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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. © 1997 John Wiley & Sons, Ltd.