Diurnal variations in blood intermediary metabolites in mild gestational diabetic patients and the effect of a carbohydrate-restricted diet

Abstract

Twenty-four hour metabolic profiles were performed in the third trimester of pregnancy in seven non-diabetic women (group A) and in two groups of mild gestational diabetics, at diagnosis (group B, seven patients) and after treatment with a 150-g carbohydrate diet (group C, seven patients). Mean 24-h blood metabolite levels (+/- SD) in groups A, B and C were: glucose: 4.65 +/- 0.82, 5.35 +/- 3.06 and 5.40 +/- 1.7 mmol/l; alanine: 1.05 +/- 0.18, 1.14 +/- 0.42 and 0.78 +/- 0.22 mmol/l; alanine: 0.31 +/- 0.03, 0.31 +/- 0.10 and 0.27 +/-0.07 mmol/l; ketone bodies: 0.11 +/- 0.04, 0.19 +/- 0.05 and 0.26 +/- 0.15 mmol/l. Glucose levels were not significantly different between the groups. Ketone body levels were elevated in the diabetics prior to treatment (p less than 0.01) and rose higher on diet. Lactate levels were reduced on the diet (0.05 less than p less than 0.10). Abnormalities in the concentrations of total blood ketone body levels in gestational diabetics may be detrimental to fetal development and therapy should be designed to minimise changes in intermediary metabolites.

Prediction of Infant Birth Weight by GDM Screening Tests: Importance of plasma triglyceride

“…GDM screening might be refined by measuring metabolic fuels in addition to glucose because diabetes is a disorder of all circulating fuels (12)(13)(14). For example, infant birth weight is predicted not only by maternal plasma levels of glucose (15)(16)(17)(18)(19), but also by maternal amino acid (20,21) and free fatty acid concentrations (22,23).…”

Ketone Bodies in Diabetes Mellitus: Friend or Foe?

“…On the other hand, in the study conducted by Mijatovic [134], a mean intake of 165 g of CHO/day was not associated with detectable urinary ketone levels in women with GDM. Similarly, Potter and associates [135] failed to reveal differences in the urinary ketone levels between women with GDM on an LCD compared to untreated ones. Based on these findings, several scientists are advocating for lowering the dietary CHO threshold for managing GDM [138], whereas others are suggesting considering the placental CHO needs and increasing the threshold to 220 g of CHO/day [139].…”

“…Potter [135] n = 7 non-diabetic women (A) n = 7 women with mild GDM at diagnosis (B), and n = 7 women with mild GDM post-treatment with a 150 g CHO diet (C) CC N/A Glucose levels were indifferent between groups. Ketone body levels were elevated in the GDM group prior to treatment (B) and rose higher after treatment with the 150 g CHO diet (C).…”

Low energy diets in the treatment of gestational diabetes

“…Although studies of diet and insulin therapy in gestational diabetes have been published (Coustan & Lewis, 1978;Potter et al 1982) these generally lack satisfactory end points for assessing the effect of treatment or suffer from selection bias. We have, therefore, in a randomised prospective study, compared the metabolic effect of treatment with diet alone and diet and insulin in women with impaired glucose tolerance in pregnancy.…”