Longitudinal changes in basal hepatic glucose production and suppression during insulin infusion in normal pregnant women

Catalano, Patrick M.; Tyzbir, Elaine D.; Wolfe, Robert R.; Roman, Noreen M.; Amini, Saeid B.; Sims, Ethan A. H.

doi:10.1016/s0002-9378(12)80011-1

Cited by 176 publications

(140 citation statements)

References 14 publications

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“…In nondiabetic women, the increase in insulin resistance with advancing gestation is almost twofold greater than increases in basal hepatic glucose production. 24 It is likely that women with T2DM, who do not need insulin preconception, have better endogenous reserves accounting for lower requirements in the fasting state. However, after a glucose load, compensation to overcome the increased insulin resistance is inadequate, resulting in relatively higher prandial requirements.…”

Section: Discussionmentioning

confidence: 99%

Effect of pregnancy on insulin requirements differs between type 1 and type 2 diabetes: A cohort study of 222 pregnancies

Padmanabhan

Jiang

McLean

et al. 2016

Aust NZ J Obst Gynaeco

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Background: Knowledge about expected insulin requirements during pregnancy, in women with pre-existing diabetes may assist clinicians to effectively respond to gestation-specific changes in glycemic pattern. Few studies have examined differences between type 1 (T1DM) and type 2 diabetes (T2DM). Aims: To compare patterns of insulin requirements in pregnancy for women with pre-existing T1DM and T2DM. Women with T1DM had a net fall in insulin requirements (3.7% in the first trimester and 4.1% in the late third trimester) while those with T2DM did not. Conclusions: This is the largest comparison study of insulin requirements in women with pre-existing diabetes, highlighting important trimester-specific differences between T1DM and T2DM to guide insulin titration during pregnancy. Our findings suggest a differential effect of pregnancy-mediated insulin resistance by type of diabetes.

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Section: Discussionmentioning

confidence: 99%

Effect of pregnancy on insulin requirements differs between type 1 and type 2 diabetes: A cohort study of 222 pregnancies

Padmanabhan

Jiang

McLean

et al. 2016

Aust NZ J Obst Gynaeco

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“…Consequently, the insulin response to oral carbohydrate is elevated and basal insulin production increases, producing an overall 2-3-fold rise in mean insulin concentrations over any 24 h period. 58,59 The naturally insulin resistant state of late pregnancy provides an adaptive mechanism, supplying sufficient fuel to support the placenta and fetal development. A state of normal insulin sensitivity is restored in the immediate puerperium.…”

Section: Maternal Metabolism During Pregnancymentioning

confidence: 99%

“…This profound insulin resistance produces a pathological response, resulting in maternal hyperinsulinaemia, hyperglycaemia and gestational diabetes mellitus. [58][59][60] Exaggerated hyperlipidaemia also occurs during obese pregnancy. VLDL concentrations are increased compared with normal pregnancy and the appearance and oxidation of small LDL particles is characteristic.…”

Section: Maternal Metabolism During Pregnancymentioning

confidence: 99%

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

Dennedy

Dunne

2010

Best Practice & Research Clinical Endocrinology & Metab

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“…In contrast, using the same technique, the suppression of HGP or hepatic insulin sensitivity has been shown to be unchanged in women [7] and enhanced in sheep [20]. The validity of the conclusions of these studies, however, needs careful consideration.…”

mentioning

confidence: 92%

“…increase in maternal hepatic glucose production [4][5][6][7] and a reduction in maternal peripheral glucose utilisation [4,8,9]. In the fed state, maternal peripheral insulin resistance enables further 'sparing' of glucose for feto-placental use by limiting maternal peripheral glucose uptake [4,8,[10][11][12].…”

mentioning

confidence: 99%

The set point for maternal glucose homeostasis is lowered during late pregnancy in the rat: the role of the islet beta-cell and liver

Nolan

Proietto

1996

Diabetologia

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SummaryThe aim of this study was to determine the effects of late pregnancy on the ability of insulin to suppress maternal hepatic glucose production in the rat. Unlike in most previous studies, suppression of hepatic glucose production was measured at levels of glycaemia above the relatively hypoglycaemic basal pregnant level. Glucose kinetics were measured using steady-state tracer methodology in chronically catheterised, conscious virgin control and pregnant rats, firstly, during basal and low-dose hyperinsulinaemic euglycaemic clamp conditions and secondly, during a three-step glucose infusion protocol (glucose infusion rates of 0, 60 and 150 ~tmol -kg -1 9 min-1). During the clamps, plasma glucose levels were not different (6.1 +0.4 vs 6.5+0.3 mmol/1, pregnant vs virgin; N.S.), but plasma insulin levels were higher in the pregnant rats (242 + 30 vs 154 + 18 pmol/1, pregnant vs virgin; p < 0.05) most probably due to stimulated endogenous insulin release in this group. Hepatic glucose production was suppressed from basal levels by 41% in virgin and 90 % in pregnant rats. During the glucose infusion studies, at matched insulin levels (147 + 10 vs 152 + 14 pmol/1), but at plasma glucose levels which were much lower in the pregnant rats (5.5 + 0.2 vs 8.4 + 0.6 mmol/l, pregnant vs virgin; p < 0.0001), hepatic glucose production was shown to be suppressed by a similar degree in both groups (41 + 5 vs 51 + 5 % from basal, pregnant vs virgin; N.S.). Both the plasma insulin and percentage suppression of hepatic glucose production dose responses to plasma glucose were markedly shifted to the left indicating that the plasma glucose set point is lowered in pregnancy. In conclusion, suppression of hepatic glucose production by insulin is not impaired and the set point for plasma glucose homeostasis is lowered during late pregnancy in the rat. [Diabetologia (1996) 39: 785-792]

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Longitudinal changes in basal hepatic glucose production and suppression during insulin infusion in normal pregnant women

Cited by 176 publications

References 14 publications

Effect of pregnancy on insulin requirements differs between type 1 and type 2 diabetes: A cohort study of 222 pregnancies

Effect of pregnancy on insulin requirements differs between type 1 and type 2 diabetes: A cohort study of 222 pregnancies

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

The set point for maternal glucose homeostasis is lowered during late pregnancy in the rat: the role of the islet beta-cell and liver

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