From the Guidelines
Diabetic patients taking lactation-inducing drugs should be closely monitored for potential interactions with diabetes medications and blood glucose control, and their healthcare provider should be informed immediately. The primary concern with diabetic patients taking lactation-inducing drugs is the potential for these medications to interfere with blood glucose control or interact with diabetes medications, as they are not approved for diabetes management 1. Some key points to consider include:
- The risk of overnight hypoglycemia may increase with lactation, and insulin dosing may need to be adjusted 1
- Breastfeeding medications like domperidone can affect heart rhythm and may be especially risky for diabetic patients with cardiovascular complications
- Metoclopramide can alter gastric emptying, potentially affecting how quickly carbohydrates are absorbed and impacting blood glucose levels
- Patients should not discontinue their prescribed diabetes medications but should inform their healthcare provider about the consumption of lactation-inducing drugs so appropriate monitoring and adjustments can be made if necessary The most recent and highest quality study, from 2022, supports the idea that lactation can have benefits for both mother and offspring, but also highlights the need for careful management of diabetes during this time 1. In terms of specific actions, patients should:
- Monitor their blood glucose levels more frequently for 24-48 hours after ingestion of lactation-inducing drugs
- Report any unusual symptoms like dizziness, irregular heartbeat, or significant blood sugar fluctuations to their doctor
- Inform their healthcare provider about the accidental consumption of lactation-inducing drugs so appropriate monitoring and adjustments can be made if necessary.
From the FDA Drug Label
Good glucose control supports lactation in patients with diabetes. Patients with diabetes who are lactating may require adjustments in insulin dose and/or diet.
The effects of a diabetic patient taking lactation-inducing drugs are not directly addressed in the label. However, lactation is supported by good glucose control in diabetic patients.
- Key points:
- Diabetic patients who are lactating may require adjustments in insulin dose.
- Diabetic patients who are lactating may require adjustments in diet.
- Good glucose control is essential to support lactation. 2
From the Research
Effects of Lactation Inducing Drugs on Diabetic Patients
- There is limited research on the effects of lactation inducing drugs on diabetic patients. However, studies have investigated the impact of breastfeeding on diabetes management and the safety of antidiabetic medications during lactation 3, 4.
- Breastfeeding has been suggested to reduce the incidence of type 2 diabetes mellitus, the metabolic syndrome, and cardiovascular disease in mothers 3.
- For diabetic mothers, antidiabetic treatment itself may affect breastfeeding, and insulin is currently considered the optimal antidiabetic treatment during lactation 3, 4.
- Some oral hypoglycemic agents, such as tolbutamide, may be used during breastfeeding, but the infant should be monitored closely for signs of jaundice 4.
- Metformin, a commonly used antidiabetic medication, has been shown to be effective in lowering blood glucose levels without increasing the risk of hypoglycemia 5, 6, but its safety during lactation is not well established.
- Early breastfeeding has been found to facilitate glycaemic stability in infants born to women with gestational diabetes 7.
Safety of Antidiabetic Medications During Lactation
- The American Academy of Pediatrics recommends tolbutamide as the preferred oral hypoglycemic agent during the breastfeeding period 4.
- Insulin is considered safe during lactation, and the required dose is likely to be substantially reduced during breastfeeding 4.
- The safety of other antidiabetic medications, such as metformin, during lactation is not well established, and more research is needed to determine their safety and efficacy in this population 5, 6.