Amongst women with gestational diabetes (GDM), the incidence of type 1 diabetes (T1DM) was 3.4% at 9 months post-partum and 6.6% at 2 years post-partum in one prospective study. Higher number of autoantibodies (Abs) during pregnancy is associated with a higher risk of T1DM. In rare cases, women with GDM can develop antibody-negative T1DM post-partum. The presentation of fulminant T1DM defined as rapid onset ketoacidosis, undetectable C-peptide, A1C<8.5%, elevated pancreatic enzymes and often negative antibodies has only rarely been reported in the post-partum period and predominantly in individuals of Japanese descent. In our case, a 34-year-old woman of Indian descent presented for GDM which required low dose Detemir 6 units nightly. She had an uncomplicated delivery and stopped insulin. On post-partum day 8 she was hospitalized for 1 day of non-specific malaise symptoms and was incidentally found to have elevated lipase 398 U/L, serum glucose 93 mg/dL and mildly bulky pancreas by ultrasound imaging. Initially she clinically improved, but on post-partum day 15 she developed symptoms of fatigue, polyuria, polydipsia, and weight loss which progressed to vomiting, tachycardia and tachypnea. She was readmitted on post-partum day 19 with glucose 482 mg/dL, arterial pH 6.95, anion gap 34, and moderate ketones consistent with severe Diabetic Ketoacidosis. Hemoglobin A1C was 6% and lipase was normal. New onset T1DM was diagnosed based on undetectable C-peptide, though GAD and ICA Abs were negative. She was treated with an insulin infusion and later transitioned to a basal-bolus subcutaneous insulin regimen. Repeat labs at 12 months post-partum confirmed persistent undetectable C-peptide and negative Abs. We present a unique case of a woman of Indian descent with GDM found to have fulminant T1DM in the early post-partum period. To our knowledge, this is the first case of fulminant diabetes post-partum reported in a patient of Indian ethnicity. Our case highlights the importance of consideration of this rare diagnosis in diverse populations.


K. Lane: None. R. Oxman: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at