Breast feeding and
blood glucose:
finding the balance
Dr Martin Ward Platt
The Newcastle upon Tyne Hospitals
NHS
Foundation Trust
Is there a “balance”?
Benefits of breast feeding
Versus
Possible harm from
hypoglycaemia?
• ormal physiology & context
• Implications for practice
• ormal physiology & context
• Implications for practice
ormal physiology & context:
This is about
HEALTHY, TERM Babies
Consider 2 crises for baby
• Birth
• Delayed maternal lactation
Crisis #1: Birth
[glucose]
2
4
Hours
Crisis #2:
Delayed maternal lactation
lactation
1
2
4
Days
Birth
[glucose]
2
4
Hours
The ‘glucose paradox’:
Clinically normal baby,
But…
hypoglycaemia
So what fuels the baby’s
brain?
Stress of birth
Protein breakdown
lactate
Liver
Glucose
Lactate
Pyruvate
Plenty of oxygen &
glucose;
supply = demand
Protein
CO2
Energy
Glucose
Liver
Energy
Pyruvate
Lactate
Short of oxygen, OK
for glucose;
Lactate produced
Protein
CO2
Energy
Liver
Glucose
Lactate
Pyruvate
Short of glucose,
OK for oxygen;
Lactate consumed
Protein
CO2
Energy
Crisis #2:
Delayed maternal lactation
lactation
1
2
4
Days
How to cope?
Glycogen running out …
Protein breakdown slowing down …
Hormonal control
Fat breakdown
Ketones
Fat
Glucose
Liver
Ketones
Pyruvate
Lactate
Protein
OK for oxygen
Short of glucose
Low lactate
Fat is a fuel
CO2
Energy
Maternal
lactation
Infant ketones
1
2
4
Days
In lactational failure …
Fat
Glucose
Liver
Ketones
Lactate
Pyruvate
Protein
OK for oxygen
Short of glucose
Starvation …
CO2
Energy
Crisis #2:
Some babies may not cope
< 36 weeks
Very small for GA
‘Wasted’
Inf. of [gestational] diabetic
Likely to be dependent on glucose
• ormal physiology &
context
• Implications for practice
Evidence for “2.6 mmol/l”
• Evoked potentials
• Epidemiology
“2.6 mmol/l” …
in absence of other fuels
So: how to find the balance?
Most breast fed babies never
need, and should never have,
a blood glucose measurement
All breast fed babies need
close, constant, physical
contact with their mothers
Some breast fed babies (high
risk) need some measurements
#1
Blood glucose is not the whole
story …
Remember lactate & ketones
#2
Consider context …
How many hours old?
Don’t measure too early
#3
Leave well grown, term,
breast fed babies alone
#4
Measure only where high-risk
• Prem
• Small (< 2nd or 3rd centile)
• Wasted
• [Gestational] Diabetes
#4
Focus on high-risk babies
• Prem
• Small (< 2nd or 3rd centile)
• Wasted
• [Gestational] Diabetic mum
#5
“Clinical” evaluation:
OT staring at baby
OT measuring glucose
Assess Level of
Consciousness
#6
Restrict glucose measurement
• Do, x 1 or x 2 for ‘high-risk’
• Do, if Level Of Consciousness #7
Restrict glucose measurement
When baby is OK, back off
Thank you