A case of fulminant type 1 diabetes mellitus acquired in the 7th week of pregnancy

A-33-year-old woman who suddenly developed excessive thirst on March 31, 2001, and was admitted on April 2, 2001, due to an impending abortion lost consciousness after the abortion and was transferred to our hospital. Her blood glucose was 789 mg/dl with severe metabolic acidosis, pH 7.006, and positive serum and urinary ketone bodies, consistent with diabetic ketoacidosis. Her HbA_1C was close to normal (6.1%), while urinary C-peptide was very low (1.2 μg/day). Serum concentrations of amylase, lipase, and elastase 1 were elevated. The results of a glucagon loading test showed impaired insulin secretion. Diabetes-related autoantibodies including anti-GAD-antibody, anti-IA-2-antibody, and ICA were all negative. Her HLA type was A2, A 24 (9), B 61 (40), B 51 (5), DR 2, DR 8, DQ 1, and DQ 4. The onset of type 1 diabetes during pregnancy has mostly been reported during the 2nd and 3rd trimesters and is rare in early pregnancy. Fulminant type 1 diabetes has been proposed characterized by near-normal HbA_1C despite diabetic ketoacidosis and rapid loss of insulin secretion. Here, we report the case of a pregnant woman who developed typical fulminant type 1 diabetes as early as 7 weeks into gestation.