Theresa, have you seen this article? It's very informative in regard to
hypoglycemia and gives a good review of the literature plus the metabolism
in the postnatal period (in normal term and preterm infants). Maybe someone
else has also read it and can also share their views????

Sara Bernard
The Netherlands
(ps I have it on my computer if you want a copy)

HYPOGLYCEMIA AND THE BREASTFED NEONATE
Arthur I. Eidelman MD
Pediatric Clinics of North America
Volume 48 . Number 2 . April 2001

"Early postnatal feeding of human milk enhances gluconeogenesis and energy
balance by providing gluconeogenic amino acid precursors, such as alanine,
long-chain fatty acids which initiate the transcription of carnitine
palmitoyltransferase,[45] an enzyme essential for ketogenesis, and a
disaccharide (lactose), which minimizes insulin secretion. In contrast,
feeding glucose water (5%-10%) in the immediate postnatal period increases
insulin secretion, decreases glucagon secretion, and delays the initiation
of the natural gluconeogenesis and ketogenic homeostatic processes.
The pattern of metabolic adaptation of breastfed infants has been studied
best by Hawdon et al.[21] In a well-designed, prospective study of term,
breastfed and bottle-fed infants, they found that the serum glucose
concentrations were significantly lower (mean, 3.6 mmol/L; range, 1.5-5.3
mmol/L) in breastfed infants compared with formula-fed infants (mean, 4.0
mmol/L; range, 2.5-6.2 mmol/L). Because 1 mmol of glucose equals 18 mg, this
is equivalent to a mean of 58 mg/dL and a range of 27 to 95 mg/dL in
breastfed infants and a mean of 72 mg/dL and a range of 45 to 111 mg/dL in
formula-fed infants. Although this phenomenon has been termed suckling
hypoglycemia, none of the breastfed infants were symptomatic despite the
fact that 12% had measured glucose concentrations of less than 2.6 mmol/L.
Most importantly, however, was that the breastfed infants responded to the
low blood glucose concentrations with a significantly increased production
of gluconeogenic substrates (i.e., lactate; pyruvate; alanine; and, most
important, ketone bodies). Of no less interest was that multiple regression
analysis correcting for postnatal age and method of feeding showed that only
the interval between the feeds was correlated with glucose concentration--an
observation that supports the importance of frequent feeding. These data
support the need for continuous mother-infant contact in the postnatal
period, which facilitates frequent, on-demand nursing periods and guarantees
adequate metabolic fuels for cerebral function.[42] "

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