My daughter has had diabetes since she was 10 years old. Six weeks ago, she delivered a healthy baby girl. She has breast fed this whole time. However, we are running into big problems with low blood sugars. She tests all of the time, but, unfortunately, she crashes unexpectedly. Last weekend, we found her in the middle of the night having seizures in bed. Since she has already breast fed for six weeks, would it harm the baby to begin formula? She has supplemented with Enfamil when she did not produce enough milk.

First of all, congratulations on the new baby!

Many babies have been bottle fed with formula and are quite healthy. If your daughter enjoys breast feeding, it is the preferred method of feeding babies as long as there are no problems. Your daughter should be able to breast feed and control her blood sugars. Breast feeding can lower the blood sugar as the baby literally eats some of the sugar the mother would normally use. Some women find that their blood sugars can drop rapidly during or after breast feeding. Also, insulin requirements may be lower for a while after pregnancy than before pregnancy unrelated to nursing. Of course, your daughter shouldn’t nurse if she can’t avoid serious low blood sugars.

She should speak to her doctor about changing her insulin to avoid these lows. She might find that she needs an extra snack either before, during, or after breast feeding. Also, she probably should be checking her blood sugar during the night to make sure it isn’t going low. Even if someone else gives the baby a bottle during the night so the mom can sleep, she is still continually making breast milk (and using up sugar) so her blood sugar may drop while she sleeps. If your daughter wants the baby to get one bottle a day so she can sleep, if possible, try not to make that bottle during the night (when most women want it). This way, she will have to wake up during the night to feed the baby and can test her blood sugar before and after nursing. Many women actually prefer to give the supplemental bottle during the evening, when the father is often home. Usually mothers are the most tired in the evening, and make the least amount of milk in the evening. If the baby gets a supplemental bottle in the evening, he/she may sleep a little longer allowing the mother the rest during the evening and first part of the night. This might make the nighttime feed go faster if mom has more milk stored up. Dad can still change the diaper and rock the baby if he/or she is crying so mom can go right back to sleep after she feeds the baby.

If it is too stressful to nurse the baby, or if your daughter can’t regulate her blood sugars, go to bottle feeding. The most important thing for the baby is to have a mom who feels well and is as rested as possible.

TGL