume your oral medications if required and if they are appropriate during breastfeeding.
Do not drink alcohol, as it can decrease milk let down and also increase your risk of “hypos” if you take insulin.

Common Myths
Baby will get my insulin and have a “hypo” – No, insulin does not pass into your breast milk. New born babies may have unstable blood sugar levels but this is very transient.