Latent Autoimmune Diabetes in Adults and Pregnancy: Foretelling the Future
W.S. is a 25-year-old woman referred for newly diagnosed gestational diabetes mellitus (GDM) after having a 1-hour plasma glucose (PG) of 150 mg/dl during a 50-g glucose challenge test at 28 weeks' gestation. She denied any history of polyuria, polydipsia, polyphagia, or visual disturbances. During this pregnancy, she had gained only 5 lb by 31 weeks and denied any complications. Before the pregnancy, her baseline weight was 205 lb, and her BMI 33 kg/m2. Overall, she was feeling well and tolerating her pregnancy well.
Her medical history was significant for a single pregnancy 4 years ago that was not complicated by GDM. She delivered a healthy, full-term girl weighing 7 lb, 4 oz, by an uncomplicated spontaneous vaginal delivery (SVD). She denied any subsequent history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). She denied a family history of type 2 diabetes. However, her 4-year-old daughter had been diagnosed with type 1 diabetes. She denied any tobacco or alcohol use.
After being diagnosed with GDM, she received appropriate dietary counseling and was instructed in home blood glucose monitoring. Secondary to persistent fasting hyperglycemia, she was started on human insulin NPH, 5 units subcutaneously daily at bedtime. She continued to monitor fasting and 2-hour postprandial blood glucose values. Her GDM was followed closely, and her NPH insulin was titrated to 14 units at bedtime.
Because of ongoing postprandial hyperglycemia, insulin lispro was added for prandial coverage, in a dose of 1 unit/20 g of carbohydrate consumed. Her blood glucose control improved on intensive insulin therapy. Her hemoglobin A1c (A1C) was excellent at 5.5%. At term, she delivered a healthy boy of 8 lb, 8 oz, by uncomplicated SVD.
The patient was scheduled for a postpartum follow-up, including a 75-g oral glucose tolerance test (OGTT). She denied …