Our two year old child has recently been diagnosed. He is still breast feeding, as well of course as eating normal meals. We are wondering how to judge the effect of this on his diet and insulin.

I’m guessing that your question relates to the inability to “see” how much your child is taking in when he’s breastfeeding, thus adding a degree of difficulty to managing the balance between food and insulin. In most children who are eating table foods, milk intake (including breastfeeding) tends to drop off to a more minor component of nutrition by age two. Because breastfeeding is driven by a feedback mechanism, mom’s milk supply will wax and wane based on the amount of sucking that takes place. As children eat a wider variety of foods, they tend to suck less because they’re getting the calories they need elsewhere. If this happens, the milk supply falls off in response.

The best way to tell of your son is getting enough breast milk at a feeding to raise blood glucose is to do some extra blood testing, before and after eating or nursing, to see what’s actually happening. Review the values with records of the other foods he’s eating and the timing and doses of insulin. If there is a consistent inappropriate rise in glucose after breastfeeding, then your son is still getting enough milk from this source to require some additional insulin. If you haven’t already learned how to modify insulin doses to fine tune control, take that data to your diabetes team so you can all work on the problem together.

Although breastfeeding has enormous benefits up to a year of age, the benefits after that age are less tangible. Teeth are nature’s sign that it’s time to move on to other foods, from a nutritional standpoint. But in older infants and toddlers, the benefits to mother and child may be more emotional than physical anyway. If breastfeeding still is a positive experience for mom and baby, diabetes is no reason to stop. Monitoring and minor insulin adjustments should allow you to keep control. Keep in mind, however, that the day will be coming fairly soon when the expanding activity level and interests of a two-year old take their toll on breastfeeding.

BB