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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.