James K. Rone, MD, FACP, FACE

Gestational Diabetes in a Previously Healthy, Thin Woman

October 25, 2012

Tags: Gestational diabetes mellitus

THIS WAS MY REPLY TO MY WIFE'S OLDEST, DEAREST FRIEND, SEEKING INFORMATION WHEN HER DAUGHTER-IN-LAW WAS DIAGNOSED LATE IN PREGNANCY WITH DIABETES.

As your research suggests, gestational diabetes (GDM) usually occurs in mothers who are already predisposed to diabetes (obesity, family history, poor lifestyle habits, irregular periods and infertility). Your daughter-in-law’s lack of these features is unusual and I don’t know enough about the situation to explain it. Pregnancy is an insulin-resistant state which can tip someone on the verge of diabetes over the edge, and the fact that it’s taken 7 months to show up suggests that she had to be “tipped” further than average.

Your genetic background is of no importance—this is a maternal issue—not one the baby’s genes causes. Poor control of the GDM though can affect the baby—at this late stage probably no birth defects, but GDM babies tend to be bigger and harder to deliver.

Not sure what the acne has to do with anything—if she had it pre-pregnancy that would be a sign of insulin resistance though.

I can speculate about 2 possibilities—she either does have some occult genetic predisposition that hasn’t obviously manifested up till now, or this is the onset of type 1 diabetes (“juvenile onset diabetes”) which young healthy thin people without family history certainly can get.

Usual treatment is insulin, but the pills glyburide and metformin have been used more lately. My personal preference, if this is not type 1 diabetes which has to have insulin, is metformin, but that must be the obstetrician’s decision.

Good luck.

jkr

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