Fulminant type 1 diabetes mellitus in pregnancy

Abstract

Fulminant type 1 diabetes mellitus (FT1DM) has received clinical attention for its low incidence and poor prognosis. Currently, few cases of FT1DM are associated with pregnancy in clinical practice, but it poses a great threat to the life of mothers and infants. Here, we present two cases of FT1DM in pregnancy. In Case 1, the patient was a 26-year-old woman who was admitted to the hospital with reduced fetal movement. She was diagnosed with FT1DM and delivered a dead female fetus. Lispro and lantus were administered to control blood glucose, and lipoic acid for antioxidant therapy. In Case 2, the patient was a 28-yearold woman who developed nausea, vomiting, diarrhea, and polydipsia, which later proved to be FT1DM. An abortion was induced and blood glucose levels were controlled using an insulin pump. All physicians should be aware of this disease in order to provide prompt diagnosis and emergency treatment, thus improving maternal prognosis. We suggest that plasma glucose/ hemoglobin A1C ratio be adopted as a new clinical parameter in predicting FT1DM.

Fulminant type 1 diabetes mellitus in a GDM pregnancy: early recognition is vital for maternal and fetal outcomes

“…The incidence of fulminant type 1 diabetes in Caucasians is relatively low ( 2 ). To the best of our knowledge, the occurrence of FT1DM in pregnancy has only been reported in patients of East Asian or Southeast Asian ethnicity ( 1 , 2 , 3 , 4 , 5 ), and our case represents the only case of FT1DM occurring in a pregnancy with GDM reported in the English literature thus far. The extremely rapid beta-cell destruction and abrupt development of hyperglycaemia associated with FT1DM are in stark contrast to autoimmune type 1 diabetes, which progresses slowly and takes at least several years from the initial appearance of autoantibodies in the peripheral blood to the clinical onset of disease ( Figs 1 and 2 ).…”

“…FT1DM was first described in Japan in 1987 and has since been reported in other parts of the world, predominantly in East Asia and Southeast Asia ( 1 , 2 , 3 , 4 , 5 ). The incidence of fulminant type 1 diabetes in Caucasians is relatively low ( 2 ).…”

“…Serum lipase or amylase levels in pancreatitis are usually at least three times greater than the upper limit of normal ( 8 ). HbA1c level is unreliable in the evaluation of FT1DM as it does not increase during the acute phase ( 5 ).…”

Fulminant type 1 diabetes: Focusing on triggering factors

“…60 The development of PF is probably triggered by significant changes in the immune environment and responses during pregnancy. 61 Compared with the age-specific incidence of type 1 diabetes in the background population of women, the incidence was at least 70% higher in pregnant than that in non-pregnant women. This increased incidence occurred in the third trimester when the risk of developing type 1 diabetes was 3.8 times that of non-pregnant women.…”

“…reported pregnancy‐associated FT1D (PF) in women during pregnancy or within 2 weeks after delivery 60 . The development of PF is probably triggered by significant changes in the immune environment and responses during pregnancy 61 . Compared with the age‐specific incidence of type 1 diabetes in the background population of women, the incidence was at least 70% higher in pregnant than that in non‐pregnant women.…”