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Connect the Dots: Low Milk Supply and Insulin Resistance

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Did you know insulin resistance and low milk supply are related? In this first topic of our "Connect the Dots" series, you'll learn how the two are connected to get meaningful insight into a common cause for low milk supply!

Insulin, secreted by the pancreas, helps glucose move into your cells where it can be used for energy. In insulin resistance, the insulin is not able to get into the cells as it should and the body compensates by producing more and more insulin. Eventually the insulin receptors on the cells get overloaded and become resistant. If not managed, the pancreas can wear out from continually dumping more and more insulin into the system and, as a result, can progress to type 2 diabetes.

So what does this have to do with breastfeeding?

Lactating women with insulin resistance may experience low milk supply. Prenatally, healthy insulin levels promote breast development and after delivery insulin levels are a key factor milk production. Ideally, the insulin receptors in the breast become very sensitive to insulin when it's time to start making milk. When insulin resistance is present, milk production is hindered, milk comes in later and overall supply tends to be lower. Lactating women with insulin resistance are also at risk for premature weaning or breastfeeding cessation earlier than planned.

Who is at risk for insulin resistance?

Up to 40% of adults 18-44 are insulin resistant. This means a significant proportion of women of childbearing age are likely insulin resistant regardless of feeding method. If you have a family history of diabetes or personal history of gestational diabetes, you are at risk. Other factors associated with insulin resistance include: PCOS, BMI >25, impaired prenatal OGTT, high triglycerides, low HDL cholesterol and high blood pressure.

What are some signs and symptoms of insulin resistance?

Some signs and symptoms commonly seen in insulin resistance include: dark patches on your skin (especially back of neck and under breasts), skin tags and menstrual irregularities. And, speaking of cycles, if your period returns sooner than expected after having your baby, this can be a sign of underlying insulin resistance.

How to test for insulin resistance?

All women experiencing low milk supply should be tested for insulin resistance. In addition, all women with PCOS (regardless of feeding method) should also be routinely tested because of the high prevalence of insulin resistance. General testing includes a fasting glucose, fasting insulin and a hemoglobin A1C. The HOMA-IR score is a calculation using glucose and insulin values and can determine degree of insulin resistance. The lower the score the better and goal is <1. Values >1 indicate some degree of insulin resistance is present and this needs prompt attention and management. Your health care provider or lactation medicine provider can usually help you get proper testing. If not, there are many avenues to self-order labs on your own without provider involvement.

How is insulin resistance treated?

In the short term, often milk supply will continue to decline until underlying insulin resistance is addressed. So the sooner you know the better and more effective management strategies will be. Efforts made to improve insulin sensitivity like lifestyle changes, exercise and nutrition modifications will improve insulin sensitivity long term. In addition to lifestyle improvements, herbs like Goat's Rue, prescription Metformin, Myo and D-Chiro Inositol and other supplements can also improve insulin sensitivity. Talk to your IBCLC or health care provider if you are thinking about adding supplements to your plan.

What happens if insulin resistance goes untreated?

Up to 70% of people with insulin resistance (or pre-diabetes) will progress to diabetes if left untreated. Early testing and management is so important for long term health whether you are breast-feeding or not!

What if I already have insulin resistance? Is it reversible?

Yes! In most cases, with efforts made to improve insulin sensitivity, you can slow (or prevent progression) to diabetes. The earlier it is identified and managed, the better!

In conclusion, there is a significant connection between insulin resistance and low milk supply. Fortunately, with identification and management you can get your supply back on track AND improve your overall health. If you are experiencing low milk supply, despite efforts to improve lactation management, and/or think you might have insulin resistance, please reach out to your health care provider or connect with a Lactation Medicine provider for testing sooner rather than later. If you don't have a local provider you are working with or want a medical investigation for persistent low supply, please reach out

and I'm happy to help!

Information presented is educational only and not to be taken as medical advice. If you have specific questions or concerns, let’s do a video visit and talk about it!

Jennifer Gerard, APRN, FNP, IBCLC


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