January 19, 2004
Diagnosis and Symptoms, Gestational Diabetes
Question from Athens, Greece:
I have diabetes type 1, diagnosed 1 year and 2 months ago at the age of 39. GAD Antibodies were positive at the time of the diagnosis when I was hospitalized with large amounts of ketones. I am presently using Lantus and Humalog and I have very good control. My last HAc1 test was 5, 5 and my total daily insulin requirements ranges from 20 to 25 units (Lantus: 7 and Humalog: 13 to 15). I don’t have a problem with lows.
Diabetes came into my life four years before my diagnosis during my second pregnancy. During that pregnancy, my diabetes was easily controlled with diet only and everything was fine with me and baby. After delivery, I was told that everything was fine, no further exams were needed and that I was in a higher risk for diabetes type 2 much later in life. I know NOW that that was a mistake. Life from there on was full of stress, raising two small kids, dealing with a new job, adapting to life in a new, big town, etc. I did not watch my diet (ate a lot of junk food) during these times but have always been slim. And finally, my grandmother had diabetes for many years, probably type 2 since she controlled very well with diet only. She died at the age of 82 from heart problems.
My questions are:
Is it possible that I had diabetes even from the first pregnancy when nothing was mentioned of diabetes and probably I was not tested at that time? Although I did all my pregnancy checks, I was never mentioned to have gestational diabetes then. The first baby was born 4, 2 kg.
Was I a type 2 diabetes turned into type 1 because after second pregnancy I was not tested to see if diabetes was cleared? Maybe diabetes type 1 could have been avoided with good diet and less stress?
It confuses me that my grandmother was type 2, that none of my brothers or sister have diabetes and that during my pregnancy I was able to control it so well with diet. I know that the important thing from now on is to have good control and I am determined to do that but it is very important to me to understand if this could have been avoided.
Answer:
It is usually standard to check an oral glucose tolerance test 6-8 weeks after delivery to demonstrate that the diabetes has disappeared with the pregnancy. This allows you to know whether you have type 2 diabetes or gestational diabetes. If you were not tested earlier, you don’t know. Understand that you have an atypical story with positive anti-GAD antibody. You may have a familial predisposition to type 2 diabetes and an element of type 1 diabetes with the antibody markers.
I am not sure that you could have avoided this; this is especially true with autoimmune diabetes (type 1 diabetes).
I am not sure it could have been avoided.
JTL
