Dietary Therapy in a Case of Gestational Diabetes Mellitus with Severe Obesity

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  • Tsunekawa Shin
    Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine
  • Miura Yoshitaka
    Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine
  • Itakura Atsuo
    Maternity and Perinatal Care Center, Nagoya University Graduate School of Medicine
  • Oiso Yutaka
    Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine

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  • 食事療法に苦慮した高度肥満合併妊娠糖尿病の1例
  • 症例報告 食事療法に苦慮した高度肥満合併妊娠糖尿病の1例
  • ショウレイ ホウコク ショクジ リョウホウ ニ クリョ シタ コウド ヒマン ガッペイ ニンシン トウニョウビョウ ノ 1レイ

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Abstract

A severely obese 24-year-old pregnant woman (BMI 51.2 kg/m2) referred for treatment of gestational diabetes mellitus, presented a diabetic pattern in 75 g-OGTT and elevated HbA1C. Laboratory findings showed elevated blood glucose and ketone bodies. Diabetic diet of 1,840 kcal (ideal body weight×30 kcal) failed to control both glucose and ketone bodies. Mealtime insulin lispro injection achieved good blood glucose control, but ketone bodies remained elevated. Increased calories to 2,000 kcal ameliorated her condition and she was discharged.<br>At 30 weeks gestational, she was hospitalized again due to impending premature delivery. Gestosis diet of 1,800 kcal elevated blood ketone bodies and liver dysfunction. Increased calories and protein ameliorated both symptoms. Her daily insulin dose was increased to 106 units and her condition stabilized. She delivered by cesarean section at 37 weeks gestation. The neonate weighed 2,542 g and had no abnormalities. The result of 75 g-OGTT in her postpartum period showed a normal pattern. Although calorie restriction was recommended for obese patients with gestational diabetes mellitus, adequate calorie control and insulin injection may be required for normal metabolic control.

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