Post-partum hypoglycaemia in lactating women with type 1 diabetes: a pilot study using continuous glucose monitoring

Authors

  • Berit Inkster Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK
  • Jacqui Elder Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Scotland, UK
  • Claire Alexander Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Scotland, UK
  • Louise Osborne Diabetes Centre, Victoria Hospital, Kirkcaldy, Scotland, UK
  • Nicola N Zammitt Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK
  • Brian M Frier Department of Diabetes, Royal Infirmary of Edinburgh, Scotland, UK

DOI:

https://doi.org/10.15277/bjdvd.2015.026

Abstract

Aims: To observe glucose profiles in post-partum women with type 1 diabetes with a particular focus on hypoglycaemia.


Methods: Post-partum women with type 1 diabetes were studied for 4 weeks using home blood glucose monitoring (HBGM) and continuous glucose monitoring (CGM). Episodes of hypoglycaemia were documented using self-reported questionnaires.

Results: Of 15 consenting participants, only six women completed the study, four of whom breastfed their baby. HBGM was performed a median of 7 times per day. No severe hypoglycaemia (requiring third party assistance) occurred, but a median of 17 (range 10–23) episodes of mild hypoglycaemia occurred. In all participants, CGM revealed several episodes of hypoglycaemia that were not detected by capillary blood glucose testing.

Conclusions: Asymptomatic hypoglycaemia is common during breastfeeding. Recruitment and retention difficulties illustrate the challenge of studying glycaemia and intensive interventions in the post-partum period. Education programmes may help to reduce post-partum hypoglycaemia in women with type 1 diabetes.

References

Taylor R, Davidson JM. Type 1 diabetes and pregnancy. BMJ 2007;334:742-5. http://dx.doi.org/10.1136/bmj.39154.700417.BE

Van Beusekom CM, Zeegers TA, Martini IA, et al. Milk of patients with tightly controlled insulin-dependent diabetes mellitus has normal macronutrient and fatty acid composition. Am J Clin Nutr 1993;57:938-43.

Achong N, Duncan EL, McIntyre D, Callaway L. Peripartum management of glycemia in women with type 1 diabetes. Diabetes Care 2014;37:364-71. http://dx.doi.org/10.2337/dc13-1348

Riviello C, Mello G, Jovanovic LG. Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocr Pract 2009;15:187-93. http://dx.doi.org/10.4158/EP.15.3.187

Soltani H, Dickinson FM, Kalk J, Payne K. Breast feeding practices and views among diabetic women: a retrospective cohort study. Midwifery 2008;24:471-9. http://dx.doi.org/10.1016/j.midw.2007.04.005

Stage E, Norgard H, Damm P, Mathiesen E. Long-term breast-feeding in women with type 1 diabetes. Diabetes Care 2006;29:771-4. http://dx.doi.org/10.2337/diacare.29.04.06.dc05-1103

Saez-de-Ibarra L, Gaspar R, Obesso A, Herranz L. Glycaemic behaviour during lactation: Postpartum practical guidelines for women with type I diabetes. Pract Diabet Int 2003;20:271-5. http://dx.doi.org/10.1002/pdi.529

Gagne MP, Leff EW, Jefferis SC. The breast-feeding experience of women with type 1 diabetes. Health Care Women Int 1992;13:249-60. http://dx.doi.org/10.1080/07399339209516000

Sparud-Lundin C, Berg M. Extraordinary exposed in early motherhood-a qualitative study exploring experiences of mothers with type 1 diabetes. BMC Women's Health 2011;11:10. http://dx.doi.org/10.1186/1472-6874-11-10

UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007;50:1140-7. http://dx.doi.org/10.1007/s00125-007-0599-y

Gold A, MacLeod KM. Frequency of severe hypoglycaemia in patients with type 1 diabetes with impaired awareness of hypoglycaemia. Diabetes Care 1994;17:697-703. http://dx.doi.org/10.2337/diacare.17.7.697

Murtaugh MA, Ferris AM, Capacchione CM, Reece EA. Energy intake and glycemia in lactating women with type 1 diabetes. J Am Diet Assoc 1998;98:642-8. http://dx.doi.org/10.1016/S0002-8223(98)00147-3

Pedersen-Bjergaard U, Pramming S, Heller SR, et al. Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab Res 2004;20:479-86. http://dx.doi.org/10.1002/dmrr.482

Pramming S, Thorsteinsson B, Bendtson I, Binder C. Symptomatic hypoglycaemia in 411 type 1 diabetic patients. Diabetic Med 1991;8:217-22. http://dx.doi.org/10.1111/j.1464-5491.1991.tb01575.x

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Published

2015-09-01

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Original Research

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