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Connect the Dots: Insulin Resistance and Low Milk Supply — A Clinical Overview

  • Writer: Jennifer Gerard, APRN, FNP, IBCLC
    Jennifer Gerard, APRN, FNP, IBCLC
  • 6 days ago
  • 5 min read

Written by Jennifer Gerard, APRN, FNP, IBCLC | Medically Reviewed

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Insulin resistance is a metabolic condition in which cells respond less effectively to insulin, leading to higher circulating glucose and insulin levels. This state often precedes prediabetes and type 2 diabetes, and it is common in people of childbearing age, especially those with a history of gestational diabetes, polycystic ovary syndrome (PCOS), obesity, or metabolic syndrome.


Emerging clinical evidence suggests that metabolic factors—including insulin resistance—may contribute to suboptimal lactation outcomes, such as delayed onset of copious milk production (lactogenesis II) and reduced overall milk volume.


How Insulin and Glucose Metabolism Relate to Lactation


During pregnancy and early lactation, the maternal body undergoes substantial metabolic adaptations. Glucose is a primary fuel for both fetal development and milk synthesis, and the mammary gland becomes metabolically active as part of lactation physiology.

Research has found that insulin and insulin-sensitive pathways are upregulated during the lactation cycle, playing a role in breast tissue differentiation and milk production. Conversely, metabolic dysregulation—such as that seen in insulin resistance—may impair these processes.


Additionally, observational studies indicate that people who have gestational diabetes, a condition closely linked with insulin resistance, are more likely to experience difficulties with timing and volume of milk production compared with those without glucose intolerance.


Who Is at Higher Risk of Insulin Resistance?


Risk factors for insulin resistance include:

  • History of gestational diabetes

  • Obesity or elevated body mass index

  • PCOS or other endocrine disorders

  • Family history of type 2 diabetes

  • High triglycerides or low HDL cholesterol


These factors often occur together and can influence insulin sensitivity before, during, and after pregnancy.


Signs That May Suggest Insulin Resistance


Common clinical indicators include:

  • Acanthosis nigricans (darkened skin patches, particularly on the neck)

  • Skin tags

  • Menstrual irregularities

  • Earlier than expected return of menstrual cycles postpartum


These signs warrant further evaluation, especially if present along with lactation challenges. Comprehensive metabolic assessment should be guided by a healthcare provider.


Evaluation and Clinical Testing


If insulin resistance is suspected, the following tests may be considered:


  • Fasting plasma glucose

  • Fasting insulin

  • Hemoglobin A1C

  • Calculated insulin sensitivity indices (e.g., HOMA-IR)


These measurements help quantify glucose metabolism and guide appropriate management. Interpretation of results should be individualized and correlated with clinical context.


Management Considerations


Addressing insulin resistance often involves a multimodal approach:


  • Nutrition and lifestyle interventions aimed at improving insulin sensitivity

  • Physical activity to promote glucose utilization

  • Medical therapy when indicated (e.g., metformin under clinician supervision)

  • Integrated lactation support to optimize breastfeeding techniques, frequency, and infant latch


Some evidence suggests that improving insulin sensitivity may support metabolic health and overall lactation performance, though individual responses vary. Any medication or supplement should be discussed with a healthcare provider experienced in both metabolic and lactation medicine.


Balancing Lactation and Metabolic Health


Importantly, lactation itself may favorably influence maternal glucose metabolism. Observational data show that higher intensity and longer duration of breastfeeding are associated with improved insulin sensitivity and lower fasting insulin levels postpartum, particularly after pregnancies complicated by gestational diabetes.


Clinical Summary


  • Insulin resistance is a metabolic condition with potential implications for milk production mechanisms.

  • Evidence suggests associations between metabolic dysregulation and lactation timing or volume, but individual lactation outcomes are multifactorial.

  • Risk assessment, testing, and personalized clinical care are essential when evaluating persistent low milk supply alongside metabolic concerns.


If low milk supply persists despite optimized lactation support—or if you have signs or risk factors for insulin resistance—a comprehensive clinical assessment with both metabolic and lactation expertise is recommended.


This content is for educational purposes only and does not replace individualized medical advice, diagnosis, or treatment. Families with concerns about milk supply should consult a qualified healthcare provider or lactation specialist. This article is supported by evidence-based clinical guidelines and medical literature. Additional references are available on our Resources page.


 📌 Evidence-Based Resources


The following resources provide additional evidence-based guidance on the medical evaluation and management of low milk supply.


These references are provided for educational purposes and reflect current evidence-based medical guidance. They do not replace individualized medical care.

Frequently Asked Questions

  • Can insulin resistance cause low milk supply?

    Insulin resistance has been associated with delayed or reduced milk production in some breastfeeding parents. Insulin plays a role in mammary gland development and milk synthesis, and impaired insulin signaling may affect these processes. However, low milk supply is multifactorial, and insulin resistance is only one possible contributing factor.

  • How does insulin affect milk production?

    Insulin supports glucose uptake and cellular metabolism, both of which are important for milk synthesis. Research suggests that insulin sensitivity in breast tissue increases during lactation. When insulin signaling is impaired, milk production may be less efficient in some individuals.

  • What are signs that insulin resistance might be contributing to low milk supply?

    Possible signs include persistently low milk output despite adequate breastfeeding or pumping support, delayed onset of copious milk production, early return of menstrual cycles postpartum, or physical signs such as acanthosis nigricans or skin tags. These signs are not diagnostic and should be evaluated by a healthcare professional.

  • Can improving insulin resistance help increase milk supply?

    Addressing insulin resistance may support overall metabolic health and, in some cases, improve lactation outcomes. Management may include nutrition counseling, physical activity, and medical treatment when appropriate. Results vary, and improving insulin sensitivity does not guarantee increased milk supply.

  • Is it safe to treat insulin resistance while breastfeeding?

    Many approaches to managing insulin resistance are compatible with breastfeeding, but any medication or supplement should be discussed with a healthcare provider who is knowledgeable about both metabolic health and lactation.

  • Does breastfeeding affect insulin resistance?

    Breastfeeding itself may have a beneficial effect on glucose metabolism. Studies suggest that longer duration and greater intensity of breastfeeding are associated with improved insulin sensitivity postpartum, particularly in individuals with a history of gestational diabetes.

  • When should someone seek professional help for low milk supply?

    If low milk supply persists despite appropriate feeding support, or if there are known risk factors for metabolic or hormonal conditions, a comprehensive clinical evaluation is recommended. This may include both lactation assessment and medical testing.



🩺 Need help evaluating supply issues or need pumping tips for low supply? I offer holistic lactation consults and Breastfeeding Medicine virtual visits that combine evidence-based care with functional testing, including screening for insulin resistance, when needed.


Jennifer Gerard, APRN, FNP, IBCLC, PMH-C


Jennifer Gerard, FNP, IBCLC is a Family Nurse Practitioner and International Board Certified Lactation Consultant specializing in breastfeeding medicine and complex lactation care through virtual consultations.



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