Assessment of therapy in gestational diabetes by substrate and hormone responses to a standardized test meal.
Postprandial substrate and hormone responses to a standard mixed meal (400 kcal) was determined at two occasions, A and B, in 11 women with gestational diabetes (GDMs) and 11 normoglycaemic controls, matched for age, body mass index, and gestational age. Levels of circulating glucose, non-esterified fatty acids (NEFA), glycerol, 3-hydroxybutyrate (3-HBA), individual amino acids, insulin, and C-peptide were analysed. A was performed when GDMs were considered inadequately controlled with diet alone, B later during gestation following initiation of insulin therapy because of hyperglycaemia. Fasting glucose, glycerol, total and individual amino acids (alanine, valine, isoleucine, leucine), insulin, and C-peptide were not different from normal during A and B, neither were postprandial amino acid levels. During test A, GDMs had elevated fasting and postprandial 3-HBA (p < 0.001), greater postprandial rise of glucose (p < 0.001), elevated NEFA (p < 0.05), but normal and parallel decreases of NEFA and glycerol. Insulin and C-peptide responses were delayed and prolonged. During B, GDMs had higher glucose response (p < 0.005), higher fasting 3-HBA (p < 0.02) but similar and parallel decreases of NEFA, glycerol, and 3-HBA as controls. The C-peptide response was not significantly different from normal; insulin response was higher (p < 0.05). In conclusion, the relative insulin deficiency characterizing GDMs, also when treated with insulin, is associated with selected defects in insulin action; mainly affecting glucoregulation, whereas suppression of lipolysis and proteolysis remain normal.
Nord
E
E
Department of Woman and Child Health, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Hanson
U
U
Persson
B
B
D020155:3-Hydroxybutyric Acid; D000293:Adolescent; D000328:Adult; D000596:Amino Acids / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood* / Q000628:therapy*; D003927:Diet, Diabetic; D002149:Energy Intake; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005865:Gestational Age; D005990:Glycerol / Q000097:blood; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood* / Q000627:therapeutic use; D019518:Postprandial Period; D011247:Pregnancy; D012016:Reference Values; D013997:Time Factors
D000596:Amino Acids; D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D007004:Hypoglycemic Agents; D007328:Insulin; D005990:Glycerol; D020155:3-Hydroxybutyric Acid