I was dx with gestational diabetes with both my pregnancies, I diet controlled both times but at the end I ended up on meds, With my son I was dx early at like 13ish weeks along...fast forward almsot exactly 2 yrs after the birth of my son and I had routine bloodwork with a fasting glucose of 359! yikes! My primary care pushed it off as type 2, but because I have a lot family members with type 1 (some dx later in life like myself, I am almost 38) I found myself an endocrinologist ASAP! she is wonderful, took one look at me and my history and said "pretty sure you are a late onset type 1" she did the extra blood work including antibody testing and called me within days to tell me to start insulin. So I sort of think my GD was realy LADA all along, I admit after having my son I didn't go back for rechecks, my fault! life was busy with a newborn and a toddler, I totally dropped the ball! Anyway my initial A1C was in the 8s, currently it is at 6.2 which I am pretty happy about. My best advice is finding a good endo one that you click with and has experience with LADA. Good luck!
The problem is to differentiate gestational diabetes (hormonally induced) from being pre-diabetic (T1 or T2). If you are indeed on your way to T1 (T1.5 is just a slower developing T1) then the pregnancy will reveal that. From an article I have read I have the impression that pregnancies need more beta cell mass (the cells that produce insulin). With T1 in pre-diabetic stage the capability to extend this mass is limited. As a result these women show all the signs of being pre-diabetic. After the pregnancy this might revert to normal levels. But more likely the autoimmune condition will gain more momentum with time leading to a sure T1/T1.5 diagnosis within 1 to 2 years after birth.
Do you have any idea what you A1C ranges might have been before the first pregnancy? If you were on insulin prior to the pregnancies, how does your endo think this would have effected the progression?
I do not know what they were prior to pregnancy, I can tell you that my random glucoses drawn during early pregnancy as part of initial pregnancy bloodwork were always in the normal range. They would then send me for the 2hr glucose test and my levels would be in the 200s...202 with my first and 256 with my second. Had I known then what I know now I would have seen an endo right away rather than going to just a maternal fetal medicine dr which is who my OB referred me to. I took glyburide during my pregnancies, it helped some but I still had to eat extremely low carb to stay in range. I did talk to my endo about this (after the fact of course) and she said had I seen her while I was pregnant she absolutely would have started me on insulin right away, she doesn't believe in oral meds for GD and believes insulin can help preserve beta cells thus slowing the progression, she also said she would have tested me for late onset type 1 right away as well based on my hx, etc. Live and learn I suppose. That being said I had 2 healthy full term kids who weren't huge or effected by my diabetes, so I hold onto that and let the rest go, what else can ya do! I just hope they don't get my "crappy pancreas genes!" I worry about that...lots!
also worth noting is that my ob never had an A1C done, now I think that is standard as part of the initial pregnancy bloodwork. Too little too late in my case...no more babies for me! ;)
That's interesting as I was led to believe that pregnant women typically aren't given insulin. My wife is looking at options as a pre diabetic and she really doesn't want to inject but she is also not crazy about taking the pills as she was told that insulin could help keep the pancreas going longer, healthier. Her endo thinks she should think about pens until inhaled insulin is available.
I truly think it is one of those things where it may vary dr to dr...like I said I treated with a high risk/maternal fetal med provider. He never once mentioned insulin to me however my endo believes that all diabetic preggos should be started on insulin ASAP. Honestly I think I hate taking pills more than injecting but I am weird like that! I use pens and the needles are so itty bitty that I truly feel like pricking my finger hurts worse than injecting. Good luck to your wife!...and you!!
An interesting study on German patients with GD, now considered an older study (~1998 I think), found that almost 100% of women with GD who had to be treated with exogenous insulin during pregnancy then developed Type 1 diabetes post-pregnancy. It's referred to as autoimmune gestational diabetes. TuD member Kelly, who had GD, was misdiagnosed as Type 2, then later correctly diagnosed as Type 1 after insisting on autoantibody testing, says "I would add that a sign of autoimmune GDM is being diagnosed under the age of 30, having no or little family history of Type 2, and being diagnosed (or testing positive for sugar in urine tests) before 25 weeks gestation."
Yes, my OB didn't even give me a choice with the oral meds. She wanted me on insulin asap. My blood sugar was very high though. I didn't know enough about diabetes to ask why. Wish I had.