Abstract
Extract: Infants born to diabetic mothers remove glucose more rapidly from plasma than do infants of normal mothers. The glucose tolerance of normal newborns in the first hour after intravenous injection of glucose is poorer than in the child or adult. Infants of diabetic mothers have higher levels of insulin-like activity in plasma a few minutes after an intravenous glucose load than do normals. The rate of removal of glucose from plasma during the second hour after loading, however, is enhanced in infants of normal mothers; this correlates with the later peak levels of immunologically reactive insulin in the normal baby.
Glucose tolerance and levels of insulin in plasma were determined under identical conditions in the infants of 14 normal mothers, of 14 diabetic mothers who had received insulin, of 6 diabetic mothers who had not received insulin, and of one mother who had had glucosuria in pregnancy and whose baby looked like the infant of a diabetic mother.
Glucose tolerance was expressed as the ‘total index’ (Kt), the percentage of glucose disappearing from the plasma in one minute. Insulin levels in plasma were determined by the method of Hales and RANDLE [9]. The Kt of infants of normal women (0.44 to 2.31, with a mean of 1.16) during the first hour after a glucose load differed little from that of infants of non-insulin-treated diabetic mothers (1.51 to 1.93, with a mean of 1.31). The Kt of both groups differed significantly from that of infants of insulin-treated diabetic mothers, in whom the Kt was in the range 0.83 to 5.78, with a mean of 3.30. In the second hour, however, the rate of glucose removal in both groups of infants of diabetic mothers appeared to fall, while in infants of normal mothers, the rate appeared to rise.
These observations on Kt correlate with changes in insulin levels in plasma of the normal and non-insulin-treated diabetic groups. Although individual differences existed within the groups, the mean for normals rose from 49, μU/ml of plasma before glucose-loading to 139 at two minutes after. The level then fell, but climbed again to reach a value of 229 μU/ml at one hour. In contrast, the mean for the diabetic group rose from a value of 34 prior to loading to one of 208 μU/ml two minutes after loading. There was, however, little if any second peak.
The presence of antiinsulin antibodies makes impossible the accurate measurement of insulin levels in plasma of babies of mothers who have been treated with insulin; in one case, however, treatment had been so brief that no antibody was formed. This baby showed a high but ephemeral insulin response to the glucose load.
The infant who looked like an infant of a diabetic mother and whose mother was found to have had persistent glucosuria in pregnancy had, in the absence of insulin antibody, the highest insulin response observed.
Speculation: In the first hours of life, insulin is released in response to a glucose load, but the size and speed of the response suggest that it simply reflects the glucose levels to which the infant's pancreas has been submitted in utero and has no specific relation to the diabetic status of the mother.
Glucose is readily removed from plasma as a result of the release of insulin, yet the opposing mechanisms for increasing plasma levels of glucose are relatively ineffective at this age, although the neonatal liver contains glycogen. Glycogen can be released readily by administering glucagon, suggesting that the appropriate metabolic pathways are functional.
When insulin response to glucose is delayed because intrauterine stimulation of the pancreas has been small, the hormone is nonetheless effective in lowering plasma levels of glucose. These observations reported suggest that although the metabolic pathways for glucose homeostasis exist in the newborn, the hormonal mechanisms for controlling these are inappropriately invoked.
Similar content being viewed by others
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Isles, T., Dickson, M. & Farquhar, J. Glucose Tolerance and Plasma Insulin in Newborn Infants of Normal and Diabetic Mothers. Pediatr Res 2, 198–208 (1968). https://doi.org/10.1203/00006450-196805000-00007
Issue Date:
DOI: https://doi.org/10.1203/00006450-196805000-00007
Keywords
This article is cited by
-
Blood sugar, free fatty acids and triglycerides in infants of diabetic mothers
The Indian Journal of Pediatrics (1985)