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Dka And Fetal Demise

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

US Pharm. 2010;35(9):HS-2-HS-8. Pregnancy is associated with increased levels of emotional and physical stress. Women with preexisting conditions such as hypertension and diabetes require intense prenatal monitoring by health care professionals. Pharmacists in direct contact with patients can play an integral role in identifying signs and symptoms that require immediate care. Two conditions that require emergent treatment in pregnant women are severe preeclampsia and diabetic ketoacidosis. SEVERE PREECLAMPSIA Hypertensive disorders can affect 6% to 8% of women and increase the risk of morbidity and mortality in both the expectant mother and the unborn child.1,2 Hypertension in pregnancy is divided into four categories: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. The focus in this article is on severe preeclampsia, but a brief discussion of preeclampsia is warranted. Preeclampsia, a pregnancy-specific syndrome of unknown etiology, is a multiorgan disease process characterized by the development of hypertension and proteinuria after 20 weeks' gestation.1,2 See TABLE 1 for diagnostic criteria.1,2 History of antiphospholipid antibody syndrome, chronic hypertension, chronic renal disease, elevated body-mass index, age 40 years or older, multiple gestation, nulliparity, preeclampsia in a previous pregnancy, and pregestational diabetes mellitus increase a woman's risk of preeclampsia.1 Preeclampsia is classified as mild or severe based on the degree of hypertension, the level of proteinuria, and the presence of symptoms resulting from the involvement of the kidneys, brain, liver, and cardiovascular system. The incidence of severe preeclampsia is 0.9% in the United States.3 Severe preeclampsia is associate Continue reading >>

Diabetic Ketoacidosis Mimicking Hyperemesis Gravidarum: Case Report

Diabetic Ketoacidosis Mimicking Hyperemesis Gravidarum: Case Report

Diabetic ketoacidosis (DKA) characterized by hyperglycemia, ketosis and acidosis is a serious metabolic decompensation of diabetes mellitus (DM). It is a medical emergency that can occur in type 1, type 2 and gestational diabetes. Polyuria, polydipsia, nausea, vomiting, weakness, weight loss are the symptoms of DKA. Acidemia, hyperglycemia, increased anion gap, ketonemia, ketonuria are the laboratory findings. DKA can cause fetal and maternal mortality during pregnancy and usually occurs in the second and third trimester due to increased insulin resistance (1). Infections, emesis, non-compliance, insulin pump failure, drugs such as corticosteroids and β- sympathetomimetic agents, undiagnosed pregnancy are the precipitating factors. Maternal acidosis, hyperglycemia, volume depletion, electrolyte imbalance may effect the fetus. Aggressive fluid replacement, insulin infusion, as well as searching, correcting and treating the precipitating factors and electrolyte imbalance are the treatment modalities (1,2). Nausea and vomiting accompany 50-90% of all pregnancies (3). It is mostly self-limiting and peaks at 9 weeks of gestation. The most severe degree of vomiting during pregnancy is hyperemesis gravidarum (HG). It is characterized by persistent vomiting, weight loss, ketonuria, electrolyte abnormalities, and dehydration (4). Metabolic acidosis and ketonaemia may occur both in HG and DKA. Metabolic disorders such as DKA, gastrointestinal conditions, pyelonephritis, neurological causes and vestibular disorders should be considered in the differential diagnosis of HG (3,4). In this report, we describe a case of type 1 DM with fulminant course which occurred in the second trimester of pregnancy mimicking HG and resulted in fetal loss. Case Report A 30-year-old woman, nullipara Continue reading >>

Diabetic Ketoacidosis Poses Fetal Risk During / After Event

Diabetic Ketoacidosis Poses Fetal Risk During / After Event

(HealthDay)—Diabetic ketoacidosis (DKA) during pregnancy poses risk for the fetus during and after the event, according to research published online June 12 in Diabetes Care. Fritha J.R. Morrison, M.P.H., from Tulane University in New Orleans, and colleagues conducted a retrospective cohort study involving pregnancies between 1996 and 2015 with at least one DKA event in women with type 1 diabetes. Data were included for 77 DKA events in 64 pregnancies among 62 women. The researchers found that fetal demise, preterm birth, and neonatal intensive care unit (NICU) admissions occurred in 15.6, 46.3, and 59 percent of pregnancies, respectively. In 60 and 40 percent of the cases, fetal demise occurred at the time of or within one week of DKA and between one and 11 weeks after DKA, respectively. The risk of fetal demise was significantly increased with maternal ICU admission and higher serum osmolality during the DKA event. Maternal smoking and higher pre-DKA hemoglobin A1c levels correlated with increased risk of preterm birth. Higher risk of NICU admission was seen with maternal smoking, preeclampsia during pregnancy, higher anion gap during DKA event, and preterm birth. "Further research is needed to identify effective methods for prevention, early recognition, and timely treatment of DKA in pregnancy to mitigate risk of fetal demise and other adverse fetal outcomes," the authors write. More information: Abstract/Full Text (subscription or payment may be required) Continue reading >>

Diabetic Ketoacidosis In Pregnancy May Lead To Fetal Death

Diabetic Ketoacidosis In Pregnancy May Lead To Fetal Death

HealthDay News Diabetic ketoacidosis (DKA) during pregnancy poses risk for the fetus during and after the event, according to research published online in Diabetes Care. Fritha J.R. Morrison, MPH, from Tulane University in New Orleans, and colleagues conducted a retrospective cohort study involving pregnancies between 1996 and 2015 with at least one DKA event in women with type 1 diabetes. Data were included for 77 DKA events in 64 pregnancies among 62 women. The researchers found that fetal demise, preterm birth, and neonatal intensive care unit (NICU) admissions occurred in 15.6%, 46.3%, and 59% of pregnancies, respectively. In 60% and 40% of the cases, fetal demise occurred at the time of or within one week of DKA and between one and 11 weeks after DKA, respectively. The risk of fetal demise was significantly increased with maternal ICU admission and higher serum osmolality during the DKA event. Maternal smoking and higher pre-DKA hemoglobin A1c levels correlated with increased risk of preterm birth. Higher risk of NICU admission was seen with maternal smoking, preeclampsia during pregnancy, higher anion gap during DKA event, and preterm birth. Further research is needed to identify effective methods for prevention, early recognition, and timely treatment of DKA in pregnancy to mitigate risk of fetal demise and other adverse fetal outcomes, the researchers wrote. Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

What is diabetes? Diabetes is a condition in which the body can't produce enough insulin, or it can't use it properly. Insulin is the hormone that allows glucose (sugar) to enter the cells to be used as fuel. When glucose cannot enter the cells, it builds up in the blood. This is called hyperglycemia or high blood sugar. Damage from diabetes comes from the effects of hyperglycemia on other organ systems including the eyes, kidneys, heart, blood vessels, and nerves. In early pregnancy, hyperglycemia can result in birth defects. What are the different types of diabetes? There are three basic types of diabetes including: Type 1 diabetes. Also called insulin-dependent diabetes mellitus (IDDM), type 1 diabetes is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. Type 1 diabetes usually develops in children or young adults, but can start at any age. Type 2 diabetes. A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It used to be called noninsulin-dependent diabetes mellitus (NIDDM). Gestational diabetes. A condition in which the blood glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes. Diabetes is a serious disease, which, if not controlled, can be life-threatening. It is often associated with long-term complications that can affect every system and part of the body. Diabetes can contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. What happens with diabetes and pregnancy? During pregnancy, the placenta supplies a growing fetus with nutrients and water. The placenta also makes a variety of horm Continue reading >>

A Case Of Ketoacidosis In Pregnancy

A Case Of Ketoacidosis In Pregnancy

Abstract: Background: Pregnant women are predisposed to accelerated starvation due to continuous nutrient demands by the fetus, and they have increased susceptibility to ketogenesis during periods of caloric deprivation [1, 2]. We report a case of starvation ketoacidosis in a patient with gestational diabetes on a carbohydrate-restricted diet. Clinical case: A 30 year-old woman, gravida 5, para 2, with a history of spina bifida and hydrocephalus status post ventriculoperitoneal shunt, presented at 37 weeks of gestation with dyspnea. Her pregnancy had been complicated by gestational diabetes mellitus treated with a carbohydrate-restricted diet of 30 g a day. Due to a previous pregnancy complicated by late intrauterine fetal demise, a caesarean section was planned at 37 weeks of gestation after administration of steroids to induce fetal lung maturity. On admission, the patient’s blood pressure was 116/69 mm Hg, heart rate 106 beats per minute, oral temperature 36 °C, pulse ox 97%, and respiratory rate 20 breaths per minute. Laboratory tests showed a mixed metabolic acidosis and respiratory alkalosis with pH 7.3 (7.33 - 7.43), HCO3 7.3 meq/l (20 - 27 meq/l), positive urinary ketones, and glucose of 75 mg/dl (65 – 139 mg/dl). Her glycosylated hemoglobin was 5.8% (4.0 - 6.0 %), C-peptide level 14.3 ng/ml (0.6 - 12.0 ng/ml), total insulin level 4.1 uU/ml (5 to 25 uU/ml), and lactate 1.8 mmol/l (0.5 - 2.2 mmol/l). Her dyspnea progressed, requiring intubation followed by emergent caesarean section. Afterwards, she was transferred to the surgical intensive care unit. She was treated with intravenous fluids containing dextrose and bicarbonate; she never received insulin and her blood glucose ranged from 65 to 139 mg/dl. By hospital day 3, the metabolic acidosis resolved, and Continue reading >>

Retrospective Analysis Of Diabetic Ketoacidosis In Pregnant Women Over A Period Of 3 Years

Retrospective Analysis Of Diabetic Ketoacidosis In Pregnant Women Over A Period Of 3 Years

1Department of Diabetes and Endocrine, Hamad Medical Corporation, Doha, Qatar 2Department of Obstetrics and Gynecology, Hamad Medical Corporation, Doha, Qatar 3Department of Obstetrics, Sidra Medical and Research Center, Doha, Qatar Corresponding Author: Khaled Ahmed Baagar Department of Diabetes and Endocrine Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar Tel: +974-66049423 E-mail: [email protected] Citation: Baagar KA, Aboudi AK, Khaldi HM, Alowinati BI, Abou-Samra AB, et al. (2017) Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years . Endocrinol Metab Syndr 6:265. doi:10.4172/2161-1017.1000265 Copyright: © 2017 Baagar KA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Endocrinology & Metabolic Syndrome Abstract Objective: The incidence of diabetic ketoacidosis in pregnancy (DKP) varies from 0.5%, the lowest reported rate in western countries, to 8.9% in a study conducted in China. The associated fetal mortality is 9-36%. This study aimed to assess the current incidence, causes, and outcomes of diabetic ketoacidosis in pregnancy and identify factors associated with favorable outcomes. Methods: A retrospective chart review of 20 diabetic ketoacidosis hospital admissions of 19 pregnant women from 3,679 diabetic pregnancies delivered between June 2012 and May 2015 was conducted. Those with successful DKP management (group A) or with intrauterine fetal death or urgent delivery during diabetic ketoacidosis management (group B) were compared. Results: Thirteen cases had type 1 diabetes, and 6 cases had Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Abstract Diabetic ketoacidosis (DKA) is a life-threatening medical emergency and is characterized by hyperglycemia, acidosis, and ketonemia. DKA is observed in 5–10 % of all pregnancies complicated by pregestational diabetes mellitus. Laboratory findings are as follows: Ketonemia 3 mmol/L and over or significant ketonuria (more than 2+ on standard urine sticks) Blood glucose over 11 mmol/L or known diabetes mellitus Bicarbonate (HCO3 −−) below 15 mmol/L and/or venous pH less than 7.3 Common risk factors for DKA in pregnancy are new-onset diabetes, infections like UTI, influenza, poor patient compliance, insulin pump failure, treatment with β-mimetic tocolytic medications, and antenatal corticosteroids for fetal lung maturity. Patient should be counseled about the precipitating cause and early warning symptoms of DKA. DKA should be treated promptly, and HDU/level 2 facility with trained nursing staff and/or insertion of central line is required during pregnancy for its management. Continuous fetal heart rate monitoring commonly demonstrates recurrent late decelerations. Delivery is rarely indicated as FHR pattern resolves as maternal condition improves. DKA therapy can lead to frequent complication of hypoglycemia and hypokalemia, so glucose and K concentration monitoring should be done judiciously. Maternal mortality is rare now with proper management, but fetal mortality is still quite high ranging from 10 to 35 %. Continue reading >>

Fetal Effects Of Diabetic Ketoacidosis

Fetal Effects Of Diabetic Ketoacidosis

The greatest hazard facing the pregnant diabetic patient with DKA is fetal loss. The exact fetal loss rate is difficult to assess because of the small reported series in the literature. Historically, the reported fetal mortality ranged between 30 and 90%7 but remarkable progress has been made both in fetal assessment techniques and in the treatment of DKA, and mortality rates in more recent reviews are 10%.20 Needless to say, fetal loss is primarily related to the severity of the maternal illness and the degree of metabolic decompensation. Most fetal losses occur prior to diagnosis and therefore to the onset of efficient treatment. As ketone bodies freely cross the placenta, maternal acidosis is assumed to cause fetal acidosis; however, the exact mechanism by which maternal DKA affects the fetus remains unclear. Suggestions include a decrease in uterine blood flow and fetal hypoxemia, maternal hyperke-tonemia inducing fetal hypoxemia, and fetal hyperglycemia causing an increased fetal oxidative mechanism and a decreased fetal myocardial contractility. Indeed, fetal potassium deficit has been found to lead to fetal cardiac arrest.7 Fetal hypoxia may also be attributed to a DKA-associated phosphate deficit which leads to depletion of red cell 2,3-diphosphoglycerate and consequent impairment of oxygen delivery. The risk of fetal distress, and even death, during the maternal DKA state makes it mandatory to continuously monitor the fetal heart and to assess the biophysical score, and to evaluate the fetal acid-base balance by cordocentesis if necessary. In the few case reports of fetal monitoring during maternal DKA, a nonreassuring pattern with tachycardia, reduced variability and late decelerations was reported.21,22 LoBue and Goodlin23 found that the administration of jus Continue reading >>

Diabetic Ketoacidosis Poses Fetal Risk During/after Event

Diabetic Ketoacidosis Poses Fetal Risk During/after Event

WEDNESDAY, June 21, 2017 (HealthDay News) -- Diabetic ketoacidosis (DKA) during pregnancy poses risk for the fetus during and after the event, according to research published online June 12 in Diabetes Care. Fritha J.R. Morrison, M.P.H., from Tulane University in New Orleans, and colleagues conducted a retrospective cohort study involving pregnancies between 1996 and 2015 with at least one DKA event in women with type 1 diabetes. Data were included for 77 DKA events in 64 pregnancies among 62 women. The researchers found that fetal demise, preterm birth, and neonatal intensive care unit (NICU) admissions occurred in 15.6, 46.3, and 59 percent of pregnancies, respectively. In 60 and 40 percent of the cases, fetal demise occurred at the time of or within one week of DKA and between one and 11 weeks after DKA, respectively. The risk of fetal demise was significantly increased with maternal ICU admission and higher serum osmolality during the DKA event. Maternal smoking and higher pre-DKA hemoglobin A1c levels correlated with increased risk of preterm birth. Higher risk of NICU admission was seen with maternal smoking, preeclampsia during pregnancy, higher anion gap during DKA event, and preterm birth. "Further research is needed to identify effective methods for prevention, early recognition, and timely treatment of DKA in pregnancy to mitigate risk of fetal demise and other adverse fetal outcomes," the authors write. Abstract/Full Text (subscription or payment may be required) This article: Copyright © 2017 HealthDay. All rights reserved. Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Pregestational and Gestational Diabetes throughout the pregnancy Pregestational vs Gestational Diabetes Pregestational diabetes is diabetes that pre exists the pregnancy Gestational diabetes develops or is first discovered during the pregnancy. Changes in glucose metabolism during pregnancy Early in pregnancy there is an increased insulin secretion At the end of the first trimester most women have an increased glucose utilization and increased insulin secretion In the second and third trimesters there is a progressive increase in insulin resistance due to pregnancy hormones from the placenta. How do these changes effect preexisting diabetes? Insulin needs may be decreased in the first trimester due to these changes as well as the nausea and vomiting pregnant women experience. There will be an progressive increased need for insulin during the second and third trimester. Post partum needs will be decreased dramatically Preconception health and diabetes This is a concept in which a mother receives care before she becomes pregnant in order to achieve optimal results for her and her baby. Primary goal in diabetes is a HbA1c of less than 7% at pre conception. To continue on birth control until it is at that level. However, remember that it is recommended that ALL women receive preconception care. Additional preconception testing Pap CBC Serum creatinine Thyroid 24 hour urine Lipid panel Retinal exam Neurological exam Medication usage Insulin regimen Referral to diabetes educator Referral to dietician Maternal Consequences of preexisting diabetes Preeclampsia Bacterial infections Polyhydraminos Birth trauma from macrosomic infants Preterm labor Cesarean delivery Postpartum hemorrhage DKA A word about DKA and pregnancies DKA is seen in 5-10% of pregnancies complicated by diabet Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes that is characterized by uncontrolled hyperglycemia, anion gap metabolic acidosis, and ketosis. Strategies for medical management that is safe for both mother and fetus will be presented. The anesthetic management of labor and delivery as well as operative deliveries will be discussed. AnesthesiaObstetricalDiabetic ketoacidosisHyperglycemiaFetal loss This is a preview of subscription content, log in to check access. Montoro MN, Myers VP, Mestman J, Xu Y, Anderson BG, Golde SH. Outcome of pregnancy in diabetic ketoacidosis. Am J Perinatol. 1993;10(1):1720. CrossRef Google Scholar Ramin KD. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin N Am. 1999;26(3):4818. CrossRef Google Scholar Kamalakannan D, Baskar V, Barton DM, Abdu TA. Diabetic ketoacidosis in pregnancy. Postgrad Med J. 2003;79(934):4547. CrossRef Google Scholar Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol. 2014;123(1):16778. CrossRef Google Scholar Cullen MT, Reece EA, Homko CJ, Sivan E. The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol. 1996;13(7):44951. CrossRef Google Scholar Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):41226. CrossRef Google Scholar Cascio M, Pygon B, Ramanathan S. Labor analgesia with intrathecal fentanyl decreases maternal stress. Can J Anesth. 1997;44(6):6059. CrossRef Google Scholar Crites J, Ramanathan J. Acute hypoglycemia following combine spinal-epidural (CSE) in a parturient with diabetes mellitus. J Am Soc Anesthesiol. 2000;93(2):5912. CrossRef Google Scholar Hogan K, Rusy D, Springman SR. Difficult laryngoscopy and diabetes mell Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis affects only 1% to 3% of pregnancies complicated by diabetes; nonetheless it is an acute medical emergency with a potential for dire consequences for both mother and fetus.9,19,31 The maternal mortality rate secondary to diabetes has fallen remarkably from a preinsulin era high of 50% to less than 1% today.18 The rate of maternal loss owing to diabetic ketoacidosis in pregnancy is unknown but most likely ranges from 4% to 15%.18,24,46 The majority of reports on ketoacidosis in pregnancy contain data on 20 or fewer patients, thus maternal mortality rates once ketoacidosis ensues must be extrapolated from nonpregnant data. In the series reported by Gabbe and co-workers,18 7 of 24 deaths in pregnant diabetic women resulted from metabolic complications, with 4 caused by ketoacidosis. Clements and Vourganti11 and Hollingsworth28 have suggested that many of these deaths could have been prevented by appropriate management. Diabetic ketoacidosis more commonly occurs in the second and third trimesters when increased insulin resistance is present.18,41 Fetal mortality has also decreased markedly since the introduction of insulin; however, it is still excessively high. Historically, fetal loss rates have ranged from 30% to 90%.16,32,33 Recently, Montoro and co-workers39 studied 20 type I diabetic pregnant women with ketoacidosis. On admission, seven women (35%) were diagnosed with a fetal demise. None of the remaining 13 women sustained fetal loss once therapy was begun. Kilvert and colleagues31 reported a fetal loss rate of 22% (including spontaneous abortions), with only one (14%) loss among seven cases occurring after the first trimester. Kent and co-workers30 compared fetal mortality among 21 pregnant women with brittle diabetes (those with recurrent keto Continue reading >>

Sun-lb029 A Case Of Gestational Diabetes With Diabetic Ketoacidosis, Insulin Injection Site Reaction And Anti Insulin Antibodies In Pregnancy

Sun-lb029 A Case Of Gestational Diabetes With Diabetic Ketoacidosis, Insulin Injection Site Reaction And Anti Insulin Antibodies In Pregnancy

SUN-LB029 A Case of Gestational Diabetes with Diabetic Ketoacidosis, Insulin Injection Site Reaction and Anti Insulin Antibodies in Pregnancy Northwestern University-Dept of Endocrinology, Metabolism & Molecular Medicine, Chicago, IL, United States Search for other works by this author on: Northwestern University-Dept of Obstetrics & Gynecology, Chicago, IL, United States Search for other works by this author on: Northwestern University-Dept of Endocrinology, Metabolism & Molecular Medicine, Chicago, IL, United States Search for other works by this author on: Obstetrics and Gynecology, Northwestern University-Dept of Obstetrics & Gynecology, Chicago, IL, United States Search for other works by this author on: Northwestern University-Dept of Obstetrics & Gynecology, Chicago, IL, United States Search for other works by this author on: Northwestern Univ Med Sch, Chicago, IL, United States Search for other works by this author on: Division of Endocrinology, Northwestern University-Dept of Endocrinology, Metabolism & Molecular Medicine, Chicago, IL, United States Search for other works by this author on: Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April-May 2019, SUN-LB029, Stephanie Hakimian, MD, Charlotte Niznik, APRN, CDE, Malek El Muayed, MD, MS, Lynn Yee, MD, MPH, Ashish Premkumar, MD, Boyd Metzger, MD, Amisha Wallia, MD, MS, SUN-LB029 A Case of Gestational Diabetes with Diabetic Ketoacidosis, Insulin Injection Site Reaction and Anti Insulin Antibodies in Pregnancy, Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April-May 2019, SUNLB029, Background: Gestational diabetes mellitus (GDM) is defined as impairment of glucose tolerance with first recognition during pregnancy and is rarely associated with diabetic ketoacidosis (DKA). The i Continue reading >>

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