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January 23, 2004

Gestational Diabetes

Question from Richmond, Virginia, USA:

I developed gestational diabetes with my second and third pregnancies in 1992 and 1997. I was an "oddball" case, because at 5' 7" I weighed 120 pounds and only gained 18 pounds with my pregnancies. I exercised and aside from evening nausea felt fine. My babies weighed in at 7 1/2 pounds. In 2000, I began losing weight and exhibiting all the classic symptoms of Type 1 diabetes and began taking insulin injections. I am now on the pump and doing well. I have met several other women like me who developed Type 1 several years after experiencing gestational diabetes with their pregnancies. We are all in our late 30s and early 40s. I can't find any medical studies, research or information describing our situation. Can you help me?

Answer:

You bring up a very interesting possibility. There is a form of type 1 diabetes that is rather late in its onset. It is referred to as LADA (late-onset autoiummune diabetes of adulthood). The basis for the categorization is that these patients are older than typical patients with Type 1 diabetes. They have autoimmune markers. These patients are not usually overweight or obese. They eventually lose their insulin secretory capacity and evolve into a more typical Type 1 diabetes picture. You and your contacts may have had that. The combination of pregnancy, which increases insulin secretory requirements, may have taxed your ability to make insulin during those pregnancies. This is just an hypothesis. You can check with your physician as to whether you have had any antibodies obtained to demonstrate autoimmune markers of Type 1 diabetes.

JTL
Additional comments from Dr. Alan Schorr:

I have not found any major studies regarding the development of Type 1 diabetes after pregnancy. I will let you know that there are at least five women in my practice who have similar stories. At this time, I suspect that each of them would have developed the disease anyway, probably autoimmune in nature. Each of them had positive insulin antibody levels and two of them had other markers that indicated that this was an autoimmune process.

ABS