During World Breast feeding week (August 1-7) women are supported and encouraged to combine breastfeeding and work. The week of spreading awareness on breast feeding in general aims to empower them to claim her baby’s right to breastfeeding whatever a woman’s profession or lifestyle. But it’s not always simple – especially when a new mother is living with diabetes. Is breastfeeding safe for all women? How long should a woman breast feed for? What are the benefits? Questions all women and mums-to-be may consider. Here Dr. Mohammed Al-Khatib, Consultant Internal Medicine, Endocrinology and Diabetology at HealthPlus (www.hplus.ae) and Dr. Muhaj Al Shaikhli, Consultant Obstetrics and Gynecology, HealthPlus give us the lowdown on breast feeding with diabetes.

Can a diabetic women breastfeed?

Dr. Muhaj Al Shaikhli: Absolutely! Breastfeeding is strongly encouraged for diabetic women. The need for insulin in diabetic patients drops abruptly within hours after birth and the oxytocin hormone released by women during breastfeeding can also help a diabetic mom feel better physically and emotionally. Not to mention all the well-known benefits of breastfeeding to the infant and mother: For the newborn, less chance to develop high respiratory infections, high blood pressure, asthma, atopy (a disorder marked by tendency towards allergic reactions) and obesity. For the mom, lower risk of ovarian and breast cancer and the added bonus of quickly burning those extra calories gained during pregnancy.

Is there a difference between diabetes and gestational diabetes?

Dr. Mohammed Al-Khatib: Gestational diabetes is one out of four types of diabetes. Type 1 usually takes place among younger patients, who have normal weight, but have an insulin deficiency (no insulin production, secretion from the pancreas). Type 2 affects older patients, who are overweight or obese and have an insulin resistance (enough insulin, but not functional). Type 3 may happen to people of all ages, as it is a monogenetic form of diabetes. Finally we have Type 4, or gestational diabetes, which happens to some women during pregnancy if they have increased blood sugar levels. It usually disappears after delivery and women only have a three to five percent risk of developing a Type 2 later on in life.

Will breastfeeding affect the mother’s glucose levels?

Dr. Mohammed Al-KhatibThe glucose metabolism in human beings is strictly controlled by hormones of the pancreas and incretion hormones from the gut. Whenever glucose levels change, there is a proper response of the body - increasing blood glucose causes increased insulin secretion while decreasing of glucose leads to reduced insulin secretion and increased glucagon secretion to stabilize the homeostasis of blood glucose. Breastfeeding transfers lactose from the mother to the baby, which activates the pancreas and gut hormones to produce/secrete glucose from the liver. The blood glucose levels stay stable in normal range.

Will milk come in normally?

Dr. Muhaj Al Shaikhli: Insulin does play a part in milk production. So, if you have diabetes, your milk may take longer to come in, especially if your blood sugar level is not well under control. It might take about five to six days, rather than the usual three to four days. Therefore, supportive intervention for early initiation to breastfeeding needs to be in place to help infants get their necessary intake and avoid neonatal hypoglycemia (low blood glucose level).

Will diabetes affect the quality of milk?

Dr. Muhaj Al Shaikhli: Blood sugar levels can affect your milk, but if your blood glucose is well controlled this should not be a problem. Most medications used to treat diabetes, such as Glucophage and insulin, are also safe to be used during nursing.

Do diabetic mothers need a higher calorie intake while breastfeeding?

Dr. Mohammed Al-Khatib: We recommend for all mothers after delivery who are breastfeeding to keep a healthy diet, especially if they had high blood glucose values during pregnancy. They should avoid high calorie intake if they are obese or had a significant weight gain during pregnancy. The kind of food recommended for mothers with diabetes during breastfeeding should contain high fibers with low-glycemic index.

Do babies of diabetic mothers have an increased risk of developing diabetes through breastfeeding?

Dr. Mohammed Al-KhatibThere is no data or evidence showing an increased risk for babies of mothers with diabetes to develop diabetes. The glucose control in babies is immediately functional after birth. Breastfeeding delivers the glucose via lactose to the baby and the transformation to glucose and metabolization of glucose mediated by insulin in the baby is not affected by breastfeeding. But babies of mothers with diabetes or gestational diabetes have a mildly increased risk of developing diabetes later in their lives, especially if they become obese and have an unhealthy lifestyle.

Tips to help prevent low blood sugar levels during nursing:

• Plan to have a snack before and during nursing

• Get the right amounts of fluids, vitamins and minerals

• Keep something nearby to treat hypoglycemia when you breastfeed

• Develop a meal plan with your healthcare provider or dietician

• Constantly monitor your blood sugar levels