Today, a nurse from nursery called me as a baby's mother ask her if she can breastfed her baby while she's on insulin daily doses. I looked up at LactMed and found the profile of Insulin
No specific information exists on the newer biosynthetic insulins (i.e., aspart, detemir, glargine glulisine, lispro) during breastfeeding. In general, mothers with diabetes using insulin may nurse their infants. No adverse reactions have been reported due to insulin in breastmilk. In fact, insulin in breastmilk may decrease the risk of type 1 diabetes in breastfed infants.[1][2]
Insulin requirements are reduced postpartum in women with type 1 diabetes. In one study, insulin requirements were lower than prepregnancy dosage only during the first week postpartum: 54% of prepregnancy dosage on day 2 and 73% on day 3 postpartum. On day 7 postpartum, insulin dosage returned to prepregnancy requirements.[3] Another study found that dosage requirements did not return to normal for up to 6 weeks in some mothers.[4] A third study found that at 4 months postpartum, patients with type 1 diabetes who exclusively breastfed had an average of 13% lower (range -52% to +40%) insulin requirement than their prepregnancy requirement.[5] A study in mothers without diabetes who were 12 to 18 months postpartum found that prolonged breastfeeding improved glucose tolerance by improving peripheral glucose utilization.[6]
A small, well-controlled study of women with type 1 diabetes mellitus using continuous subcutaneous insulin found that the average basal insulin requirement in women with type 1 diabetes who breastfed was 0.21 units/kg daily and the total insulin requirement was 0.56 units/kg daily. In similar women who did not breastfeed, the basal insulin requirement was 0.33 units/kg daily and the total insulin requirement was 0.75 units/kg daily. The 36% lower basal insulin requirement was thought to be caused by glucose use for milk production.[7]
Lactation onset occurs later in patients with type 1 diabetes than in women without diabetes, with a greater delay in mothers with poor glucose control.[3][8] Mothers with type 1 diabetes also discontinue nursing at a higher rate during the first week postpartum.[9][10] Once established, lactation persists as long in mothers with diabetes as in mothers without diabetes.[8][11] However, as in women without diabetes, smoking has a strong negative impact on lactation among mothers with type 1 diabetes.[5][12] Other factors that have been identified as causes of shorter duration of breastfeeding among type 1 diabetic patients are more frequent caesarean sections and earlier delivery.[13]
Insulin requirements are reduced postpartum in women with type 1 diabetes. In one study, insulin requirements were lower than prepregnancy dosage only during the first week postpartum: 54% of prepregnancy dosage on day 2 and 73% on day 3 postpartum. On day 7 postpartum, insulin dosage returned to prepregnancy requirements.[3] Another study found that dosage requirements did not return to normal for up to 6 weeks in some mothers.[4] A third study found that at 4 months postpartum, patients with type 1 diabetes who exclusively breastfed had an average of 13% lower (range -52% to +40%) insulin requirement than their prepregnancy requirement.[5] A study in mothers without diabetes who were 12 to 18 months postpartum found that prolonged breastfeeding improved glucose tolerance by improving peripheral glucose utilization.[6]
A small, well-controlled study of women with type 1 diabetes mellitus using continuous subcutaneous insulin found that the average basal insulin requirement in women with type 1 diabetes who breastfed was 0.21 units/kg daily and the total insulin requirement was 0.56 units/kg daily. In similar women who did not breastfeed, the basal insulin requirement was 0.33 units/kg daily and the total insulin requirement was 0.75 units/kg daily. The 36% lower basal insulin requirement was thought to be caused by glucose use for milk production.[7]
Lactation onset occurs later in patients with type 1 diabetes than in women without diabetes, with a greater delay in mothers with poor glucose control.[3][8] Mothers with type 1 diabetes also discontinue nursing at a higher rate during the first week postpartum.[9][10] Once established, lactation persists as long in mothers with diabetes as in mothers without diabetes.[8][11] However, as in women without diabetes, smoking has a strong negative impact on lactation among mothers with type 1 diabetes.[5][12] Other factors that have been identified as causes of shorter duration of breastfeeding among type 1 diabetic patients are more frequent caesarean sections and earlier delivery.[13]
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1. Shehadeh N, Gelertner L, Blazer S et al. Importance of insulin content in infant diet: suggestion for a new infant formula. Acta Paediatr. 2001;90:93-5. PMID: 11227343
2. Shehadeh N, Shamir R, Berant M et al. Insulin in human milk and the prevention of type 1 diabetes. Pediatr Diabetes. 2001;2(4):175-7. PMID: 15016183
3. Stanley K, Fraser R, Bruce C. Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycemic clamp technique. Br J Obstet Gynaecol. 1998;105:756-9. PMID: 9692417
4. Davies HA, Clark JD, Dalton KJ, Edwards OM. Insulin requirements of diabetic women who breast feed. BMJ. 1989;298:1357-8. PMID: 2502253
5. Stage E, Norgard H, Damm P, Mathiesen E. Long-term breast-feeding in women with type 1 diabetes. Diabetes Care . 2006;29:771-4. PMID: 16567813
6. Da Costa TH, Bluck LJ. High lactation index is associated with insulin sensitivity. J Nutr Biochem. 2010. PMID: 20655718
7. Riviello C, Mello G, Jovanovic LG. Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocr Pract. 2009;15:187-93. PMID: 19364685
8. Neubauer SH, Ferris AM, Chase CG et al. Delayed lactogenesis in women with insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993;58(1):54-60. PMID: 8317390
9. Ferris AM, Dalidowitz CK, Ingardia CM et al. Lactation outcome in insulin-dependent diabetic women. J Am Diet Assoc. 1988;88(3):317-22. PMID: 3279099
10. Hummel S, Winkler C, Schoen S et al. Breastfeeding habits in families with type 1 diabetes. Diabet Med. 2007;24:671-6. PMID: 17403118
11. Schoen S, Sichert-Hellert W, Hummel S et al. Breastfeeding duration in families with type 1 diabetes compared to non-affected families: results from BABYDIAB and DONALD studies in Germany. Breastfeed Med. 2008;3:171-5. PMID: 18778212
12. Knudsen A, Pedersen H, Klebe JG. Impact of smoking on the duration of breastfeeding in mothers with insulin-dependent diabetes melllitus. Acta Paediatr. 2001;90:926-30. PMID: 11529544
13. Sorkio S, Cuthbertson D, Barlund S et al. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev. 2010;26:206-11. PMID: 20474068
2. Shehadeh N, Shamir R, Berant M et al. Insulin in human milk and the prevention of type 1 diabetes. Pediatr Diabetes. 2001;2(4):175-7. PMID: 15016183
3. Stanley K, Fraser R, Bruce C. Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycemic clamp technique. Br J Obstet Gynaecol. 1998;105:756-9. PMID: 9692417
4. Davies HA, Clark JD, Dalton KJ, Edwards OM. Insulin requirements of diabetic women who breast feed. BMJ. 1989;298:1357-8. PMID: 2502253
5. Stage E, Norgard H, Damm P, Mathiesen E. Long-term breast-feeding in women with type 1 diabetes. Diabetes Care . 2006;29:771-4. PMID: 16567813
6. Da Costa TH, Bluck LJ. High lactation index is associated with insulin sensitivity. J Nutr Biochem. 2010. PMID: 20655718
7. Riviello C, Mello G, Jovanovic LG. Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocr Pract. 2009;15:187-93. PMID: 19364685
8. Neubauer SH, Ferris AM, Chase CG et al. Delayed lactogenesis in women with insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993;58(1):54-60. PMID: 8317390
9. Ferris AM, Dalidowitz CK, Ingardia CM et al. Lactation outcome in insulin-dependent diabetic women. J Am Diet Assoc. 1988;88(3):317-22. PMID: 3279099
10. Hummel S, Winkler C, Schoen S et al. Breastfeeding habits in families with type 1 diabetes. Diabet Med. 2007;24:671-6. PMID: 17403118
11. Schoen S, Sichert-Hellert W, Hummel S et al. Breastfeeding duration in families with type 1 diabetes compared to non-affected families: results from BABYDIAB and DONALD studies in Germany. Breastfeed Med. 2008;3:171-5. PMID: 18778212
12. Knudsen A, Pedersen H, Klebe JG. Impact of smoking on the duration of breastfeeding in mothers with insulin-dependent diabetes melllitus. Acta Paediatr. 2001;90:926-30. PMID: 11529544
13. Sorkio S, Cuthbertson D, Barlund S et al. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev. 2010;26:206-11. PMID: 20474068
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