A case of recovery from a fulminant type 1 diabetes mellitus-like episode during pregnancy

A 26-year-old primipara with a positive family history of type 2 diabetes mellitus presented with abrupt onset of thirst, generalized malaise and slight disturbance of consciousness at 11 weeks of gestation. Her BMI was 15.7 kg/m². Blood chemistry tests revealed a plasma glucose level 1,049 mg/dl, HbA1C of 5.5%, serum total ketone body level of 13,260 μmol/l; arterial blood gas analysis revealed a pH of 7.282 and BE of -17.9 mmol/l. The patient was diagnosed as having diabetic ketoacidosis and started on an intravenous infusion of insulin and saline. The patient tested negative for both anti-GAD antibody and the HLA haplotype associated with type 1 diabetes mellitus. However, the serum levels of exocrine pancreatic enzymes were elevated despite the absense of clinical findings of pancreatitis. After insulin therapy for 3 weeks, the blood glucose levels decreased, and the insulin therapy was discontinued. A 75-g OGTT revealed normal glucose tolerance. Glycemic control was well maintained by diet therapy alone until 39 weeks of gestation, when she delivered a healthy girl vaginally. While the clinical features in our patient resembled those of fulminant type 1 diabetes mellitus at the onset. Endogenous insulin secretion was preserved, and the glucose tolerance became entirely normal following short-term insulin therapy. Recovery from diabetic ketoacidosis during pregnancy is extremely rare.