Korean J Med.  2017 Apr;92(2):186-189. 10.3904/kjm.2017.92.2.186.

Fulminant Type 1 Diabetes Developing during Pregnancy in Patient with Gestational Diabetes Mellitus

• Baek JH
• Kim KY
• Kim SK
• Jung JH
• Hahm JR
• Jung J

• KMID: 2382660
• DOI: http://doi.org/10.3904/kjm.2017.92.2.186

Abstract

A 32-year-old pregnant woman (34 + 5 weeks) was admitted with dizziness, nausea, and vomiting. Previously, she was diagnosed with gestational diabetes mellitus at 28 weeks with 100 g-OGTT and insulin therapy was started. Her average fasting glucose level was 97 mg/dL and postprandial 1-hour glucose level was 130 mg/dL with basal-bolus insulin therapy (total dose of 28-30 IU/day). At 34 + 0 weeks of gestational age, polyuria and unexpected weight loss (2 kg/week) with hyperglycemia occurred, and total dose of daily insulin requirement was increased up to 50 IU/day. At admission, her serum glucose level was high (502 mg/dL), and urinalysis revealed ketonuria +3. Arterial blood gas analysis revealed pH of 6.83, pCO2 of 9 mmHg, and bicarbonate of 2 mmol/L with an anion gap of 23.5 mmol/L. The diagnosis of diabetic ketoacidosis was established and emergency caesarean section was conducted due to fetal distress. She was finally diagnosed with fulminant type 1 diabetes mellitus, and multiple daily insulin injection therapy was continued after delivery.

Keyword

Diabetes mellitus, Type 1; Diabetes, Gestational; Diabetic ketoacidosis

MeSH Terms

Acid-Base Equilibrium
Adult
Blood Gas Analysis
Blood Glucose
Cesarean Section
Diabetes Mellitus, Type 1
Diabetes, Gestational*
Diabetic Ketoacidosis
Diagnosis
Dizziness
Emergencies
Fasting
Female
Fetal Distress
Gestational Age
Glucose
Humans
Hydrogen-Ion Concentration
Hyperglycemia
Insulin
Ketosis
Nausea
Polyuria
Pregnancy*
Pregnant Women
Urinalysis
Vomiting
Weight Loss
Glucose
Insulin