Endocrine Abstracts

We report the case of a 27 year old female who was referred to our diabetes team from the antenatal clinic, when she was found to have an abnormal glucose tolerance at 16 weeks of gestation (fasting and 2 hours blood glucose values of 5.1 mmol/L and 12.2 mmol/L respectively). At the same time she was suffering with severe hyperemesis gravidarum for many weeks and had suffered significant weight loss (thyroid function tests were unremarkable). She had no specific symptoms to suggest diabetes mellitus although she did give a history of weight loss which she attributed to poor food intake and recurrent vomiting for few weeks. After review in the combined antenatal diabetes clinic she was advised to monitor her blood sugars regularly at home and was reviewed in the clinic on a regular basis. Her home blood glucose monitoring readings were always within normal range and her capillary ketone tests always negative. Her HbA₁C was reported as 4.4%. In view of her normal home blood glucose values her glucose tolerance test was repeated six weeks later and was then reported to be normal (Fasting blood glucose: 4.2 mmol/L, 2 hours: 5.7 mmol/L). By then her symptoms of hyperemesis gravidarum were also settled. This case illustrates an example of a discrepancy in glucose tolerance test results. Careful interpretation of glucose tolerance test results are warranted in the setting of pregnancy, more so when associated with conditions like hyperemesis gravidarum. We speculate that significant weight loss may have been contributory, causing a diabetic GTT profile secondary to malnutrition.