Lisa wrote
> Does anyone know of any studies that correlate maternal glucose level with what >the milk glucose level is at the same time? I have a neonatologist who is >questioning this. We realize that milk is produced throughout the rise and fall of a >diabetic mom's levels but wonder if there is any correlation of the mom's levels to >a potentially lower milk glucose level. 

No studies that I am aware of that look at direct correlations between
mothers BSL and milk glucose - this type of data would probably not be
very meaningful as milk glucose does not provide an  energy source of
any note, but is the precursor for lactose which is the main energy
source and would be of the most interest. There a couple of studies
that might provide  information you seek related to this.

Neubauer, SH et al. 1993. Delayed lactogenesis in women with insulin
dependant diabetes mellitis. Am J Clin Nutr. 58:54-60.

Butte, N et al. 1987. Milk composition of Insulin dependent women. J
Pediatr Gastoenterol Nutr 6:936-41.

Bitman et al. 1989. Milk composition and volume during onset of
lactation a diabteic mother. Am J Clin Nutr. 1364-9.

Arthur et al 1993 Metabolites of lactose synthesis in milk from
diabetic and non-diabetic women during lactogenesis II. J Pediatr
Gastoenterol Nutr 19:100-108.

Briefly, onset of lactogenesis II (biochemical changes asssociated
with milk coming in) is delayed but by Day 4 milk glucose and lactose
in IDDM mothers was similar or higher than non diabetics.
Biochemically it was shown (Arthur et al.) that the lactose synthetic
pathway in IDDMs appears impaired at this time causing this temporary
delay. In established lactation IDDMs appear to have an increased milk
glucose, sodium and nitrogen conc'n and decreased lactose compared to
non diabetics. Specifically the glucose concentrations (milk) varied
greatly during 24 hours with no apparant pattern, however, although
lower, lactose remained fairly stable (lactose is the main contributor
of CHO energy in milk, not glucose) and all these babies gained weight
appropriately.

There is also a very large section in Lawrence discussing a much
broader view of lactation and diabetes which may give a good overview
for the neonatologist to read.

Cheers
Cathy Fetherston CM PhD IBCLC
Perth, Western Australia.

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