medwireNews: A small Danish study in breastfeeding women with long-term type 1 diabetes could provide useful information on which insulin pump settings to use after childbirth.
Six-day continuous blood glucose monitoring (CGM) at 1, 2, and 6 months after childbirth in up to 12 women revealed median basal insulin rates that were approximately 14% lower during full or predominant breastfeeding than before pregnancy, while median carbohydrate-to-insulin ratios were around 10% higher.
Women who exclusively or predominantly breastfed at least six times per day maintained good glycemic control, with insulin pump settings mostly remaining stable, and there was a low prevalence of hypoglycemia during breastfeeding, the researchers report in Diabetes Technology and Therapeutics.
At each 6-day CGM recording period, breastfeeding women spent a median of at least 70.8% of the time in the glucose target range of 4 to 10 mmol/L and spent no more than 3.8% of the time below the target of 4 mmol/L both over 24 hours and at nighttime only.
Furthermore, median glycated hemoglobin (HbA1c) levels a year before pregnancy in the 13 women originally recruited into the study were similar to levels in the eight women who still exclusively or predominantly breastfed at 6 months, at 52 and 58 mmol/mol, respectively.
The researchers add: “It is reassuring that none of the women experienced severe hypoglycemia, and on average mild hypoglycemia occurred twice weekly with an appropriate HbA1c level.”
Nonetheless, the proportion of time spent with median glucose levels below 4.0 mmol/L did increase to 15.5% at nighttime and to 13.6% over a period of 24 hours in certain cases.
The study recruited 13 women on insulin pump therapy who had lived with type 1 diabetes for a median of 22 years and included 12 women who were exclusively or predominantly breastfeeding (≥ six times/day) at 1 month, 11 who breastfed at this level at 2 months, and eight who did this at 6 months.
The women were recommended a personalized diabetes diet with a minimum of 210 g of daily total carbohydrate to prevent ketonemia during breastfeeding and were encouraged to continue normal daily life during each 6-day CGM recording period without changing breastfeeding, food, or exercise patterns. The insulin pump target glucose level during breastfeeding was 5.8 mmol/L.
Reporting their findings, Sidse Nørgaard (Rigshospitalet, Copenhagen) and colleagues conclude: “These data are useful when recommending insulin pump settings after delivery until further studies are available.”
By Anita Chakraverty
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