Hyperinsulinaemia and normal glucose tolerance tests in pregnancy

Hyperinsulinaemia is a condition present during late pregnancy, returning to normal after delivery. Since some pregnant women are not able to adapt themselves to this high insulin secretion they could become gestational diabetics. We attempt here to describe the insulin metabolism during late pregnancy according to the women's levels of fasting insulin at six months postpartum. Sixty-seven pregnant women underwent a glucose tolerance test at weeks 20, 30 and 36 of pregnancy and at 6 months postpartum. Glucose and insulin values were measured. The women were classified as follows: group one, women who at 6 months postpartum had fasting insulin levels above the mean (13.5/dl) and group two, who fasting levels were below the mean. The significant difference between the groups was found at all points of the insulin curve at six months postpartum, but not for the glucose curve. During pregnancy, a difference in insulin was also found for weeks 20;30 and 36 but not for the glucose. Group one, whose insulin level were higher since week 20, presented with hyperinsulinaemia, while group two behaved as described in the literature, i.e., secreting more insulin as the pregnancy advanced. Women of group one are at major risk to develop diabetes mellitus, type II later in life (AU)

Hyperinsulinaemia accompanies the development of pre-elcampsia - abstract

Hyperinsulinaemia with insulin resistance has been observed in pre-eclampsia. In this longitudinal study, we examined whether this state of insulin resistance preceded the development of eclampsia. At 12, 24 and 36 weeks of gestation and at 12 weeks post-partum in twenty-five primigravidae, insulin and glucose were measured in the fasting state and in samples collected during intravenous glucose tolerance tests (IVGTT). Five women were diagnosed as pre-eclamptic (PE) at 34 - 39 weeks' gestation. In these PE, there was hyperinsulinaemia in the fasting state at 24 weeks compared to the normal pregnant (NP) women, 20.07 ñ 8.31 mU/ml vs. 13.74 ñ 5.64 mU/ml, (p<0.05). The degree of hyperinsulinaemia increased and, at 36 weeks' gestation it was 26.4 ñ 7.7 mU/l in the PE compared to 13.1 ñ 6.1 mU/l in the NP, (p<0.0001). The sensitivity of this measure for predicting pre-eclampsia at mid-pregnancy (24 weeks) was 80 per cent which increased to 100 per cent in late pregnancy (36 weeks). The specificity of this measure went from 57 per cent in mid-pregnancy to 43 per cent in late pregnancy. The glucose levels in the fasting state were not different at any time in the study. In the IVGTT, the area under the insulin curve was significantly larger in the PE as a group compared to the NP, (p<0.05). The area under the glucose curve was not different between the two groups at any time. The rate of disappearance of glucose Kg was significantly larger in the PE as a group compared to the NP, (p<0.05). Hyperinsulinaemia in the fasting state precedes the development of pre-eclampsia. It has a high sensitivity but low specificity for predicting the development of pre-eclampsia. Hyperinsulinaemia in the fasting state may have some value in screening those primigravidae at risk for developing pre-eclampsia (AU)

Islet cell lesions of the pancreas

The clinical features and surgical management of islet cell lesions of the pancreas are discussed in detail. The Zollinger-Ellison Syndrome is also reviewed and recommendations made with respect to treatment (AU)