Is it possible to mix breastfeeding and basal rates?

Adjusting to life with a new baby can be exhausting at the best of times however throw a type 1 diabetic, breast feeding mother into the mix and the game becomes even more gruelling.

I’d spent nine months fine tuning my blood glucose levels with the Hutt hospital diabetic team to ensure our newest family member arrived safe and healthy. My insulin requirements increased during my pregnancy and towards the end I was taking 70 units of insulin a day, almost double what I’d take before I was pregnant but as I held our little man for the first time, everything changed. As expected overnight my insulin requirements dropped drastically. We were prepared and reduced my carbohydrate ratios (how many grams of carbohydrate one unit of fast-acting insulin will cover), basal rates (the rate of continuous insulin needed to keep blood glucose level) and insulin sensitivity factor (the number of points one unit of fast-acting insulin lowers your blood glucose). I thought I was one step ahead. Take that diabetes!

I woke in the middle of the night sweating and convinced I had squashed my baby, even though I could see him fast asleep in the crib next to me. Why was I wide awake? Why did my body feel so heavy? Why was I scared? The penny finally dropped – my blood sugars were low (2.4 mmol/L – 43 mg/dL). Okay diabetes you won this round.

The next morning we tweaked my medication again. I’d hoped to be sent home that day but the consensus was I shouldn’t be discharged until we had my blood sugars under control, with no more hypos. At times it was hard to tell without testing whether my blood sugars were low or it was the tramadol I’d been prescribed for pain relief that made me feel disorientated and sleepy. I quickly stopped taking it. A new baby, hypos and constantly feeling spaced-out is never a good mix.

Four days after our little man was born I was sent home. Now the fun begins!

With a bit of forward planning and insulin adjustments type 1 diabetics can navigate their way through most things unscathed, but throw breastfeeding into the mix and you face a whole set of different challenges. Feeding a new baby, on-demand is so unpredictable it felt almost impossible to avoid the drop in blood sugar levels after each feed. I couldn’t reduce my basal rates or carb ratios to combat this because every day was different. Surviving on broken sleep, caring for a new baby and being smashed by constant daily hypos was a recipe for disaster. I had to do something!

I was so glad I’d bought a Freestyle Libre glucose monitor from Australia and smuggled it into the country. With a simple swipe of the sensor I knew my blood sugar levels. This was invaluable as I was testing a lot! Before meals, before feeds, after feeds and before bed. Using the Libre I was able to test my blood sugars while carrying a crying, wriggly baby. A task that would have been that much harder if I’d been using my Caresens metre that requires a drop of blood and therefore two hands to calculate my blood sugar levels.

Carrying a hungry baby while testing my blood sugars, preparing food and counting the carb content was an uphill battle. So when our little man slept (which didn’t happen all that often in the early months) or in the evening when my husband was home I’d prepare and carb count a variety of snacks to get me through each feed, especially the night feeds. (I wanted to make sure my head hit the pillow as soon as our little man gave into sleep.)

With the swipe of my sensor I knew my blood sugar levels and with a little trial and error (like so many things diabetes related) I knew what kind of snack I needed to combat the expected drop in sugars. Sometimes I got this wrong and would either reach for more food or correct with extra insulin. During these first few months I was mentally prepared to run my blood sugars a little higher than normal to avoid going low.

My go-to snacks were:

  • 150g fresh cut strawberries = 6g carbs

  • 1 x pot of Fresh and Fruity light yoghurt = 7-8 g carbs, depending on flavour

  • 4 x crackers with cheese = 15g carbs

  • Juice box:

  • Small = 18g carbs

  • Large = 26g carbs

Before I knew it our little man was three months old and we had found our rhythm. I could predict when he would sleep and feed (as much as that’s possible with a baby). Breast feeding no longer knocked me around and the hypos settled down. My premade, carb counted snacks are still within arm’s length, because baby or not, people living with diabetes know that managing it can be as unpredictable as New Zealand’s weather. Summer can’t be too far away?!