Breastfeeding & Hypoglycemia (Low blood sugar)
Breastfeeding can cause a drop in blood glucose levels. To avoid going hypo, have a snack (containing protein and carbohydrates) and some fluids either before or during nursing. Keeping a non-perishable snack stash in baby’s room or your regular nursing spot can help during those middle-of-the-night feedings. You may even consider setting up a small portable fridge for cold drinks and food here also to lessen any temptation to skip the snack at that 2 a.m. feeding. In addition, keep some glucose tablets or other fast-acting sugars within reach in case of a hypoglycemic emergency.

Medicine and Breastfeeding
Although regular insulin injections by mom pose no risk to breastfeeding infants, certain diabetes medications and other over-the-counter and prescriptions drugs do pass into breastmilk in varying amounts. In some cases the benefits of breastfeeding may outweigh any negative impact of medication in breastmilk, or there may be an alternate, safer prescription available. Consult with your doctor or pharmacist about your current prescriptions in advance to decide what’s best for you and baby.

Rest
Some women find that the hormonal changes their bodies go through when breastfeeding help to prevent blood sugar highs and give them better control. However, other women with diabetes find they have difficulty keeping the same tight management of their blood sugars when nursing. Why? One reason may be that being a new mom is a high stress, low rest job, and stress is notorious for sending blood sugars off the deep end. Try napping when baby naps, and you’ll be able to make up some of that lost sleep. It may be tempting to catch up on laundry or housework during this respite, but don’t do it. Your body needs the time more than your house does right now.

Finally, breastfeeding is worth all the trouble as it is the best food designed by our Creator God for babies.

This article is courtesy of Dr Dicky Ng, a Wellness Physician from a private hospital in Penang.

Breastfeeding in mothers with diabetes

Breastfeeding is good for women with diabetes, but it may make blood sugar a little harder to predict. During the first weeks at home with baby, mothers are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood sugar is a real danger. It’s important for baby’s safety to avoid blood sugar reactions that could confuse the diabetics. For all of the above reasons, it is important to check blood glucose often during this time. And the records of blood glucose levels will help the patients and healthcare professionals to adjust their medications.

To help prevent low blood sugar levels due to breastfeeding:
• Plan to have a snack before or during nursing.
• Drink enough fluids. Plan to sip a glass of water or a caffeine-free drink while nursing.
• Keep something to treat low blood sugar nearby when you nurse, so you don’t have to stop a feeding to treat low blood sugar.

Women who breastfeed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose. You will need to work with your doctor and dietitian to adjust your meal plan while you are nursing.

Because women with diabetes have the extra challenge of managing their disease through diet, meals can be somewhat of a balancing act. If you can, meet with a registered dietitian before the birth to set up an action plan for eating right and losing that pregnancy weight at a safe rate.

Why breast is best?

You’ve heard breastfeeding beats formula hands down, but you wonder if nursing will cause your diabetes to spin out of control, or worse yet, harm the health of your baby.
Rest easy. Women with diabetes can and do breastfeed with great success. And the great news is that clinical research has shown that mother’s milk may even lessen the chances of passing on diabetes. Babies who breastfeed at least three months have a lower incidence of type 1 diabetes, and are less likely to become obese as adults. And some research has linked early exposure to cow’s milk and cow’s milk-based formula to the development of type 1 diabetes, another good reason to nurse your child.

Clinical studies have also shown that women who breastfeed after a bout with gestational diabetes demonstrate improved pancreatic beta-cell function, which may lessen their chances of developing diabetes later in life. A history of gestational diabetes is a risk factor for the development of type 2 diabetes.

Breastfeeding is also protective for the children who are at-risk for type 2 diabetes.

This article is courtesy of Mr. Ng Chee Eng, Paediatric Surgeon of a private hospital in Penang.

TONGUE TIE & NURSING

QUESTION

Mothers of babies with this condition have difficulties in breastfeeding because of sore nipples. This condition is diagnosed by lactation consultant and paediatrician. Currently, are paediatric surgeons still performing the procedure to snip the part of the tongue to enable breastfeeding? What are involves? Does the baby has to go under general anaesthesia (GA)? Other than breastfeeding problems, will the baby have problems with his speech later on?

ANSWER

Whether a tongue tie needs to be released / snipped depends on its severity and whether it is causing any problems.

Latching on to the nipple/breast and breast feeding can be difficult if not impossible with a severe tongue tie. Release is then clearly justified and during the first few weeks of life, it can be done without any anesthesia and without any distress to the baby. However if the membrane (frenulum) that holds the tongue down is thick, then release will need to be under GA because of the risk of bleeding. All older children are done under GA.

Regarding speech, again it depends on the severity of the tongue tie. Some of these children may mispronounce certain syllables. However it must be said that the vast majority of children with tongue ties speak normally. Tongue tie that is detected very early but did not cause any problems like breast feeding, should not be released until he/she is much older, maybe even at 2 to 3 years old. The tip of the tongue does become longer and the underlying membrane / frenulum may recede with the child’s growth. If there is still a speech problem, release is indicated but even then I always caution the parents that the speech may not improve. They are always advised to seek a Speech Therapist’s assessment and advice.

There is also another indication for release of a severe tongue tie even when there are no problems with feeding or speech and that is to allow the tongue greater movement and mobility within the mouth. This is important for purposes of mouth hygiene as they are able to sweep the inside of the mouth of food debris.

The Japanese / Koreans / Chinese – I think what is happening is that the the parents want their children to speak better English by lengthening the children’s tongues. These children have normal tongues to start with. I am very doubful if it works and I will certainly not do it even at the request of the parents.

In summary, release of tongue tie is only justified in severe cases especially if there are difficulties with it. Generally a severe tongue tie is one that the tongue is unable to protrude beyond the lips. In newborns, some of them can’t even protrude beyond the gum margin.

I hope I have answered your queries about this fascinating subject.

Ng C.E.