Glucose and amino acid turnover in untreated gestational diabetes.
OBJECTIVE
Although gestational diabetes affects as many as 3% of all pregnant women, specific aspects of glucose and protein metabolism in this population have not been clearly delineated. We tested the hypothesis that gestational diabetes mellitus (GDM) results in increased glucose production and proteolysis during fasting.


METHODS
Using tracer isotope infusions, the rate of appearance (Ra) of glucose, leucine, phenylalanine and tyrosine, phenylalanine hydroxylation, leucine oxidation, and urea nitrogen excretion were determined after an overnight fast in 10 GDM subjects, within 2 weeks of diagnosis and before initiation of treatment, and in a matched control group of nine healthy nondiabetic pregnant women.


RESULTS
Fasting glucose Ra was similar in GDM patients and control subjects (GDM, 12.8 +/- 1.1 vs. control subjects, 12.8 +/- 0.9 mumol . kg-1 . min-1). Leucine and phenylalanine Ra (reflecting proteolysis) also were not different between GDM patients and control subjects (GDM leucine Ra, 128 +/- 14 vs. control subjects, 124 +/- 5; phenylalanine Ra GDM, 35 +/- 4 vs. control subjects, 40 +/- 2 mumol . kg-1 . h-1). Furthermore, leucine oxidation and phenylalanine hydroxylation were not increased in GDM subjects, urea nitrogen excretion was actually lower in GDM patients. However, fasting insulin concentrations were significantly elevated in GDM subjects (GDM, 165 +/- 35 vs. control subjects, 30 +/- 5 pmol/l; P < 0.01).


CONCLUSIONS
Hepatic glucose release and whole-body proteolysis in GDM patients were remarkably similar to matched pregnant control subjects. This was achieved with insulin concentrations three- to fivefold higher than normal, suggesting significant insulin resistance for both glucose and protein metabolism in GDM.
Zimmer
D M
DM
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis 46202-5210, USA.
Golichowski
A M
AM
Karn
C A
CA
Brechtel
G
G
Baron
A D
AD
Denne
S C
SC
D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism*; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D002151:Calorimetry; D002245:Carbon Dioxide / Q000032:analysis; D002247:Carbon Isotopes; D016640:Diabetes, Gestational / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D007930:Leucine / Q000378:metabolism; D010101:Oxygen Consumption; D010649:Phenylalanine / Q000378:metabolism; D011247:Pregnancy; D012016:Reference Values; D012044:Regression Analysis
D000596:Amino Acids; D001786:Blood Glucose; D002096:C-Peptide; D002247:Carbon Isotopes; D007328:Insulin; D002245:Carbon Dioxide; D010649:Phenylalanine; D007930:Leucine; D005947:Glucose