Just wanted to comment on the mother with diabetes whose blood sugars go
up when baby sleeps through a feeding on occasion.  I looked it up in
Lawrence, 5th edition: pp 516-17:  "The mean glucose value was 0.70
+/-0.11mg/g in diabetic women and 0.32+/-0.08mg/g in the reference
women.....the infants were noted to gain weight appropriately.....The
glucose elevations probably have little clinical significance to the
infant because glucose makes up only about 0.4% of the total energy
content."  I think it's safe to say that there is no concern for the baby
if he nurses and gets milk with slightly higher glucose levels.  I am more
concerned, however, about the effects of these spikes in the mother's
glucose on her own health.  It's probably not a major problem if it's a
very rare situation, but if it occurs fairly frequently, she could be at
increased risk of infections.  One option may be to pump when the baby
misses a feeding.  That way, she could lower her blood sugar somewhat.

I would also like to respond to Josefine's post with a reference about
increased risk of mastitis if the glucose levels are increased in the milk
("the insulin using mother needs to be taught how to maintain optimal
blood glucose values because higher blood glucose levels increase the
glucose content of the breast milk and puts the mother at risk for breast
infection." from "Breastfeeding and Diabetes" by Cathy Fagen, MA, RD, CDE,
Practical Diabetology, March 99.")  Although theoretically a mother with
diabetes would be at increased risk for mastitis because she is generally
at increased risk of infections if her sugars are not well controlled, I
was just wondering whether there have actually been data to show increased
rates of mastitis in these mothers.  I also wonder whether it's the
increased glucose levels in the milk which would predispose the breast to
mastitis (after all, according to the quote from Lawrence it appears to be
a very small amount of glucose in the milk), or whether there would be
some other mechanism.  I guess more research is needed in yet another
field related to lactation.  Regards, Alicia Dermer, MD, IBCLC.

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