I would like to point out that not all oral hypoglycemics are
contraindicated during breastfeeding.  Indeed, maybe none of them are
really, but some are pretty safe.

Metformin, as I have put on lactnet several times, does not cause lowering
of sugar in non diabetics (like the baby, duh).  That's what the company
literature says.

Most of the sulfonylureas (tolbutamide, glyburide) pass into the milk in
only very small concentrations.  Since the baby gets only tiny amounts, and
gets it with food, the chances of hypoglycemia are very very low.  Probably
better to avoid long acting drugs, though, such as chlorpropamide.

Acarbose would be the ideal hypoglycemic.  Only 2% oral bioavailability, and
of that probably none would get into the milk because of its large molecular
weight.

Troglitazone has high protein binding and molecular weight, and likely safe
for that reason.

I should point out, though, that for many of these drugs no *clinical* data
in breastfeeding babies is available.

Jack Newman, MD, FRCPC

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