Autoimmune Gestational Diabetes

hi - has anyone heard of this term being used to describe a woman diagnosed with T1 during pregnancy? I was GAD positive following a positive glucose tolerance test. i applaude my endocrinologist for thinking outside the box and actually running the antibody screen. i have been insulin dependent ever since, but i still require very, very little insulin. from what i have read on autoimmune GDM, it follows a very different course when compared to other types of diabetes. i recently read that GAD testing may become standard when a pregnant woman is diagnosed iwth GDM. i would love to connect with other women who were also diagnosed with autoimmune diabetes during pregnancy. thanks, melissa

Hi Melissa: Yes! I wrote an entire blog on autoimmune gestational diabetes (link here). Autoimmune GDM occurs in about 10% of Caucasian women who have GDM. Kelly and Super Sally are two that come to mind here on TuD that had autoimmune GDM. And yes, there is a push to do antibody testing on women with GDM, because if it is not caught quickly the consequences are disastrous. You are so very lucky it was caught early. Basically, autoimmune GDM is just Type 1 diabetes that is “revealed” by pregnancy. So you have Type 1 diabetes, and should follow the course for that. Be sure to check out the LADA group here on TuDiabetes.


I’m concerned that I have this. During my first pregnancy, I was diagnosed with gestational diabetes at the traditional 27 week screening since I had no symptoms (I am thin/ maybe even a bit underweight and no genetic family history). After my pregnancy, my diabetes stayed while I was nursing for 10 months. After I finished nursing, my blood sugars appeared to go back to normal. Now, I’m 6 weeks pregnant again, and my blood sugars started increasing immediately (in response to carb heavy meals)… even with things like oatmeal!

I also want to note that my daughter was born at 33 weeks with no explanation (I maintained blood sugars with diet). Not sure if this could be related…

In between pregnancies, I was tested for a panel of auto antibodies, which came our negative, but my c-peptide was low.

Any insight from anyone?

Hi Holly: Do you know which autoantibodies you were tested for? There are five. A problem is, there may be autoantibodies that have not yet been identified. For example, ZnT8 is the “new kid on the block,” whereas ICA has been around since the early 1970s. Also, there are genetic markers for autoimmune diabetes and c-reactive protein which indicates the autoimmune process, but those are never tested outside of research studies. If you have low c-peptide and are thin, it is much more likely that you have autoimmune gestational diabetes, not insulin resistance. And if you have low c-peptide, it might be good to discuss with your doctor using insulin to treat your diabetes. Just my two cents.

Hi Holly,

I am 6 weeks pregnant now. Insulin requirements have already more than doubled compared to 4 weeks ago (up to TDD of 50 units/ day as of yesterday, compared to about 20 -25 U/ day under normal conditions).

Your type of diabetes may be autoimmune, however, pregnancy hormones and the placenta massively increase insulin resistance. Thus the relative lack of insulin, or inability of the pancreas to ramp up insulin production, become a problem during pregnancy.

I was diagnosed very early in my first pregnancy 9 years ago. Insulin ever since. Typically quite low doses required, except during pregnancy when my requirements soar.

I am antibody negative (for the antibodies tested), but have low c-peptide too. Interestingly, both of my daughters also have higher than normal blood sugars levels (negative antibodies, and the oldest has low-normal c-peptide), which are currently being contolled on low carb diet and under monitoring. So definitely something genetic happening in my case. Though my identical twin sister apparently doesn’t have the same issues…

Insulin is the standard care for diabetes in pregnancy. Eating a low carb diet is also helpful (Baby doesn’t need carbs which are simply C-H-O molecules), baby needs stable blood sugar levels (normal blood sugar levels are lower during pregnancy than outside of it).

This is now my 3rd pregnancy (unexpectedly), and I have heaps of experience from the first two, and adding to it now. So please ask questions, if you have any, and I’ll do my best to share my experience…