This is puzzling. They are not basing the baby's insulin on the # of gms of CHO the baby is eating, so what does it matter that they don't know the exact volume he is getting? Maybe they want the insulin in and working within XX minutes of his starting his meal, and BF lengthens the time before the insulin is in and working? As long as baby is nursing his "usual" amt, it seems that introducing crappy simple carbs is doing a great disservice to this baby's nutritional state, as well as giving mom the notion that measurable but nutritionally inferior CHO are of greater value than her milk... Why not pump and bottle if it's that critical to know volume? Can she find an endo who is more BF-savvy/friendly? Perhaps this is a group to pull into our Baby Friendly practices discussions? Do we have anyone on this list who is familiar with peds endo or is also a peds diabetic educator?
Anne Cassens, MS, RN, IBCLC, Minneapolis, MN
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Date: Sun, 3 Nov 2013 12:49:39 -0500
From: Louanne McGhee <[log in to unmask]>
Subject: Type 1 Diabetes in 15 Month Old BF Infant
Mother is told to begin to wean a 15 month old infant due to Type 1 Diabetes because it is difficult to determine how many carbs/fats/proteins infant will be taking in. Is this right?
Details:
Babe was born naturally and breastfed exclusively until 6 months. He is the 4th child. He is now about 25 pounds and does eat solids as he desires and had been nursing many times a day (possibly out of thirst the mother thinks in hind sight. He was nursing more than her other 3 children at that age but within the "usual" range).
Babe developed spasms about 5 months of age and then at 7 months seizures. He was being treated with Trileptal until 10/28/13. An antispasm steroid was administered instead, ACTH. On 10/30 the babe was taken to the ER with difficulty breathing, grey/blue skin, fever. He had a blood glucose of 700 with acidosis.
The pediatric endo. told the mom that she should only be bfing a 15 m/o 3 to 4 times a day, and she should begin only nursing the babe after each meal as a snack and not at all at night. She is to check blood glucose levels after each meal and before bed(4 times a day).
Topamax is being used instead of ACTH. They are giving Klonopin for 5 days (11/1 to 11/6). It Topamax relieves seizures and spasms then he will get just Topamax. Trileptal will be given if required.
Babe is now receiving 1.5 units Lantus once a day. Novolog is given if needed--none if BG is under 250, .5 units if BG is 251 - 350, 1 unit if BG is 351 - 450 and 1.5 units if BG is over 451. Babe's A1c was 8.1 and they are awaiting test results for antibodies. The doctor is also telling the mom to give the baby plenty of carbs such as animal crackers for the next while so they can get a baseline on his blood glucose. (Child would probably not get sweet snacks as a general rule--mom is pretty careful with diet.)
Mom has been active in LLL for 8 years and has nursed each child until the age of 2 (as is her cultural norm). She is also a Bradley Birth Instructor. She would like to continue to breastfeed her child until he is 2. She has given me permission to post this information.
Any thoughts, information or suggestions would be appreciated.
Thanks--Louanne McGhee, LLL Leader, Irving TX
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