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Diabetes and lactation
Lactation is the term that describes the secretion of the milk from the mammary gland and the time period a mother usually feeds her young ones. In humans, lactation is also named as breastfeeding. Breastfeeding to young ones have various benefits such as to provide nourishment, in development of immune system and also provides various health benefits to mother and infant (8). My research is related to diabetes and lactation. Diabetes mellitus is a metabolic disorder characterized by deranged glucose homeostasis. There are mainly two forms of diabetes. Type 1 diabetes (T1D) which is caused due to insulin deficiency and type 2 diabetes(T2D) which is caused due to insulin resistance. It was found that breastfeeding also have influence on diabetes. Lactation seems to be altered in diabetic women and many studies also reported the altered milk composition in diabetic women (2,3,5). The diabetic women also feeds their babies as often as normal women . So it makes important to determine the milk composition in diabetic women. The objective of this research is to determine the volume and milk composition in diabetic women including lipids, glucose, lactose, sodium, potassium, chloride, calcium, magnesium and total protein during 3-7 d postpartum period. This period selected because in diabetic women lactogenesis mainly starts at 3 day of postpartum. Milk will be collected from diabetic and nondiabetic mothers. Volume of milk will be recorded and other milk components will be examined using different separation techniques such as chromatography. We will compare the diabetic women milk with the nondiabetic mother.
Background: Breastfeeding has various advantages both for diabetic mother and babies. As the mother who usually breastfeed have improved glycaemic control and can reduce their requirements for insulin. Breastfeed babies also have reduced risk of T1D and T2D. Longer duration of breastfeeding also reduces the risk of diabetes in women (8). So this mutual advantages orient the focus towards the milk composition in diabetes to make it sure that it is healthy for neonatal development. Milk composition vary among different species as in case of humans, milk contains very high concentration of lactose and oligosaccharides and very low concentration of protein. Fat is the variable component in each lactation (4). In diabetes, studies reported the altered lactation as well changes in milk composition. One study found higher concentration of sodium and glucose in diabetic women but concentration of other minerals found to be in normal ranges (3). Neubauer et al founds that lower lactose and higher nitrogen in the milk of diabetic women indicating delayed lactogenesis (5,6). Lipid metaboliosm also founds to be altered in the mammary gland of diabetic womens that alters the milk composition . Some animals rats and goats in which induced hyperglycaemia decreases the milk yield (2) .One study found that changes in metabolite concentration in milk after birth responsible for delay lactogenesis. This research found reduced concentration of lactose in milk from day 1 to day 3 as well as reduce concentration of glucose from day 1 to day 3 which suggest that low uptake of glucose by mammary gland contribute to the low synthesis of lactose and delayed lactogenesis (1). Delayed lactogenesis in diabetic women also linked to poor metabolic control. In humans, many hormones like prolactin, placental lactogen plays an important role in the secretion of milk and milk delivery to offspring but study founds low level of prolactin, parathormone which affect the milk production and secretion in diabetic women (3).
Specific aim of the research: To determine the volume and milk composition during 3-7 d postpartum period including lipids, glucose, lactose, sodium, potassium, chloride, calcium, magnesium and total protein and comparison to milk composition of the control subjects.
Research design: i) Selection of pregnant subjects with diabetes and non diabetic conditions who wants to breastfeed after the delivery and also get informed consent approval. Subjects will be chosen that are aged between 25-30 year and of one race.
ii) After delivery, milk samples will be collected from the subjects by breast pumping as well as blood samples will also be collected to determine whether there is any relationship in the concentration of milk glucose and plasma glucose.
iii) Volume of the milk will be measured by using graduated cylinder and will be recorded.
iv) Samples will be further analysed to determine the milk composition.
v) Results obtained from diabetic women will be compared with control subjects.
vi) Milk samples will be kept at 4° C and some samples will be frozen at -80° C for further analysis.
vii) Various techniques will be used for the measurement of milk composition. Such as first lipids will be extracted from the milk specimens and then will be determined by thin layer chromatography. Fatty acids will be determined by gas liquid chromatography. Sodium, calcium and magnesium will be measured by calorimetric procedures and the proteins by the BCA assay(2).
Hypothesis: It will be hypothesized that at the onset of milk, volume will be low in diabetic women as compared to control. It will also be hypothesized that milk composition will found to be altered in diabetic women.
Specific aim 2: Delayed lactogenesis and lower lactose concentrations in diabetic mothers milk was reported by various studies. So we will determine the concentrations of metabolites involved in lactose synthesis in milk from diabetic and non diabetic women to find out the association with delayed lactogenesis. Milk samples will be deproteinized and and lactose will be analysed by spectrophotometric method. Other metabolites like glucose, glucose 1 phosphate, glucose 6 phosphate, UDPglucose, UDP galactose will be measured by using bioluminescent methods(1).
- Arthur PG (1994) Metabolites of lactose synthesis in milk from diabetic and nondiabetic women during lactogenesis ll. Journal of pediatric gastroenterology and nutrition 19: 100-108
- Bitman J et al (1989) Milk composition and volume during the onset of lactation in a diabetic mother. American society for clinical nutrition 50: 1364-9
- Butte NF et al (1987) Milk composition of insulin dependent diabetic women. Journal of pediatric gastroenterology and nutrition 6:936-941
- Hartmann PE et al(1998) Homeostatic mechanisms that regulate lactation during energetic stress. American society for nutritional sciences: 394-399
- Neubauer SH et al(1990) Lactation in insulin dependent diabetes. Prog food nutr sci14(4): 333-70
- Neubauer SH(1993) Delayed lactogenesis in women with insulin dependent diabetes mellitus. American society for clinical nutrition 58: 54-60
- Steube AM et al (2005) Duration of lactation and incidence of type 2 diabetes. JAMA 295(20): 2601- 2610
- Stuebe A (2007) Breastfeeding and diabetes- benefits and special needs. Diabetes voice 52: 26-29
Project significance/ outcomes:
Breastfeeding and lactation have advantages both for mothers and babies. So the opportunity to determine the milk composition in one specific race and one definite age group proves to be useful for diabetic breastfeed mothers as well as proves to be implacable in clinical purposes. The findings will also open way for future research and new discoveries.
We will use first three months ( march, april, may) selection of diabetic and nondiabetic patients and collection of milk samples. Then next three months will be used for the determination of various milk components in milk using various specified techniques. Next three months will be used to determine the concentration of metabolites of lactose synthesis. After that when the results will be obtained and compared with the control one ,focus will be on the thesis compilation.