Endocrine Abstracts

Background

There is ample data linking GDM to risk of type 2 diabetes mellitus postpartum, however, development of type 1 diabetes mellitus and presentation with DKA is rare especially few weeks postpartum.

Case

A 28 year old female 4 month postpartum was admitted to hospital with rapid weight loss and osmotic symptoms. She did not have any past medical history of note, with history of T2DM in both mother and father. She had gestational diabetes during her pregnancy which required insulin to control. Her weight dropped from 72 kg post-natally to 55 kg on presentation with significant weight loss in the 2 weeks prior to admission. Her HbA1c in her third trimester was 42 which jumped to 98 mmol/mol. She was admitted with a glucose 20.5 mmol/l, H + 63 nmol/l, HCO3 10 mmol/l and was started on treatment for DKA at that point. Because of the history of Hb D Punjabi trait, fructosamine was checked which was also elevated at 600 umol/l. Her c-peptide was 0.11 nmol/l and GAD antibodies were negative. The patient was discharged 2 days later on Levemir and novorapid and followed up by the diabetes team.

Discussion

Previous case reports have shown that T1DM either presents early on in the first few days after delivery or few months afterwards, while our patient presented with DKA 4 months postpartum with DKA. The case presented here highlights that patients treated for GDM can present with T1DM postpartum and this should be considered.