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 Case 15.4 Diabetes mellitus

A 26-year-old pregnant woman attended the antenatal clinic regularly. She had no family history of diabetes. At 24 weeks' gestation she was found to have asymptomatic glycosuria. A glucose tolerance test showed that not only was her fasting blood glucose raised but she had poor glucose tolerance. Gestational diabetes was diagnosed and the patient was admitted for diabetic control. This was achieved on oral hypoglycaemic agents alone and the patient was instructed to check her urine daily. The pregnancy was uneventful and a normal, 3.8kg baby was born. The patient's glucose tolerance returned to normal in the puerperium; however, her serum, which was found to contain antibodies to pancreatic islet cells at the time of diagnosis, remained positive. Nine years later, after yearly checks, the patient developed overt diabetes mellitus.

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