2017 Volume 69 Issue 3 Pages 300-305
The patient was a 28-year-old nulliparous woman who had no past or family medical history. She had a regular prenatal checkup from five weeks gestation and had a vaginal delivery at 35 weeks. There was no postpartum problem and she was discharged on postpartum day six. No abnormality was found in random blood glucose level, glucose urine test during pregnancy, blood glucose level immediately before delivery, and glucose urine test on postpartum day four. On postpartum day 23, she had flu-like symptoms and lower abdominal pain. The next day she felt worse and was aware of tachypnea, and thus she was referred to our hospital. At the time of admission, laboratory results were blood glucose 549 mg/dl, arterial blood gas pH 6.955, HCO3- 1.5 mmol/l and base excess -31.8 mmol/l. Remarkable metabolic acidosis was observed and diagnosed as diabetic ketoacidosis. Blood glucose level was normalized by administration of insulin and transfusion. Blood and urinary C-peptides were low and islet-related autoantibodies were negative. Although the patient was considered to have fulminant type 1 diabetes from the onset pattern, HbA1c was 9.2% (NGSP value), which did not meet the diagnostic criteria for fulminant type 1 diabetes. Her HLA typing and rapid beta cell destruction were consistent with the clinical course associated with pregnancy related fulminant type 1 diabetes, but only the HbA1c did not meet the diagnostic criteria. This case is important because it increases our understanding of the pathology of fulminant type 1 diabetes and pregnancy related fulminant type 1 diabetes. [Adv Obstet Gynecol, 69 (3) : 300-305, 2017 (H29.8)]