Gestational diabetes mellitus with profound insulin resistance. A case report.

Gestational diabetes resistant to insulin therapy occurring in association with insulin receptor antibodies has not been reported previously. A patient developed diabetes mellitus at 21 weeks' gestational age and had a previous history of thrombotic thrombocytopenia purpura, then in remission. She developed life-threatening diabetic ketoacidosis that was severely resistant to insulin treatment despite the usage of adjunct therapy, including plasmapheresis, and intravenous cyclophosphamide and steroids. She also had lupus nephropathy. Termination of the pregnancy at 22 weeks' gestation resulted in a rapid resolution of both the diabetes and lupus nephropathy.