Wednesday, February 13, 2013

Breast Feeding and Diabetes

For months now I've been saying that I'd write a blog post about breast feeding as a diabetic.  I'd skipped the topic while still pregnant since it wasn't quite relevant at the time and for the past 11 weeks since GV was born I just haven't made a priority of writing about it since doing it seemed more important.  But seeing as she's happily asleep in her swing chair and GW is at least pretending to nap in his room, I'm going to take this opportunity to tell you about it since I know you all must have been anxiously loosing sleep over it since I first mentioned I'd write about the topic back in 2012.

No? Just me? Ah well, c'est la vie.

According to the American Diabetes Association, the best thing that a diabetic mother can do for her new born child is to breast feed.  Citing multiple research studies, the ADA explains that babies that are exposed to diabetes in utero and are breast fed for upwards of six months after delivery have a decreased incidence of respiratory infections, a lower risk of asthma and atopy, tend to have lower blood pressure and are less likely to develop childhood obesity.   All great things, right?  Well, combining these medical benefits with the fact that the disease is not transmittable, that there have been research studies connecting certain types of baby formula containing bovine protein to the development of autoimmune diseases like diabetes and that I thoroughly enjoyed breast feeding GW, the choice was easy for me.  The practice of breast feeding with diabetes, however, is not so easy.

Blood sugar affects everything we do in our daily lives because it provides us with energy, so it seems only logical that there be some relationship between blood glucose and the natural formation of breast milk.  While you've probably heard that breast feeding burns calories, you may not have taken the next mental step to connect that with blood sugar... Essentially, in a similar way to how our bodies burn both calories and glucose when we exercise, a mother's body burns both fuels to create milk for her infant. So while a non-diabetic mother can singularly reap the weight loss benefits of nursing her little one due to her self-regulation of glucagon and insulin, a diabetic mother needs to monitor her blood sugar with extreme caution so as to not put herself (and by extension her baby) in danger of hypoglycemia.

To prevent this and to keep blood sugar stable, it's important that I eat before, during and sometimes after feeding GV.  But that brings me to the next topic of difficulty: weight gain and nursing.  Because of my sugars I need to eat more to keep my blood sugar up to be able to safely nurse -- but then that means that although I am burning calories while nursing I am required to ingest more calories to nurse which means any weight loss I should have with breast feeding is replaced with weight maintenance, if not additional weight gain.  Obviously this creates a source of stress for someone as physically self-conscious as me, but to take it to a less superficial level, weight gain can change a diabetic's chemistry enough to change the body's response to glucose and therefore its artificial insulin requirements.  So... to keep this complicated... that means that I need to eat more to nurse more and that I must exercise more to compensate for not only remaining pregnancy weight (15 lbs to go) but the extra calories necessary to nurse (and exercise) all in order to keep my sugars stable enough to nurse in the first place.

Furthermore (because why, really, would it end there?) not only should my blood sugar be kept from going low while breast feeding, but they should not be permitted to go high either.  While the majority of perinatologists, pediatricians, obstetricians and diabetes organizations insist that there is no connection between a mother's in-the-moment blood sugar and the quality of her breast milk, there is a school of thought out of the Sansum Diabetes Research Institute in Santa Barbara, CA that believes the value of a mother's breast milk decreases when her bg is over 150 mg/dL.  According to these researchers, such deficient breast milk can cause infants to have "reactive hyperglycemia" which causes them to vomit, be excessively irritable and require more milk to satisfy their nutritional needs.  While there aren't additional studies to backup these claims and I've never seen such negative effects in GV's behavior when I have nursed her while high, a lack of evidence doesn't necessarily refute the possibility and I've decided to play it safe rather than sorry.  Admittedly it voluntarily adds another level of complication to breast feeding, but what does it really cost me?  If it is no big deal, then oh well.  If it actually matters, then it's worth the effort.

The bottom line is, I am thrilled to be nursing; it's a very personal choice and I find it completely satisfying. But breast feeding and diabetes take a lot of conscientious thought -- and at 3 o'clock in the morning when GV wants to nurse that is a lot to ask for.  Don't get me wrong, glucose control is definitely less critical and requires far less attention to minutia now than in pregnancy, but it's still exhausting to continuously consider.  I could let it go and give myself an easy DKA-sponsored trip back to my skinny jeans, but I cannot justify cutting myself any self-satisfying slack on my sugar control since a lax take on it would imply irresponsible parenting at best.

Seeing as I take my vocation as wife and mother extremely seriously, I guess this is just another one of those necessary "diabetes says this is how it is going to be" horse pills to swallow and get over it... now if only they made that in a gummy I'd be happier.

Why take a horse pill when you can have a gummy?  


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