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Subject:
From:
"Ruth Sweet, IBCLC, LLLL" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 29 Sep 1995 08:29:56 -0500
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I am concerned that we now seem to be using an infant's blood glucose level
to justify interventions that interrupt breastfeeding in much the same
manner that we used to use ac/pc (before feed/after feed) weights with the
old barely accurate scales.

Unless a tube of blood is analyzed in a lab, we do not have any way of
knowing an infant's true blood glucose.  The meters used by people with
diabetes are not designed to be used for neonates.  High hemoglobin causes
the strips and meters to give a glucose value lower than it actually is.  If
an adult had a BG of 40 they would be acting incoherent and would be on the
verge of needing another person's help at obtaining food.  (I usually can
perform the test and get myself some food if I get as low as 50, I don't
want to think about the few times that I may have been lower.)  Infants, on the other hand are fine with a BG of 40.  However, the meters are not as accurate
in the lower ranges.  I could give more detail, but the first problem is that
the instrument being used cannot give accurate information.

A second problem, is that user technique can greatly effect the result.
When the same meter is always used by the same person, we can be fairly sure
that the results will be usable.  e.g. a 120 result might actually be 100 or
140, and a 180 might actually be 150 or 200, but we know that the 120 is
always lower.  We cannot come to the same conculsions when we look at
results done by many different operators in a Hosp. Nursery.  I once trained
health professionals in use of the meters for the American Diabetes Association.We stopped the practice because of problems in obtaining accurate results
(and some other problems also).  Some of the quality control problems that
were present when I worked in a Hosp more than 5 years ago may have improved,
but the meters and strips are still the same.  I questioned each of the
companies, and none of them claimed to be able to give accurate results
for neonates.

If we see symptoms of hypoglycemia (jittery, very lethargic, seizures) we
need a lab draw and IV intervention.  I do not accept that we can other
wise use BG as an excuse for feeding ABM.  We don't need any reason at all
for bringing a baby to breast.

Somehow infant care areas jumped on this new technology but we need to look
at it more carefully and decide if what we are doing is appropriate.

A Diabetes Educator friend is looking into any change from what I know was
true 5 years ago.

Ruth Sweet of Verona, WI <[log in to unmask]>

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