May 2018 Newsletter: Managing Breastfeeding & Diabetes

By Cheng Yong (BMSG Volunteer)

This month’s Mother’s Sharing strikes a chord as we speak to Cheng Yong, a stay-at-home-mother of 1, who has had Type I Diabetes Mellitus* for nine years now. Hear from Cheng Yong how diabetics can include breastfeeding as part of their parenting goals and how they can manage breastfeeding while maintaining their blood glucose levels.

*About Type I Diabetes Mellitus: Type 1 Diabetes Mellitus is an autoimmune condition in which the beta cells of the pancreas are destroyed by the body’s own immune system. It can occur at any age but is more common in children and young adults. The exact cause of Type 1 Diabetes is still not clear. It is likely to be due to both genetic factors and environmental triggers which include viruses. In general, T1DM comprises around 5-10% of the total diabetes prevalence. In Singapore, the incidence of childhood type 1 diabetes mellitus is the predominant form of diabetes affecting children in Singapore (1).

Pregnancy

Prior to being pregnant, I had heard from many relatives and friends that they could not breastfeed due to their various conditions. Thus, initially, I was not very confident myself about breastfeeding as a diabetic patient. However,  when I brought up the idea to my endocrinologist, she did not specifically raise any concerns. Hence, I worked on taking care of my blood glucose during my pregnancy and hoped that things would work out.

Medical & Healthcare Support

My health care team comprised an endocrinologist, a dietitian, a diabetic specialist nurse and an obstetrician. During pregnancy, my endocrinologist helped me switch from insulin pens to a pump. She helped me immensely in titrating my insulin dosage which doubled by the end of the pregnancy! She is still helping me titrate my requirements now that I’m breastfeeding. My dietitian helped me plan my caloric intake with regards to carbohydrate, protein and fat during pregnancy and breastfeeding. As my pregnancy was considered high risk, I had more frequent checkups and ultrasounds. Above all, my husband provided the most important support as he reassured me whenever I broke down crying over unexplained high blood sugars. He was also my personal nurse during labour and recovery.

 

Post-Birth: Initiating Breastfeeding

My baby was taken to the High Dependency Unit right after the C-section to monitor his blood glucose levels. He was born at about 10pm and I was only able to meet him the next morning. I was still recovering and had to go up in a wheelchair. The nurses at the Singapore General Hospital (SGH) were really helpful as they patiently helped me express colostrum and delivered it to my baby. My baby had a mixture of formula and colostrum after birth. When I saw my baby for the first time, there was a Lactation Consultant (LC) present who helped me latch. He did manage to latch but it was still a struggle the next few times and I always buzzed for the nurses to help.

Monitoring Glucose Levels

Diabetic patients need to monitor their blood glucose levels several times a day. For myself, the minimum would be four times (before bed, breakfast, lunch and dinner). However, now that I’m breastfeeding, I will check my sugar levels about eight to ten times a day as my blood glucose levels are much harder to predict. There is also an increased risk of hypoglycaemia*. I definitely check my levels after each breastfeeding session during the night and whenever I experience hypoglycaemia symptoms.

*hypoglycaemia: When blood sugar levels drop below what is normal.

I do experience hypoglycaemic symptoms frequently. I usually have a few in a week but thankfully I get symptoms before they go dangerously low. My symptoms are shaky hands, hunger, cold sweat and tingling tongue. Suggestions to prevent hypoglycaemia (or hypos for short) would be to count one’s carbohydrate intake as accurately as possible if you are doing dosage adjustment for normal eating. Never ignore hypo symptoms and always keep hypo treatments near you. I usually keep my test kit and sweets within reach whenever I am breastfeeding.

 

A Typical Day

I breastfeed on demand so my days are not really structured, just like many SAHMs. At one point, my baby would only go to bed between 1 to 2 am and his sleepy period would last till 1-3pm! I would get some sleep then and an uninterrupted lunch. Now that he is eight months old, he typically sleeps around 10 or 11 pm, feeds once or twice in the middle of the night and wakes up between 7 to 9 am. My day is spent breastfeeding, changing diapers and entertaining him. Whenever he is taking a nap or is contented playing by himself, I slot in some household chores, online courses and prepare dinner, all this while making sure that I never miss including my routines to check my blood sugar levels too.

 

Snacks to Maintain Consistent Blood Sugar Levels

If I’m having a hypo (below 4 mmol/L), I eat a piece of candy which is considered as 6g carbs, followed by another 5-10g carbs with a biscuit, milk or chocolate. During the night after a breastfeeding session, if my levels are between 5-6 mmol/L, I would have a 5g carb snack which could be a biscuit or 100ml of milk. I don’t usually snack in between meals unless my levels are dipping. I find the following bite-sized food handy to have around: soft jellies (these are fast enough for me to treat hypos), caramelised biscuits, digestive biscuits, mini chocolate bars, easy-to-eat fruits like kiwis, milk in the fridge and a tub of ice cream in the freezer which I can weigh out any amount of carbs that I like.

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Interesting Fact:

Scientific studies have shown that youths who received any breastfeeding for at least 12 months or full breastfeeding for at least six months had lower odds of developing Type 1 Diabetes(2) and children who were never breastfed had twice the risk of Type 1 Diabetes compared with those who were breastfed.(3)

Cheng Yong’s story shows us that breastfeeding with Diabetes is possible and can provide far-reaching benefits to both mother and child. Whether you have Type 1, 2 or even if you have had Gestational Diabetes, you can and should continue to breastfeed.

 

References:

  1. https://www.singhealth.com.sg/DoctorsAndHealthcareProfessionals/Medical-News/2012/Pages/Type1-Diabetes-Mellitus-Contemporary-Management.aspx
  2. Diabetes Care 2017 May; dc170016. https://doi.org/10.2337/dc17-0016 Martens PJ, et al. Abstract #0511. Presented at: World Diabetes Congress; Nov. 30-Dec. 4, 2015.
  3. Infant Feeding and Risk of Type 1 Diabetes in Two Large Scandinavian Birth Cohorts. Diabetes Care 2017 Jul;40(7):920-927. doi: 10.2337/dc17-0016. Epub 2017 May.

April 2018 Newsletter: Inducing Lactation – An Adoptive Mum’s Story

As told to the BMSG Editorial Team

At the end of 2017, we chanced upon Janet (not her real name) who had made known her intentions to induce lactation. This is her story of how she had managed to breastfeed her adopted daughter after getting support from medical professionals, experts and her family.

My husband and I had decided to adopt a child last year. I first heard that it is possible to induce lactation without having given birth from my aunt, when we shared with her our adoption plans.  This made me very curious so I started doing research on general information about it on the Internet.

I had also read a lot about the benefits of breastmilk for the baby’s health and I had imagined that the bonding experience was extremely priceless.  I had read that it wouldn’t be easy but I decided that I would love to give it a try. However, I was clear that I didn’t want to put too much pressure on myself.

 

Different Ways to Induce Lactation

There are few different methods to try depending on your situation and the amount of time you have to prepare before the baby arrives.

They include using ‘the Pill’, which causes your body to mimic pregnancy, and the medication Domperidone, which causes a rise in your prolactin levels, which is responsible for milk production. (*BMSG Note: It is necessary to use these medications under the supervision of a doctor or a qualified lactation consultant.)

Another way is to go natural and only use stimulation via using a pump.

 

Kickstarting the Journey: Finding the Right Support

I had also discovered that getting the advice of a Lactation Consultant (LC) would be valuable so I searched around for one and chanced upon the Mother and Child Clinic, which was run by International Board Certified Lactation Consultants (IBCLCs). They were agreeable and we had a meeting, and I found them really helpful and supportive.  

They provided ample information about lactation, how it works, how to go about inducing it and also gave me recipes for lactation cookies and smoothies. I then bought an electric breast pump and went on my way to stimulate my body to begin the lactation process.

I decided that I would start on the natural route as I did not have much time to try to mimic pregnancy and was also unsure about consuming Domperidone.  Much to my surprise, twelve hours after beginning, I got my first drops of milk!

 

Challenges
Unfortunately after a few days of pumping, I could not keep up with my pumping schedule as I had to leave home for long hours at a time.  I discovered that it would be challenging for any mother who chooses to pump till the day baby arrives as consistency in stimulation is key to sustaining my supply.  Pumping every two hours proved to be challenging, so I began a schedule of pumping every three to four hours instead.

I watched my breasts change over the course of the first week I began pumping.  They felt a little fuller and heavier and the areolas also felt a bit different.  While I didn’t produce a significant amount then, I managed to get a pool of milk each time that I accumulated together with earlier batches.At that stage, while I pumped, I also did a lot of massage and stimulation with my hands. The LC explained that this was probably more effective than pumping alone.

The Plan

We had to do some planning for when baby came along. I had been given strict instructions to go to Mother and Child and check in with my LC immediately once baby arrived. She would help us set up the Supplemental Nursing System (SNS) and teach us how to get baby to latch. If I didn’t produce 100%, it wouldn’t matter.  Any amount of breastmilk is helpful to an infant. The most important thing for me was to bond with my baby and if I didn’t end up producing enough for all her feeds, I could always rely on the generous ladies on the Human Milk for Human Babies Singapore (HM4HB Singapore) page to help my little one flourish from their milk donations.

 

When Baby Arrived

We brought our daughter home at two weeks old and she is now 12 weeks old. We first attempted to use the SNS but it proved to be quite challenging for me. Upon reflection, I felt I would have been able to build up more of a supply if I had more time to pump and if I could have used the SNS optimally as she would have spent more time at my breast.

However, I am mostly at home alone and don’t have domestic help, so it’s hard to find time to do all the extra pumps. I top up whatever amount of milk I can produce with donated breast milk from people I trust. I am happy to say that I currently produce around 80% of my daughter’s breastmilk needs while 20% comes from donated milk. The night time and early morning feeds do not require top ups but the afternoon and early evening feeds definitely do!

I had also attempted to use Domperidone to increase my supply eventually. However, other mothers may find it more helpful if they start the full protocol of induced lactation whereby you take the contraceptive pill for several months before baby arrives. Unfortunately, I had difficulties finding a doctor who could support me in this aspect.

One of the most amazing things that has happened was that my daughter’s birth mum had actually provided our daughter with colostrum, which is an incredible gift from a birth mother who is placing her baby for adoption. She’s really had a lucky start to life with her nourishment despite her unfortunate circumstances of losing her birth mother.

I, too, feel so blessed to be able to nourish her from my own body like my biological child and the bonding experience has been amazing. I also continue to work together with the LCs at Mother and Child, and they have been ever so supportive and provided me with so much information.

It has been such an amazing experience and I am thankful for all the support and help we have received. I was asked why it was important to me to breastfeed her. Once I realised that breastfeeding was possible, I felt a responsibility to give her the very best of what I can. We had both already lost so much and it gave us back something powerful. An emotional connection, the very best nutrition and I can only hope it helps to heal some deep wounds she would carry.

Janet’s baby is now 12 weeks old.

I was asked why it was important to me to breastfeed her. Once I realised that breastfeeding was possible, I felt a responsibility to give her the very best of what I can. We had both already lost so much and it gave us back something powerful. An emotional connection, the very best nutrition and I can only hope it helps to heal some deep wounds she would carry.

Useful Resources for Inducing Lactation:

  1. The Newman Goldfarb Protocol for Induced Lactation
  2. Relactation & Induced Lactation Resources on KellyMom