Good summary. I should point out that a fat soluble drug can still be highly protein bound and thus not pass readily into the milk. The way you wrote it, it sounds as if the two are mutually exclusive. The usual situation that I see at least, of women "requiring" oral hypoglycemics is that their blood sugars are taking a while to come down after delivery. Women in the reproductive age group only very occasionally have the sort of diabetes requiring oral hypoglycemics. Thus, the oral hypoglycemics are ordered because the physician has pity on the mother and decides it is better to give oral hypoglycemics than continue insulin which the mother used during pregnancy. However, the requirement for hypoglycemic medication is usually very short (weeks at the most), and thus, I usually suggest the mothers continue insulin rather than fiddling with oral hypoglycemics. Thus they don't have to worry about these drugs and whether they can breastfeed. Jack Newman, MD, FRCPC