Dear Susan,
Your post touched me and although I don't have specific medical information
for you  I would like to comment.  First of all I agree with Dr. Jack's post
about this.

I used to work as a diabetic educator a lot in my life as a nurse before
children.  The doctors want to be able to measure everything the diabetic
person eats to regulate the insulin.  Well, with a compliant adult that can be
possible, but even most adults do not adhere 100% to their diets.  I agree
completely that excellent control of diabets is the important goal and reduces
all the bad complications that can occur short and long term.  You should be
working to achieve the best control for Annie possible.

Now, before you even start to partially wean your 3 yr. old, please get a lot
of information about junvenile diabetes, specificially about the management of
diabetes in preschoolers.  Challenge your doctors to give you lots and lots of
reading material and a bibliography on the subject.    Go to the medical
library at your local hospital or university.  Get the persmission needed to
get in and use their facilities.  You are paying the doctors a lot and they
owe you ALL the information about the subject, not just their summary.  Talk
to the diabetic educator nurses, (more than one as they can have different
amounts of education ) and the dietitians that work with children with
diabetes.  Ask them about REAL cases and the problems regulating the diet and
insulin for a 3 year old.  Get the names and phone numbers of parents who have
had children this age with diabetes.  Find out everything you can. What
problems did they have?  How did they cope, manage their treatment, etc.? Call
the local chapter of the diabetes association.  Go to their meetings.

Also call La Leche League and ask for the names of other mothers who have had
young children that are still nursing with diabetes.  Talk with you Area
Professional Liaison Leader about communication techniques you can use when
talking with your doctors.  Many mothers have continued nursing children with
diabetes, and other chronic diseases when ordered to wean, and been happy they
did. Often the advantages to the child of continued breastfeeding is not being
given proper weight in considering the options. Ask your doctors if they have
worked with a nursing child with diabetes before, and then ask how many times.
They may have NO experience working with a nursing child.  "Rephrase" what
they say to you.  "Doctor, you are suggesting that my husband and I "consider"
weaning Annie. That is not an option for us at the present time.  What else
can you suggest?"  (This "rephrasing" way of talking, that the doctor has
presented you with a suggestion, rather than an order, and that you and your
husband have the right to make choices has worked wonders with many other
mothes--one in particular who had a child with major heart defects who had to
undergo multiple major surgeries throughout childhood.  Each time a procedure
or surgery needed to be done, they pressured her to wean.  With a gentle but
firm approach  they managed to find ways to work around her nursing and her
child has had the best results of any of their pediatric patients with similar
conditions, fewer complications and is growing better.)

What I think you will find is; it not easy to regulate the insulin of a small
child under any circumstances, because you cannot MAKE them eat the same
amounts, at exactly the same times every day.  What I am saying is that
weaning her will not necessarily result in you being able to regulate her
insulin precisely or easily.  It is not a quick, certain cure for that
problem.  Pre-schoolers are notorious for eating well one day and poorly the
next, being picky, refusing to eat certain foods they loved yesterday, or
refusing to eat at all sometimes.  This is another case of  some doctors not
familiar with breastfeeding, not liking it because they cannot control it or
measure it.

You may have to do some extra blood sugars on you little one to calculate her
doses, but  during this very stressful time, the stress reducing,
immunoligical, and nutritional value of nursign can be a great benefit for
both you and Annie.

Arm yourself with information!  Then make YOUR own decision and ask the
doctors to help you.  Make them do their homework and challenge them to do
their best for you.

Jane Bradshaw RN, BSN, IBCLC
LLLL and former APL of VA
Lynchburg, VA

Three yo was recently diagnoised with
 Juvenile Diabetes, the docs all want me to discontinue the morning feed
 because we are unable to calculate the sugar levels in the milk.  I'm hoping
 that some of you may be able to help us to continue till Annie is ready to
 stop.  Our nursing session usually lasts for twenty minutes.  And we only
 nurse once more late in the evening.  TIA.  Susan

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 End of LACTNET Digest - 9 Jan 1998 - Special issue