Metabolic realignments in late pregnancy : a clue to diabetogenesis.

Abstract

The general features of carbohydrate metabolism during pregnancy may be summarized as follows (J): in the pregnant female with adequate pancreatic reserve, tolerance to intravenous glucose is normal whereas the hypoglycemic response to exogenous insulin is subnormal. The hypoglycemic effectiveness of endogenous insulin also may be diminished as judged by the subnormal lowering of blood sugar after intravenous tolbutamide. The dichotomy would suggesc that an enhanced elaboration of endogenous insulin is required to maintain normal glucose tolerance during pregnancy. The histologi,: al finding of islet cell hyperplasia during normal gestation, and the clinical experience in subjects with marginal or absent pancreatic islet cell reserve are in accord with this premise.