SUN-532 - Abrupt-Onset Insulin Deficiency Presenting as Diabetic Ketoacidosis Following Cesarean Delivery

Introduction: Insulin-deficient diabetes is typically associated with autoimmune β-cell destruction and evolves over time. Acute, profound insulin deficiency immediately following cesarean delivery in the absence of prior dysglycemia is not well described.

Case Presentation: We report the case of a 35-year-old East Asian woman who presented with decreased fetal movement and underwent primary cesarean delivery at 38 weeks’ gestation. Her antenatal course was notable for a normal second-trimester oral glucose tolerance test. In the immediate postoperative period, she developed marked hyperglycemia without exposure to glucocorticoids and was found to be in diabetic ketoacidosis. Following stabilization, she was initiated on a basal–bolus insulin regimen. Laboratory evaluation demonstrated a glycated hemoglobin (A1C) of 5.5%, undetectable C-peptide, and negative pancreatic autoantibodies, including islet antigen-2, glutamic acid decarboxylase-65, zinc transporter 8, islet cell, and insulin antibodies. At two weeks post-discharge, she remained insulin-dependent without reduction in insulin requirements.

Discussion: This case represents an unusual presentation of abrupt insulin deficiency following non-pancreatic surgery in the peripartum period, with no prior evidence of dysglycemia, as supported by a normal A1C and negative gestational diabetes screening. While cases of type 1 diabetes onset in the postpartum period have been described, they are typically preceded by gestational diabetes or evolving hyperglycemia. The absence of detectable autoantibodies in the setting of undetectable C-peptide is most consistent with idiopathic (type 1B) diabetes, potentially precipitated by surgical stress and peripartum immunologic shifts.

Conclusion: This case underscores the potential for abrupt-onset insulin deficiency in the immediate post-cesarean period and the need for prompt recognition of diabetic ketoacidosis despite normal prior diabetes screening.

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