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KMID : 0882420170920020186
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Korean Journal of Medicine
2017 Volume.92 No. 2 p.186 ~ p.189
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Fulminant Type 1 Diabetes Developing during Pregnancy in Patient with Gestational Diabetes Mellitus
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Baek Jong-Ha
Kim Kyong-Young
Kim Soo-Kyoung
Jung Jung-Hwa
Hahm Jong-Ryeal
Jung Jae-Hoon
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Abstract
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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.
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KEYWORD
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Diabetes mellitus, Type 1, Diabetes, Gestational, Diabetic ketoacidosis
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