SUN-124 Latent Autoimmune Diabetes of the Adult (LADA): Is It Gestational Diabetes?

Latent autoimmune diabetes in adults (LADA), is a recognized form of Diabetes Mellitus (DM), that initially presents in middle-aged adults and sometimes it is misdiagnosed as type 1 or 2 DM. However, patients often have autoantibodies directed against pancreatic islet-cells, and the progression to insulin dependence is much faster. Studies indicate that 10% of patients who present with Type 2 Diabetes Mellitus (T2DM) have a positive serum glutamic acid decarboxylase (GAD) antibody titer. The subsequent case report will demonstrate the progression of Gestational Diabetes, complicated with Diabetic Ketoacidosis (DKA) and later diagnosed with LADA due to positive GAD antibodies in a patient without history of autoimmune predisposition. It is important to address that DKA is an extremely rare complication of women with Gestational Diabetes, occurring in only about 0.5 -3.0 %. DKA usually is associated with T1DM but also it can occur in T2DM under extreme conditions, unwantedly on pregnancy could lead to a fetal mortality up to 35% and risks of preterm birth. The following case presents a 27 year old female G2P2A0 on week 25 of pregnancy that came to our institution after a high blood glucose level detected before performing routine 75g OGTT screening for Gestational Diabetes. Patient had a previous history of Gestational Diabetes four years ago and referred that after vaginal delivery blood glucose levels were within normal limits, but denied routine outpatient screening for DM after delivery. Patient referred that 1 week before arrival to the hospital developed a generalize weakness associated with anorexia, nausea, vomits, polydipsia and polyuria. Besides previous Gestational Diabetes, patient denied any other medical conditions and denied family history of autoimmune conditions as well. At physical examination pertinent findings were a BMI of 18.3, dry oral mucosa, fruity breath odor, drowsiness, and evidence of vaginosis at pelvic examination. At hospital arrival patient had ABGs with a pH of 7.2, with serum HCO3 in 7, serum glucose in 605, and large ketones fulfilling criteria for DKA. Patient was admitted to ICU for DKA management with success and subsequently discharged on tight subcutaneous insulin regimen. This case reveals the importance of screening for postpartum DM after a Gestational Diabetes, and when the diagnosis does not fit, further investigation should be made. Taking in consideration the previous case report, a focused family history, risk factors, and demographics an autoimmune workup should be ordered for patients who do not have the classic presentation of T2DM. This case made a statement in which early identification makes the difference, recertifying what studies have shown that identifying LADA early and initiating insulin therapy helps preserve beta cell function, improve quality of life and may prevent a potentially life threatening condition such as DKA.