DIABETES AND PREGNANCY

The effect of diabetic pregnancy on fuel metabolism is one of underutilization of exogenous fuel in the fed state (facilitated anabolism reduced) and over- production from endogenous source in the fasted state (hyperaccelerated starvation). The first sign of preg- nancy in a diabetic (particularly in type 1 diabetes) as early as the first week of gestation and even before nausea or vomiting sets in may be early morning fasting ketonuria. A minor proportion of women lack the necessary B-cell reserve to maintain euglycemia during pregnancy, and develop impaired glucose tolerance (IGT). They have significantly lower insulin responses at 30 and 60 min after oral glucose load compared with glucose-tolerant controls, while insulin sensitivity is similarly reduced in the second trimester.