Experience tells us that the problems mothers with IDDM may face are:
        1) early postpartum hypoglycemia after nursing.  This may be caused by the
change in insulin sensitivity following the delivery of the placenta.  I have heard much less
about early postpartum hypoglycemia with good postpartum diabetes care such as careful
monitoring, reduction or cessation in insulin, etc.  Frequent meals and/or 4 oz. juice or 8 oz.
milk with nursing and careful monintoring has been useful to persons I have dealt with.
        2)  several studies have indicated that lactogenesis may be delayed in women with
pregestational diabetes- Neubauer et al Am J Clin Nutr 1993;58:54-60.  Therefore, early
measures to optimize lactation-- ie pumping if mom or infant are separated, etc. are indicated.
        3)  glucose concentrations are higher in breastmilk when mom is hyperglycemic.
HOWEVER, GLUCOSE IS PRESENT IN SUCH SMALL AMTS TO BEGIN WITH
THAT THERE IS PROBABLY NO PHYSIOLOGICAL SIGNIFICANCE.  We have
checked with taste and smell specialists and have found that the concentration elevation is
probablyo not high enough to change the flavor of milk.
        4)  Hyperglycemia was very prevalent in 33 women with IDDM who nursed their
infants in Connecticut.  Many professionals/scientists believe that less insulin is needed during
lactation.  Careful/frequent monitoring and adjustment of insulin coordinated with individuals
and their physicians and/or diabetes educator is necessary.