In light of the recent slow wt gain posts, I recently received a phone call
from a mother who is diabetic. She uses an insulin pump and still is not
well controlled. Her question was could her out of balance blood sugar
levels be affecting her milk supply? They certainly could be, I guess, I
would think any system that was out of order could affect all other systems,
and we all know how insulin resistance and pcos are associated with low
production in some moms. However, I said I wouldn't think that would be the
main thing, and so began to ask some questions. It came to pass that mother
had started birth control pills 3 wks ago, but I still didn't have the whole
picture and asked if the baby had been weighed recently and how did that go.
She proceeded to tell me the baby 's weights. The baby was now 7 wks old and
had never regained birthweight yet. We had seen her in the beginning, and
had 3 followup visits after hospital discharge, all within about the first
week, baby had lost no more than 8%, and had gained 40 grams at last visit
and had a peds visit scheduled in 4 days, so we discharged her to peds and
call us as needed. She never called back until that day, at 7 wks or a
little past. The weight problems (see below) were before the bcp's, so I
can't necessarily blame that, altho it probably isn't helping now.
Well, the new ped was in a different town, so we did not get referred back
to, and at that 4 day visit baby had lost 4 oz (sorry mom didn't have
grams). Mom said it was ok because he had gained in length. The next visit
was in 2 wks! The weight gain was 3 oz. The next visit was scheduled for
between 4 and 5 wks later! Which wasn't even until 2 more weeks so I had her
come right in. The baby still under birthweight, had gained 3 oz in 3 wks.
Well you can imagine how distraught and concerned I was, and how complicated
this simple call got to be. So a reminder to use your counseling skills, a
good triage tool, and common sense.
Laurie Wheeler RN MN IBCLC

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