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Diabetes and Maternal Breast-Feeding

Is possible for me to breastfeed my baby?

Yes, provided you monitor your diet and lifestyle extra carefully in order regulates your condition. Some women report better overall health — and less of a need for insulin — during lactation, possibly because of their body's natural adjustment to physical and metabolic changes after delivery. In fact, a diabetic's need for insulin drops abruptly within hours after birth. The stress-busting hormone oxytocin that a woman's body releases during breastfeeding can also help a diabetic mom feel better physically and emotionally.

Women with diabetes in pregnancy, whether they have gestational diabetes (GDM) or Type 1 or Type 2 diabetes, should be encouraged by their health-care practitioner to breast-feed their infant. The nutritional, antibody and mother-infant bonding benefits of breast-feeding are well known. Studies now also indicate that breast-feeding may not only decrease the risk of breast cancer, ovarian cancer, and osteoporosis, but reduces the incidence of diabetes in both mothers and their children. Women with GDM who decide to breast-feed may delay their own onset of Type 2 diabetes and infants who are breast-fed for at least three months are less likely to develop Type 1 diabetes compared with those who are fed formula. Infants of women with Type 2 diabetes are at a higher risk of childhood and adult obesity. Breast-feeding may reduce this risk, as breast-fed children tend to be leaner than formula-fed children.

The first two to five days of breast-feeding are important for resolving any complications and establishing good lactation. One potential complication, due to poor metabolic control in women with Type 1 diabetes, is delayed lactogenesis. These women need to be instructed before delivery that early breast-feeding activity, increased frequency of breastfeeding, and good glycemic control enhance secretion of prolactin, the principal lactogenic hormone

A mother should be encouraged to pump her breast in case that the infant is not able to start breast-feeding and it has to be postponed.

Breast-Feeding and Insulin Use Can I breastfeed?

While there are no published reports of hypoglycemia in the breast-fed infants of mothers using oral hypoglycemic agents, there is at least a theoretical concern since these agents promote insulin secretion. Infants of women with Type 2 diabetes are at high risk of sustaining neonatal obesity. To avoid neonatal hyperinsulinemia, it would be best to ask the breast-feeding mother to continue using insulin therapy for at least one month postpartum (the neonatal period) and then transition over to the oral agent.

Many oral agents are new and have little or no research on their use in breast-feeding women. The insulin-using mother needs to be taught how to maintain optima) blood glucose values because higher blood glucose levels increase the glucose content of the breast milik and puts the mother at risk for breast infection. Additionally, she should learn how to avoid hypoglycemia that may result from the increased caloric demand of breast-feeding.

Now it seems that sooner that later Metformine maybe used in gestational diabetes and during pregnancy in type 2 diabetes patients but the indication is not yet approved. We know very little on metformine on lactation and for the time being should not be used.

Education Tips for the Breast-Feeding candidates

It is extremely important to take an active role in educating our patients. The following tips can increase the likelihood that the insulin-using mother maintains good diabetes managemen twhile breast-feeding:

1. Meals Times

We have to instruct the mother to eat a meal or snack before napping and also before or while breastfeeding (that is, one serving of starch, fruit, or milk).

2. Blood glucose self-monitoring

Have the mother test her blood glucose level before breastfeeding and sleeping. Occasional testing after breast-feeding will help her learn the effects of breast-feeding on her blood glucose levels. Adequate blood glucose seif-monitoring with adjustments of diet and insulin should keep blood glucose values above 70 mg/dl and one-hour postprandial values no higher than 160 mg/d1. Nowdays with the increasing use of HCGM home continuous glucose monitoring this task will be a lot easier.

3. Preventing Infection

InfectionInstruct the mother on signs of breast infections such as soreness accompanied by redness, fever, or flu-like symptoms. The mother should report any symptoms to her health-care provider right away. The incidence of mastitis does not in-crease with diabetes but any infection will make it harder to control blood glucose levels. Treating these infections quickly, sometimes by antibiotics, and checking blood glucose levels regularly is essential for maintaining normoglycemia. The baby can and should continue to nurse on the affected breast.

Maintain contact. Diet and insulin adjustments will need to occur in the initial stages of breast-feeding

4. Nutritional Guidelines

•  Eat three meals and three or more snacks a day;

Choose a variety of foods every day;

Include three or more servings from the milk group daily. Talk to a dietitian about other sources of calcium if the mother is unable to tolerate dairy products;

Drink to satisfy thirst only. Excess fluids have no benefit on breast-milk production;

Coffee, tea, and other caffeine containing beverages should be limited; and

Keep extra portions of foods in the freezer for future use and don't ignore offers from family and friends to help with meals.

Many women want to lose weight while breast-feeding. A dietitian can help a new mother to achieve her goal in a healthy way, emphasizing slow weight loss on an individualized mea¡ plan designed for breast-feeding mothers.

Weaning the Baby

A variety of situations will determine the right time to wean a baby from the breast. If a mother is returning to work, she may want to wean her baby from the breast or she can continue to breast-feed by expressing and storing her milk, which can be bottle-fed to her baby while she is away. One example of this is in the case study to the left. Some mothers or babies do not want to use a bottle and will breast-feed until their babies are weaned to a cup. Others will continue to breast-feed as long as both mother and baby have an interest in it.

Weaning should be a gradual process to avoid breast engorgement and to allow the baby to adjust to the new routine. Omit one feeding for several days, and then a second feeding for several days. The last breast-feeding period to be omitted is usually the nighttime feeding. The ease of this transition will depend on baby's readiness, use of bottles, and the bond between mother and infant.
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