임신성 당뇨병 환자에서 발생한 전격성 제1형 당뇨병 1예
Fulminant Type 1 Diabetes Developing during Pregnancy in Patient with Gestational Diabetes Mellitus
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초록
임신 후반기에 주로 발생할 수 있는 전격성 제1형 당뇨병은 드물지만 산모와 태아의 사망률이 높고, 임신성 당뇨병진단 하에 인슐린을 사용하고 있는 환자에서도 발생할 수 있으므로 주의와 함께 면밀한 경과 관찰이 필요하겠다.
Abstract
A 32-year-old pregnant woman (34 + 5 weeks) was admitted with dizziness, nausea, and vomiting. Previously, she was diagnosed with gestational diabetes mellitus at 28 weeks with 100 g-OGTT and insulin therapy was started. Her average fasting glucose level was 97 mg/dL and postprandial 1-hour glucose level was 130 mg/dL with basal-bolus insulin therapy (total dose of 28-30 IU/day). At 34 + 0 weeks of gestational age, polyuria and unexpected weight loss (2 kg/week) with hyperglycemia occurred, and total dose of daily insulin requirement was increased up to 50 IU/day. At admission, her serum glucose level was high (502 mg/dL), and urinalysis revealed ketonuria +3. Arterial blood gas analysis revealed pH of 6.83, pCO2 of 9 mmHg, and bicarbonate of 2 mmol/L with an anion gap of 23.5 mmol/L. The diagnosis of diabetic ketoacidosis was established and emergency caesarean section was conducted due to fetal distress. She was finally diagnosed with fulminant type 1 diabetes mellitus, and multiple daily insulin injection therapy was continued after delivery
참고문헌 (10)
- Imagawa A, "Report of the Committee of the Japan Diabetes Society on the research of fulminant and acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012)", J Diabetes Investig, 3, pp.536~539 (2012)
- Jung TS, "A Korean patient with fulminant autoantibody-negative type 1 diabetes", Diabetes Care, 27, pp.3023~3024 (2004)
- Kim NH, "A pooled analysis of 29 patients with fulminant type 1 diabetes in Korea: a comparison with a nationwide survey in Japan", Diabetes Res Clin Pract, 86, pp.e43~e45 (2009)
- 유형권, "임신과 연관된 전격성 제1형 당뇨병 1예", Diabetes and Metabolism Journal, 31(2), pp.180~183 (2007), 대한당뇨병학회
- Oh TS, "A case of fulminant type 1 diabetes during pregnancy", J Korean Diabetes, 17, pp.134~138 (2016)
- Kim HS, "Fulminant type 1 diabetes in a pregnant woman as an initial manifestation of the insulin autoimmune syndrome", Diabet Med, 29, pp.1335~1338 (2012)
- Shimizu I, "Clinical and immunogenetic characteristics of fulminant type 1 diabetes associated with pregnancy", J Clin Endocrinol Metab, 91, pp.471~476 (2006)
- Guo RX, "Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy", J Obstet Gynaecol Res, 34, pp.324~330 (2008)
- Kamalakannan D, "Diabetic ketoacidosis in pregnancy", Postgrad Med J, 79, pp.454~457 (2003)
- Cullen MT, "The changing presentations of diabetic ketoacidosis during pregnancy", Am J Perinatol, 13, pp.449~451 (1996)