Endocrine Abstracts

JOINT1340

A 27-year-old female was referred to the outpatient clinic due to symptoms of insulinopenia, unintentional weight loss, polyuria, and polydipsia. The patient was obese with an ITM of 31 kg/m² and had prior GDM during her first pregnancy three years ago with a burdened family history (her father has DM2). Fasting blood glucose was 9.3 mmol/l with HbA1c 10.9% and mild ketonuria but no DKA. Due to anamnestic data, pancreatic islet cell antibodies and C-peptide were measured. Treatment with lifestyle modification—diet to reduce weight, with basal insulin detemir and metformin—was recommended. After one week, C-peptide came around the low reference range limit (0.30 nmol/l), and IA-2, ICA, and GADA antibodies all came back positive. Three weeks later, the patient came for a check-up after she found out she was pregnant. Since pregnancy, insulin treatment was continued with a basal bolus insulin regime and strict control of glycemia was targeted. The patient refused the insulin pump and continued to use the CGM Dexcom One Plus. Detemir two times daily with aspart insulin before meals were given, and the patient had satisfactory levels of blood glucose with a fasting glucose level usually below 6 mmol/l and PPG < 8 mmol/l. Nine months later, the patient gave birth naturally to a healthy baby girl weighing 3 kilograms. Shortly after delivery, the patient had hypoglycemia, so insulin therapy was discontinued completely. Since she continued to use the Dexcom One Plus glucose sensor and glycemic values were continuously within limits, she discontinued any medication and came for a diabetologist check-up one month after delivery. Since this situation seemed to be a complete remission of type 1 diabetes, C-peptide and pancreatic islet cell antibodies were measured again. Now C-peptide arrived within normal values (1.12 nmol/l) with still positive anti-insulin antibodies in repeated measurements. The patient was advised to preserve lifestyle and diet measures and to take metformin since she was obese and did not breastfeed. The patient will continue to be under diabetologist care since her diagnosis of diabetes mellitus type 1 is established, and insulin treatment is expected to be necessary again once the honeymoon period passes. We present this case since it is not usual for obese adult women with prior GDM and a family history of type 2 diabetes mellitus to develop type 1 DM and even less often to develop complete remission shortly after delivery and pregnancy.