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Permalink Reply by Melitta on January 15, 2010 at 2:20pm

Hi Kelly: Probably the "10% of all Caucasian women diagnosed with gestational diabetes have Type 1 diabetes" is the accurate one. In the German study, the percentage is skewed because there was follow up over many years, and evidently the women with autoimmune gestational diabetes/Type 1 were the ones who continued in the study, while more non-autoimmune GDMers dropped out. So it is much more common for women with GDM to later be diagnosed with Type 2, and a small subset (~10%) immediately have Type 1 or later have full-blown Type 1. What I thought was significant about the German study was that most of the women who required insulin during pregnancy were antibody positive (indicative of the autoimmune response). Also, autoimmune gestational diabetes tends to show up earlier in the pregnancy than "conventional" GDM. All fascinating stuff. Amy Tenderich of diabetesmine.com was diagnosed after her third pregnancy (age 37) and Mary Tyler Moore was diagnosed after a miscarriage (age 33).

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Permalink Reply by Sarah on January 15, 2010 at 1:45pm

For the record, I suspect pregnancy triggered my autoimmune response as well.. I had totally normal prenatal bloodwork done at the end of my first trimester, with a perfectly normal BG level. I was diagnosed diabetic (as GD) shortly after 19 weeks, with a random BG over 400.. the bloodwork was done to keep an eye on my liver function because my doctor thought due to my age I was at higher risk of developing pre-eclampsia (though as I found out later with babies #2 and #3 my BP while pregnant is on the higher end of normal (normal for me is like 115/70.. while pregnant it's more like 135/85, right on the cusp of them wanting to treat it.. but it STAYS THERE, it doesn't go higher and I never developed Pre-E with any of them). Anyways, a random BG so high really doesn't happen with GD or even T2 so soon after a normal level. It was just over 6 weeks between them. I always had doubts from the beginning if it was GD... I did not come across another woman with GD that ever had a BG much over 200, nevermind 400+, and I had an uphill struggle as a result of that GD diagnosis. I've been officially diagnosed with all 3 major kind of diabetes... two of which were misdiagnosed.

I've come across a handful of people who had GD and were then discovered to have T1 (not, not developed T1 years later, literally transitioned from GD to full time diabetic immediately).. my CDE says she's had quite a few patients who presented that way. It's not common, but not impossible either... being pregnant sort of leads automatically to a GD diagnosis, even if you were to present in DKA while pregnant.

I won't get into the argument of maybe I had LADA or a slower onset form of T1 prior to my pregnancy, and getting pregnant pushed my residual beta cell function too far, because really it's irrelevant... my BG was normal when it had been checked, and then suddenly NOT normal... and obviously I'm T1 now, so I don't really put myself into any of the inbetween categories. I was never really symptomatic (other than being thirsty and peeing a lot, but I was pregnant, so that's not exactly a big red flag) and I have no family history of either kind of diabetes.

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Permalink Reply by Kelly on January 15, 2010 at 2:25pm

Well, I wouldn't rule it out. I wasn't implying that I didn't believe I had diabetes before pregnancy, quite the opposite. I actually believe I had diabetes since about 2005, a year or so before my pregnancy with my son.

My whole journey started when I was working as an editor a small town newspaper. At the time we were using manual focus cameras and my publisher came to me and asked why my photos were always blurry. I thought they looked fine but that, combined with the fact that I was always getting razzed about how close I zoomed into pages to edit them, made me take a trip the town's optician. In one year I went from a prescription of -.25 in both eyes to -2.25 and -1.5. (My prescription is now somewhere around -4.5 and worsening). He told me to take a diabetes test. I went to the local walk-in clinic, he took one look at me and said, "you're too young, you're too fit and you're not sick enough." I did a random test about four hours after eating. I never got a call back so I thought for a very long time that that meant I was clear. Up until last July, I would've passed a random glucose if I hadn't eaten in that long. And so it went, every six months back the eye doctor for new prescriptions.

It was around this time that I also got persistant infections that wouldn't go away. I was told I was resistant because I used the medication too much. I also needed naps when I came home from work. And I did my exercising at night because I wouldn't otherwise be able to stay awake throughout the day. I was 25.

Then I got pregnant with my first son. I hired a team of three midwives to treat me throughout the pregnancy and birth. I had sugar in my urine very early in the pregnancy and they kept telling me I was just eating poorly. I told them the story about what happened with the optician, which made them dismiss the possibility that this is anything but gestational diabetes. So I was put on no carbs for the rest of the pregnancy. That didn't work because by the time I was 36 weeks pregnant, I had blood pressure of 150/110 and edema. I was induced at 37 weeks and my son was 8 lbs 11 oz, which is huge for that gestation. Vaccuum birth. He looked like a little sumo wrestler. They never sent me for an ogtt or a fasting test, but blood tests two hours after meals and they came back ranging from 6.8 to 9.5 mmols (remember I was eating almost no carbs, which in itself is horrible advice).

So next pregnancy comes around and I tell my gp that I had some troubles with sugars in my urine in the first pregnancy. She ignores it and we proceed. Then when I was four months pregnant, I got a very bad cold/flu and I lost 6 kgs in two weeks! I go back to her and she sends me for an ogtt. It's 18 mmols. She sends me to an endo who requests an A1c. It's 6.7. I think I've told the rest of the story.

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Permalink Reply by Kelly on January 18, 2010 at 2:25pm

An update -- So I spent the weekend mulling over your advice and decided I will go off insulin to see where I land. If of course my numbers jump substantially, I will take my insulin again to be safe.

As far as the treatment that was recommended for me. I've decided that even if I turn out to be a true Type 2, I will not take any medication that stimulates my pancreas to produce more insulin. If I can't manage my blood sugars with other oral medications, then I'm ok with supplimenting them with insulin.

I'm going to take a break from TU for a while because I just need some time to not think about my diabetes and get back to being a mom and wife and all the other things that I am. Thanks so much for your input, all!

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Permalink Reply by Brian (bsc) on January 18, 2010 at 5:46pm

Each of us must find our own way. I'm sure that you know the signs that things are not working and will take appropriate action should it be needed. It is fine to take a break from things for a while, but just remember, in the end only you can properly take care of yourself. Do come back and tell us how things are going.

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