ENERGY-INTAKE AND GLYCEMIA IN LACTATING WOMEN WITH TYPE-1 DIABETES

Objective To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes. Des ign A prospective observational study conducted at 2, 3, 6, 14, 42, an d 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood g lucose concentrations and glycated hemoglobin [HbA(1c)] values) are de scribed for women with type 1 diabetes. Dietary intake, weight, and la ctation onset for women with type 1 diabetes are compared with those w ithout the disease. Subjects/setting Fourteen lactating women with typ e 1 diabetes and 25 women without diabetes (control subjects) were rec ruited from private obstetrician offices and high-risk prenatal clinic s at 3 major medical centers. Statistical analyses A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum. Results Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hy perglycemia. Their HbA(1c) levels increased by 20%, confirming relativ e hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than contro l subjects. Average insulin dose was returned to prepregnancy levels o f 45.3+/-3.6 U/d (least square means+/-standard error of the mean) by 1 week. Application Achieving desired metabolic control during the est ablishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with t ype 1 diabetes is needed.