>I have a 20 mo bf child whose mom was just told she had Diabetes.  She
>didn't want to stop BF to go on the oral hypoglycemic meds so is on inulin
>shots.  Mom's doctor wants her to be on the oral meds. Her doctor seems to
>think she will lose weight better on the oral meds.
>
>Any help?? Are the oral meds safe?? old verses new ones??

This topic is very familiar to me as I have recently researched
polycystic ovary syndrome and latest theories and therapy, which are
related to diabetes issues. Most likely the drug being suggested is
metformin (glucophage), which appears to be quite effective for NIDDM and
also has the added advantage of facilitating weight loss (I know two
women who have taken it, and both found that they began to shed excess
weight immediately; they were thrilled). Another new drug that works
similarly on insulin resistance is troglitizone (rezulin), only it does
not have the same benefit for weight loss. Metformin is a small molecule
that is 50% protein bound and would theoretically pass into the milk
readily; troglitizone is a large molecule that is 99% protein bound and
would theoretically pass only in small amounts. Therefore, of the two,
troglitizone would be most likely be considered the better choice if
weight loss is not an issue.

Currently there is little or no known experience with either of these two
medications in relationship to lactation.  Studies in adults show that
when they are administered to non-diabetics, they do *not* induce
hypoglycemia. However, that still appears to be a major concern in
theoretical reviews, which list hypoglycemia as a symptom to watch for.

A second concern to consider is the potential adverse reactions, which
include (Metformin): nausea, vomiting, diarrhea, bloating, lactic
acidosis; (Troglitizone): nausea, vomiting, diarrhea, skin rash. Also
scattered reports of decreased RBC, hemoglobin, hematocrit, and BUN with
this drug.

I think that it would be wise to take into account the fact that the
infant in question is 20 mos old and most likely getting the majority of
its calories from solids rather than human milk.  Given that supposition,
 I personally might choose to take the "risk" and try metformin, and
monitor baby for any adverse reactions.  If weight loss is not an issue,
then troglitizone would be the drug of choice.

While I personally suspect that these medications may eventually be found
safe for younger breastfeeding dyads, I am currently attempting to seek
more information internationally, where the experience with these meds is
20-30 years old compared to just a few in the United States. I do believe
that Dr. Newman has had several moms on metformin, and might be able to
comment on his observations.  I'm still open to any leads from
lactnetters!

Troglitizone: Dunaif, et al. The Insulin-Sensitizing Agent Troglitizone
Improves Metabolic and Reproductive abnormalities in the Polycystic Ovary
Syndrom. Journal of Clinical Endocrinology an Metabolism, Vol. 81 No. 9,
p. 3299-3306.

Metformin: Velazquez, et al. Metformin therapy in women with polycystic
ovary syndrome reduces hyperinsulinemia, insulin resistance,
hyperandrogenemia, and systolic blood pressure, while facilitating
menstrual regularity and pregnancy. Metabolism 1994; 43647-655

Lisa Marasco, BA, IBCLC