BLOOD-PRESSURE PREDICTS INSULIN REQUIREMENT AND EXOGENOUS INSULIN IS ASSOCIATED WITH INCREASED BLOOD-PRESSURE IN WOMEN WITH GESTATIONAL DIABETES-MELLITUS

Fifty gestational diabetic women were studied to determine the interac tion of blood pressure, insulin resistance, and the effect of exogenou s insulin on blood pressure response. Gestational diabetes was diagnos ed according to the criteria affirmed by the Third International Works hop-Conference on Gestational Diabetes at 20 to 32 weeks' gestation. A t diagnosis, all women were placed on a standard diet and performed gl ucose monitoring on arising and 1 hour after meals. The criteria for i nitiation of insulin included fasting whole blood finger stick glucose more than 90 mg/dL, ketonuria that could only be cleared by increasin g carbohydrate to a level causing postprandial hyperglycemia, or postp randial glucose levels at 1 hour above 140 mg/dL. Of the initial cohor t, 28 required insulin to maintain target glycemia. Within this group, there was a significant positive correlation between mean arterial pr essures at initiation of therapy for gestational diabetes mellitus and insulin requirement quantified by the amount of insulin required to m aintain euglycemia at term (r(2) = 0.259; P = 0.006). The initiation o f insulin was associated with a significant blood pressure increase in this group when compared with values prior to insulin administration or to values in the group treated with diet alone. These observations are consistent with an interaction of blood pressure and insulin resis tance as reflected by insulin requirement in women with gestational di abetes mellitus.