Effect of prolonged oral terbutaline therapy on glucose tolerance in pregnancy.
OBJECTIVE
Our objective was to elucidate the pathophysiologic effects and potential reversibility of terbutaline-induced changes in carbohydrate metabolism.


METHODS
We prospectively evaluated serum glucose, insulin, glucagon, C-peptide, and pancreatic polypeptide levels in response to a 100 gm glucose challenge (oral 3-hour glucose tolerance test) in 17 obstetric patients without complications who were given terbutaline (5 mg orally every 4 hours) for 5 consecutive days between 24 and 32 weeks' gestation. Each patient served as her own control, with day 1 representing pretreatment, day 7 the treatment phase, and day 14 the posttreatment evaluation. Body mass index and posttreatment serum terbutaline levels were also measured.


RESULTS
A significant initial treatment effect (day 1 versus 7) was observed for glucose (elevated), insulin (elevated), insulin/glucose ratio (elevated), and pancreatic polypeptide (elevated). A significant delayed treatment effect (day 1 versus 14) was also observed for insulin (elevated), insulin/glucose ratio (elevated), and pancreatic polypeptide (elevated). Body mass index directly correlated with postchallenge measures of insulin, insulin/glucose ratio, pancreatic polypeptide, and C-peptide. Posttreatment serum terbutaline levels directly correlated with pancreatic polypeptide, but not with other parameters.


CONCLUSIONS
Our data support a dose-independent, terbutaline-induced glucose intolerance mediated by glucagon and caused by diminished insulin sensitivity.
Foley
M R
MR
Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus.
Landon
M B
MB
Gabbe
S G
SG
O'Dorisio
T M
TM
Waxman
M
M
Leard
R
R
Iams
J D
JD
D000284:Administration, Oral; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000139:chemically induced; D005260:Female; D005934:Glucagon / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D010191:Pancreatic Polypeptide / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D013726:Terbutaline / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D010191:Pancreatic Polypeptide; D005934:Glucagon; D013726:Terbutaline