Hi All,

 

I have permission to post.

 

Mom had complete hysterectomy several years ago.  Has adopted 2 babies – 2nd
one is 6 months old – she got him just a couple months ago.  She is BF with
an SNS using ABM.  She started on an inducing lactation protocol 3 ½ months
ago taking 90mg of Domperidone per day.  She also took Goat’s Rue and
Fenugreek.  She felt breast changes, grew 1 cup size, felt the tingling
sensations – everything she was told to expect.  But – no milk.  

 

Mom has type 2 diabetes that was no longer responding to insulin shots so
Docs started her on oral meds but told her she’d have to wean NOW and that
the meds she was taking were contraindicated (and dangerous)  with BF.  She
started oral meds 2 days ago and is doing much better.  She was also told
that she is insulin resistant.  Here are the meds she is taking and what we
discussed:

 

Metformin – she is to work up to 1000mg twice a day    Risk Category L1 –
safe.  She was relieved and has no issue with this drug and BF.

 

Glipizide – 10mg 3 times per day   Risk Category L3 – moderately safe
molecular wt is 446

 

Lisinopril – 5mg per day  Risk Category L3 – moderately safe – dose is tiny
– avg dose is 20-40 mg per day – molecular wt is 442.  

 

 

Questions:  

1)       Is the lack of a milk supply due to complete hysterectomy, insulin
resistance or both?  

 

2)       Given that currently there is no milk supply to speak of what is
the harm of continuing to BF this baby?  He is getting 100% ABM and the
benefit of the BF relationship.  

 

3)       When her blood sugars are brought back into a normal range will the
insulin resistance correct itself and a milk supply begin to come in?  If
yes – then is there a serious risk to baby with the Glipizide or Lisinopril
– taking into consideration that she may never have a 100% supply of her
own…but then again she might…  If no – we need to know so she can stop
taking the domperidone and enjoy what she has now.

 

4)       Should she continue to take the Domperidone to assist the milk
supply with all these other factors?

 

5)       Mom really wants to BF this baby – she was unable to BF the first
baby and very much is enjoying the relationship she has with #2 – and wants
to give this baby HER own milk as a bonus to what she is already doing.

 

 

I really want to find a way to help her BF this child – her milk and all –
if at all possible.  My understanding of the situation says that she should
(if she wants to) continue taking the Domperidone and her meds and let the
milk come in if it is going to come in…But – then again, diabetes in NOT my
specialty and I know next to nothing about insulin resistance and BF after a
complete hysterectomy.  I am looking for an education.  :-)

 

Thank you!  Please e-mail privately and to the list…

 

Warmly,

Jaye Simpson, IBCLC, CIIM

 

 

 

 

 

 


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