Tips for treating your patients with Type 1 diabetes and celiac disease

Type 1 diabetes and celiac disease. Individually, they each require a high level of knowledge and vigilance to manage. Counting carbs, reading labels, buying specialty foods, doctor visits, deciphering food additives, you name it. Now imagine combining the two conditions. Carb counting just got a lot more complicated.

The link between Type 1 diabetes and celiac disease

Both Type 1 diabetes and celiac disease are classified as autoimmune disorders, which means a person’s own body is attacking itself in some capacity. For Type 1 diabetes, the body has destroyed the beta cells on the pancreas, which produce insulin. And for celiac disease, the body attacks its own small intestine when gluten is consumed, resulting in damage to the intestinal lining.

So what’s the connection between Type 1 diabetes and celiac disease? According to the Celiac Disease Foundation (CDF), having one autoimmune disorder puts you at increased risk for developing another. The incidence of celiac disease in individuals with Type 1 diabetes is six to ten times higher than in the general population. For this reason, CDF recommends screening for celiac disease in all patients who have been diagnosed with Type 1 diabetes, even if they are asymptomatic because many of the symptoms of celiac disease can easily be mistaken for complications of Type 1 diabetes:

• unexplained high or low blood sugars
• abdominal bloating and pain
• chronic diarrhea
• vomiting
• constipation
• pale, foul-smelling, or fatty stool
• neuropathy
• weight loss
• fatigue
• irritability and behavioral issues
• short stature
• failure to thrive

What to know when treating a patient with Type 1 diabetes and celiac disease

If it weren’t enough of a challenge to count and balance intake of carbohydrates and remove all traces of gluten from one’s diet, now you are tasked with helping your clients do both at the same time. Here are some tips to remember:

• Even if a patient is asymptomatic, it is still essential to follow a strict gluten-free diet. Eating foods that contain gluten, even if there is no GI distress, still results in damage to the intestinal lining. Intestinal damage hinders nutrient absorption, including carbohydrates, which may result in low blood sugars.
• Standard carbohydrate exchanges may no longer apply. Assuming that a slice of gluten-free bread is still 15 grams of carbohydrates may under- or overestimate. Gluten-free foods often have different carb counts. Encourage your clients to read food labels on foods with which they are unfamiliar to get the correct amount of carbohydrates.
• Be prepared with gluten-free snacks. Individuals with Type 1 diabetes know all too well how a low blood sugar can sneak up on you. While items like juice and soda are gluten-free and can treat a low, it’s important to follow those fast-acting carbs with a more substantial snack. Encourage your clients to find some nonperishable, gluten-free snacks (think: granola bars, trail mix, protein bars, etc.) and keep them in their purse or pocket at all times.

A dietitian is an excellent resource for those managing Type 1 diabetes and celiac disease. And here are some great resources for you:

• Gluten-free recipes
• 7-day gluten-free menu for adults or kids
• Informational video with instruction for managing a gluten-free diet
• List of name brand gluten-free foods (with pictures!)
• Gluten-Free Recipes for People with Diabetes cookbook

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References:

Celiac disease and Type 1 diabetes. Celiac Disease Foundation website https://celiac.org/blog/2015/08/celiac-disease-and-type-1-diabetes/. Update August 4, 2015. Accessed January 21, 2018.

Celiac disease symptoms. Celiac Disease Foundation website https://celiac.org/celiac-disease/understanding-celiac-disease-2/celiacdiseasesymptoms/. Accessed January 21, 2018.

Gluten free diets. American Diabetes Association website http://www.diabetes.org/food-and-fitness/food/planning-meals/gluten-free-diets/?loc=logo. Updated February 28, 2014. Accessed January 21, 2018.