Metabolic adaptation to feeding and fasting during lactation in humans

The aim of these studies was to determine the metabolic adaptation to fasting and feeding during lactation. Normal lactating (L) and nonlactating (NL) women (n = 6 each) were studied using infusions of [U-13C]glucose and [2-13C]glycerol during: 1) a 24-h fast, and 2) ingestion of Sustacal (protocol 1). In addition, 8 L and 6 NL women were studied during infusion of [6,6-2H2]glucose and ingestion of a glucose meal containing [1-13C]glucose (protocol 2). Protocol 1: Glucose production rate (GPR) during fasting was 33% higher in the L women (12.5 +/- 1.0 vs. 9.4 +/- 0.5 micromol x kg(-1) x min(-1); P < 0.03). Fractional gluconeogenesis (GNG), GNG rate, glucose, lactate, beta- hydroxybutyrate, FFA, insulin, and C-peptide were similar in both groups during feeding and fasting, but glycogenolysis was 50% higher in fasting L women. Protocol 2: Although GPR was slightly increased in the L group (L, 1.8 +/- 0.2 micromol x kg(-1) x min(-1); NL, 1.2 +/- 0.2 micromol x kg(-1) x min(-1); P < 0.04), no other differences were observed in splanchnic and systemic metabolism of ingested glucose between L and NL women. Insulin concentrations were lower in L women compared with controls (L, 15 +/- 3 microU/ml; NL, 28 +/- 6 microU/ml; P = 0.05). In conclusion, the increased glucose demands of lactation are met by increased GPR as a result of increased glycogenolysis but not GNG or by increased use of FFA. During feeding, lactating women handle oral carbohydrates normally but have increased insulin sensitivity.