Case Study: Pregnancy and Early-Onset Type 1 Diabetes

C.B., a 24-year-old woman, came to our clinic for a diabetes consultation after being referred by her mother, who is one of our regular patients and has type 1 diabetes herself. The older woman’s diagnosis was made elsewhere 7 years before she sought care with our office and had been based on her lean frame (5% below ideal body weight [IBW] based on height) at presentation and relatively normal insulin sensitivity (insulin requirements have always been <0.5 U/kg/day). No antibody studies or C-peptide levels were done at the time of diagnosis.Her daughter, C.B., was diagnosed with type 2 diabetes at a community clinic in a rural area near Seattle 3 weeks before her visit with us. The diagnosis was based on her lack of ketones at presentation, “low” presenting blood glucose of 254 mg/dl, and age at diagnosis.Oral agents were suggested for C.B., but her mother insisted on insulin therapy. Her primary care provider was concerned about this, noting that insulin is rarely the best first-line treatment in patients with type 2 diabetes, but prescribed a temporary regimen for her to use until her appointment with me. At bedtime, she was told to take 2–4 U of NPH, depending on her bedtime blood glucose level, as obtained with home blood glucose monitoring. She was also given a sliding scale for lispro to be taken before eating, depending on her blood glucose readings. If her blood glucose value was …