Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity with onset or first recognition during present pregnancy, is associated with adverse pregnancy outcome such as macrosomia, birth trauma, and metabolic
complications of newborn. Although most women with GDM have a normal glucose tolerance at postpartum, impairment of insulin secretory capacity and/or increased insulin resistance has been reported in these women, and a substantial proportion of
women
with GDM will eventually develop NIDDM. Recently the prevalence of GDM in Korean has been reported as 2-3.6%, which is not different from that in white women published in North America.
IDDM (type 1 diabetes mellitus) may also be newly acquired during pregnancy. It has been suggested that latent IDDM is presented as GDM during pregnancy., although there are limited reports in Europe and North America. However, there is no case
of
new-onset IDDM presenting with diabetes ketoacidosis during pregnancy in Korean women.
A 36-year-old woman, gravida 1, para 0, was admitted at 37 weeks gestation because of sudden-onset, lower abdominal pain. Her 1-h plasma glucose was 5.5mmol/L after 50g oral glucose challenge at 26 weeks gestation. Initial physical and
ultrasonographic
examination reveals that she and ultrasonographic examination reveals that she had an intra-uterine fetal death. Seum glucose was 25.1 mmol/L (453 ㎎/dL), sodium 139 mEq/L, potassium 5.8 mEq/L, chloride 112 mEq/L, bicarbonate 4.1 mEq/L, and
arterial
blood pH 7.19 when initial laboratory evaluation was done. She was treatedwith insulin and intravenous fluid under the impression of diabetic ketoacidosis (DKA). After recovery from the DKA, fasting serum C-peptide concentration was 0.09 nmol/L
(0.27
ng/mL) and HbA1c was 5.9%. Insulin therapy has been needed for glycemic control.
We experienced a case of new-onset IDDM presenting with DKA in a pregnant women and report it with a literature review.
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