Effect of treatment with insulin or diet on intermediary metabolites in pregnant women with chemical diabetes in the third trimester of pregnancy.

The diurnal (07(30) - 16(00) profiles of glucose, 3-hydroxybutyrate (3-HB), non-esterified fatty acids (NEFA), and glycerol were studied in 19 pregnant women with gestational diabetes and eight pregnant non-diabetic controls. Nine of the gestational diabetic women were treated with intermediate and in some cases with fast acting insulin and diet and 10 were treated with diet alone. Although fasting plasma glucose levels were normal (less than 6.0 mmol/l) in 8 insulin-treated and 9 diet-treated gestational diabetics before the start of treatment, the profiles of glucose, NEFA and glycerol were generally higher in gestational diabetic compared to non-diabetic pregnant women. The insulin-treated group had lower, but not normal, plasma glucose and higher levels of glycerol than the women treated with diet only. The levels of 3-HB and NEFA were not significantly influenced by the type of therapy. It is suggested that treatment of gestational diabetes should consist of multiple injections of fast acting insulin.