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Question:

From Newcastle upon Tyne, United Kingdom:

I am Caucasian, have no family history of diabetes, and I have never been very overweight. At the age of 30, I became pregnant and seemed to have a fairly routine pregnancy apart from frequent positive urine glucose which was explained as being typical in pregnancy.

At 28 weeks gestation, I had a blood glucose test which was 14.8 mmol/L [266 mg/dl], but this result was not noted at the time. At 30-32 weeks gestation, I presented with thrush and the result was spotted, so my general practitioner ordered a fasting blood glucose which was 6.6 mmol/L [119 mg/dl], and he said it was normal. Over the next few weeks, I had frequent bouts of thrush along with positive urine glucose, and I developed a boil on my thigh. However, due to the 'shared care' I was under no one was seeing the whole picture, and it was only at 37 weeks that one of my midwives picked up on it and sent me for an oral glucose tolerance test. The results showed a normal fasting sugar but 12.6 mmol/L [227 mg/dl] at two hours. I was admitted to hospital the following day to be induced (38 weeks gestation at this stage).

Throughout all this I was feeling okay, considering I was very pregnant. I worked up to 37.5 weeks without any problems. My bump did grow quite rapidly during the last few weeks, though I didn't put on much excess weight (went from 147 to about 185 pounds).

After being admitted to hospital I had my blood sugar checked fairly frequently (up to this point I had never tested my blood sugar and was not on any treatment). I can't remember exactly but it tended to be in the 5-7 mmol/L [90-126 mg/dl] range. They tried to induce me for five days (six attempts) with no success, and because a scan on day five showed that the baby was quite large, we agreed to go for a C-section. It was never deemed necessary to give me any insulin treatment for my diabetes mellitus, and after giving birth my blood sugar was no longer monitored.

My beautiful daughter was born weighing 9 pounds 3 ounce and had slight hypoglycemia after birth, but we were advised that she didn't need any treatment, just frequent feeding. I breastfed her very successfully from the start and continued to exclusively breastfeed until I returned to work when she was 13 weeks old, and then combined fed her until 24 weeks.

I had a six-week postnatal OGTT which again showed an acceptable fasting reading, and a result of 10.8 mmol/L [194 mg/dl] after two hours. I was then diagnosed with impaired glucose tolerance. (I was breastfeeding at the time). By now, I was starting to get a bit concerned. I was told I had a very high chance of developing type 2 diabetes so I decided I wanted to take some control over the condition.

I purchased a glucose meter and began to test occasionally. A few months later, I noticed I was going to the bathroom more frequently. A glucose test showed my blood sugar to be 18-19 mmol/L [324-342 mg/dl] so I went to my doctor who ordered an hemoglobin A1c which was 6.6%, and I was told that this was fine. The short end to this long tale is that I was hospitalised two months later with DKA and told that I had type 1 diabetes which came as a huge shock to me. (My 29 year old sister was diagnosed three months later.)

Did I have gestational diabetes? If so, did this lead to developing type 1 diabetes? Did I have gestational diabetes, and then by coincidence got type 1? Did I have type 1 diabetes all along, and the the DKA was delayed because of breastfeeding? My daughter does not show any adverse effects yet. Should I have any concerns about the effect all this had on her?

I am really struggling to get a definitive answer from my medical team and would appreciate another opinion. Being fairly recently diagnosed I have a huge amount of other questions, but getting an answer to this one will really help me to accept and understand my condition.

Answer:

DKA [diabetic ketoacidosis] is the defining event for the diagnosis of type 1 diabetes. It does not sound like you had severe hyperglycemia before pregnancy, although this was not tested for during the pre-pregnant state. The stress of pregnancy does challenge the body. If you were already developing type 1 diabetes, which is most likely the case, the stress of the pregnancy pushed you over the limit and you started getting hyperglycemic. This did not stop with delivery of your daughter and you continued to have your sugars rise until you developed the DKA. Since type 1 diabetes evolves from a subclinical condition over years, it is likely you were developing type 1 diabetes before your pregnancy. This should be verified with testing of your insulin secretory reserve. Your physician can do this with measurement of a C-peptide level after a test meal. This is my best guess for the evolution of your diabetes.

Your daughter need not have direct problems. There is some increased risk of diabetes in the future for her, although it would be less for type 1 diabetes than for type 2 diabetes. Her large size is a product of high blood sugars during pregnancy. This may or may not have been prevented with insulin during pregnancy.

JTL

DTQ-20030606043246
Original posting 15 Jul 2003
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:46
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