173-LB: Two Cases of Autoimmune Type 1 Diabetes Mellitus (DM) with Prolonged Honeymoon Phase Leading to Partial and Complete Remission following Pregnancy

Abstract

Background and Purpose: Describe clinical course and outcomes of two cases of autoimmune DM who experienced remission and have remained insulin-free or on significantly reduced doses following pregnancy. Case Description: Case 1: 41 year old female G1P0 at 27w1d presented with diabetic ketoacidosis and was found to have new onset autoimmune diabetes with positive anti-GAD antibodies. She was treated with insulin therapy through the remainder of her pregnancy, and at post-partum follow-up found to be having hypoglycemic episodes. Insulin therapy was titrated down and eventually stopped. She has remained insulin-free with A1C <6% for two and a half years. Case 2: 28 year old female G2P2002 with history of DM 1 since age 8 at 33w6d presented with preeclampsia requiring early induction. Her hospital course was complicated by severe hypoglycemia. She was discharged on 14% of her pre-pregnancy insulin dose and was still hypoglycemic while on only 3 units of glargine. Outcome: Two cases of autoimmune DM with prolonged remission following pregnancy requiring little to no insulin therapy. Discussion: During pregnancy, multiple biological adaptations lead to increased insulin resistance and clearance, and following deliver many of these alterations revert and allow return to pre-pregnancy insulin dosing. These two cases demonstrate prolonged honeymoon phase. In addition to the cases, a literature review of the physiology of honeymoon phase including development of immunologic tolerance and possible mechanisms of resolution of autoimmune DM including suppression of autoimmunity and development of endogenous insulin production is included. Disclosure M.M. Kristan: None. Y. Kim: None. S.E. Thomas: None. K.M. Munir: None.