Researchers from Copenhagen, Denmark have published an update on diabetes management during breastfeeding for women with type 1 diabetes (T1D).
Due to limited clinical studies and a scarcity in the volume of literature pertaining to diabetes management and dietary advice during breastfeeding for women with T1D, the update aims to provide a comprehensive overview of blood glucose management of type 1 diabetes during breastfeeding. The paper focusses on diet and insulin treatment to prevent low blood glucose (hypoglycaemia), ketoacidosis, and weight retention.
The key suggestions from their research update are:
- Breastfeeding is encouraged because of its advantages for women and their newborns
- Carbohydrate in breastmilk is almost exclusively produced from the mother’s glucose and galactose
- Immediately after delivery, the need for insulin declines and may be approximately 30–50% lower than the pre-pregnancy dose*
- Over the next 1 to 4 months, insulin requirements in breastfeeding women may remain 21% lower than before pregnancy with wide individual variation*
- The recommended aim for glucose values 4.0–7.0 mmol/L (72–126 mg/dL) fasted or before food and 4.0–10.0 mmol/L (72–180 mg/dL) at all other times, including after meals*
- With sufficient daily carbohydrate intake (the research suggested a minimum of 210g per day), the need for a snack for prevention of hypoglycaemia during breastfeeding may be reduced, and the risk of ketoacidosis may be reduced*
- Aim to achieve maternal pre-pregnancy bodyweight (the research suggested within 3–6 months after delivery)
- Manual insulin and, when indicated, insulin pump therapy can be used during breastfeeding.
*Recommendations for insulin requirements, blood glucose targets and carbohydrate intake should be individualised – The above recommendations are suggestions following the research, and individual advice from your healthcare team is recommended.
Further, large scale studies are needed to improve and guide diabetes management for T1D during breastfeeding. Studies in the areas of insulin dose adjustment, manual versus pump delivery and dietary guidelines including carbohydrate intake, weigh management and blood glucose monitoring are still required to further support blood glucose management for T1D while breastfeeding.