Impairment of counterregulatory hormone responses to hypoglycemia in pregnant women with insulin-dependent diabetes mellitus

Michael P. Diamond, E. Albert Reece, Sonia Caprio, Timothy W. Jones, Stephanie Amiel, Nancy DeGennaro, Andrea Laudano, Mario Addabbo, Robert S. Sherwin, William V. Tamborlane

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Intensive insulin therapy directed at elimination of hyperglycemia is advocated during pregnancy in women with insulin-dependent diabetes mellitus. Because such treatment is complicated by frequent hypoglycemic episodes, we evaluated maternal and fetal responses in nine intensively treated pregnant women with insulin-dependent diabetes mellitus during an insulin-induced, gradual, controlled fall in plasma glucose levels. In contrast to values in nonpregnant control women, reductions in glucose to 44 ± 2 mg/dl in pregnant diabetic patients failed to elicit an increase in glucagon levels. Epinephrine release during hypoglycemia was also markedly suppressed in the pregnant diabetic subjects (106 ± 32 vs 327 ± 52 pg/ml in controls, p < 0.001). Furthermore, the plasma glucose level at which epinephrine and growth hormone were released was 5 to 10 mg/dl lower in the pregnant women with insulin-dependent diabetes mellitus (p < 0.05). The basal fetal heart rate remained unchanged and continued to manifest accelerations during the hypoglycemic state. We conclude that the high frequency of hypoglycemia in intensively treated pregnant women with insulin-dependent diabetes mellitus may be due in part to impaired counterregulatory hormonal responses.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalAmerican journal of obstetrics and gynecology
Volume166
Issue number1 PART 1
DOIs
StatePublished - Jan 1992
Externally publishedYes

Keywords

  • Hypoglycemia
  • counterregulation
  • diabetes mellitus
  • insulin
  • pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Diamond, M. P., Reece, E. A., Caprio, S., Jones, T. W., Amiel, S., DeGennaro, N., Laudano, A., Addabbo, M., Sherwin, R. S., & Tamborlane, W. V. (1992). Impairment of counterregulatory hormone responses to hypoglycemia in pregnant women with insulin-dependent diabetes mellitus. American journal of obstetrics and gynecology, 166(1 PART 1), 70-77. https://doi.org/10.1016/0002-9378(92)91832-U