Diabetes and Breastfeeding: What You Should Know

If you’re pregnant and have diabetes, you might be wondering whether or not you can breastfeed your baby.

The short answer: Yes.

You can and possibly should try breastfeeding, as it has a number of benefits for your health and your baby’s health.

For birthing parents who live with diabetes, breastfeeding — also known as chestfeeding — may help keep glucose levels in check. For babies, breast milk may help lower the potential risk of type 1 diabetes (T1D) later in the child’s life.

Keep reading to learn more about breastfeeding with diabetes, what the benefits are, and what questions you might want to talk with your healthcare team about.

 

The American Diabetes Association shares that not only can birthing parents with diabetes breastfeed, but they also should try breastfeeding to help manage their diabetes. They recommend breastfeeding for at least the first 6 months of a baby’s life to reap the most benefits for both parent and child.

 

 

Medications like metformin and insulin are safe to take while breastfeeding.

La Leche League International further explains that insulin molecules are “too large” to pass through breast milk to the baby. That said, you may need to work with your care team to adjust your dose after pregnancy and during breastfeeding.

Researchers point out that some newer medications for T2D may not be safe or do not have enough study concerning breastfeeding.

  • SGLT-2 inhibitors: Sodium-glucose cotransporter 2 inhibitors increase glucose excretion in the urine. This class of drugs includes canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These drugs have no human lactation information and are not FDA-recommended in their respective package inserts because of the theoretical risk of injury to the developing kidney.
  • GLP-1 agonists: The glucagon-like peptide-1 receptor antagonists are a class of medications that include dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide. Taken by injection each day or week, the current FDA-approved labeling recommends against nursing with all of these drugs, although there are no reports of their use in breastfed infants.
  • DPP-4 inhibitors: Known as dipeptidyl peptidase-4 inhibitors, these are a class of prescription medications used along with diet and exercise to manage blood sugar in adults with type 2 diabetes. The meds in this class include alogliptin, linagliptin, saxagliptin, and sitagliptin. There’s no information available on their excretion into milk or use in lactation, but this research notes that saxagliptin and linagliptin may be “better choices among drugs in this class for nursing mothers.”

Some of the lesser-used drugs for diabetes that prescribers can also suggest include colesevelam, meglitinides, pramlintide, and thiazolidinediones.

Regardless, some people may find that breastfeeding makes their blood sugar more difficult to predict, so speak with your doctor about drugs as well as closer monitoring or even continuous glucose monitoring, if necessary.

 

Up to 9 percent of women develop high blood sugar during pregnancy. Also known as gestational diabetes (GD), this condition usually goes away on its own after a baby is born. But having GD may put a woman at higher risk of developing T2D later on.

Research shows that breastfeeding may lower this risk by increasing both a mother’s insulin sensitivity and glucose metabolism. Duration of breastfeeding also matters.

  • 2 months. Women who breastfeed for at least 2 months may see a reduction in risk by around half.
  • 5 months. Women who breastfeed for at least 5 months see more than half a reduction in risk.

 

 

Experts recommend keeping your glucose levels somewhere between 90 and 180 mg/dL while breastfeeding. Any lower glucose levels may lead to dangerous hypoglycemia, or low blood sugar.

Some people may discover that their blood sugars drop between 54 and 90 mg/dL during a breastfeeding session. That’s because the body uses the glucose in the blood to make breast milk.

Be sure to keep hypoglycemia treatments close by, if needed. Whatever the case, you may need help from your diabetes care team to adjust your insulin and medication doses or to eat differently in order to manage your blood sugars while breastfeeding.

 

A 2016 case study indicates that having gestational, T1D, or T2D may impact milk supply.

The researchers uncovered that women with low milk supply were likely to have a diagnosis of one of these types of diabetes rather than latch issues, nipple issues, or other breastfeeding issues.

Beyond that, the researchers share that higher body mass indexes (BMIs) are associated with low milk supply and that insulin resistance may be to blame. More research is needed to establish the specific link.

 

While the exact causes of T1D are not known, the number of cases in young children have increased in the last 50 years. This has led researchers to believe environmental factors — like smoking during pregnancy, type of birth, or infant diet — may be at play.

While various studies on breastfeeding have not yielded clear evidence that breastfeeding prevents T1D, others do show promise.

For example, one Scandinavian study revealed that babies who’d never been breastfed had a two-fold increase in the risk of developing T1D compared to those who did breastfeed.

Interestingly, there wasn’t much difference in data between babies breastfed for different durations of time. The same goes with those who were fully breastfed and those who had breast milk combined with other feeding methods, like formula.

 

 

Breastfeeding may increase the chance of developing hypoglycemia in the overnight hours. This can be addressed by working with your diabetes care team to adjust sleeping schedules for breastfeeding, and also adjusting insulin doses and medications during these times.

You may want to make sure that you eat before breastfeeding sessions or have a snack on hand if you’re breastfeeding while you’re out and less able to keep your glucose levels stable.

You’ll need to eat extra calories each day to support milk production. The American College of Obstetricians and Gynecologists suggests speaking with your doctor about exactly how many extra calories you should eat and what type of calories are best to manage your blood sugar.

Women with diabetes who breastfeed are also at a higher risk of developing yeast infections. One type of yeast infection that may occur is called breast and nipple thrush, which can affect breastfeeding. Symptoms include:

  • nipple pain or itching
  • discharge
  • change in nipple color

If you notice these symptoms, talk with your diabetes care team or lactation consultant about treatment options and modified feeding practices.

 

You can and likely should try breastfeeding if you have diabetes. Fortunately, you may be able to take your usual medications safely. Breastfeeding may even help regulate your blood sugar — all while providing a host of other benefits to both you and your baby.

Your doctor can answer questions you may have about other issues, like adjusting your medication dosages, avoiding hypoglycemia, or managing yeast infections.

If you deal with low milk supply, reach out to a lactation consultant for support or try searching for one via the United States Lactation Consultant Association’s online directory.