What About Celiac Disease?
My celiac disease went undiagnosed until middle age—resulting in major osteoporosis and a lot of damage to my intestinal tract (despite my careful adherence to a gluten-free diet). I still have problems with unpredictable absorption of food. The amount of insulin I need for the same meal can vary greatly even if all other things are seemingly equal (sleep, exercise, etc.). All the doctors I have asked about celiac disease and diabetes have said they don't know anything about it. Barbara Grinnell, Wynnewood, Pennsylvania
Sue Robbins, RD, CDE, responds: Celiac disease is a digestive disease that damages the intestines and blocks the absorption of the nutrients in food. (To learn more about celiac disease and how to adhere to a gluten-free diet, check out "A Tricky Diagnosis," May '08, p. 35.)
Unfortunately, in your case it appears that you have significant long-term damage to the intestinal tract that may be affecting the absorption of the food that you are eating. Normally, ingested carbohydrate will be absorbed and your blood glucose will start to rise in about 15 to 20 minutes. Rapid-acting insulin, such as Humalog, Novolog, or Apidra, will begin working about the same time as the blood glucose begins to rise. If you take your insulin, and you do not absorb the carbohydrate, you are certainly at risk for low blood glucose. I would recommend that you ask your doctor about the possibility of using a continuous glucose monitor, which allows you to know what your blood glucose is at any time.
Many people with diabetes, especially type 1, have unexplained variability in blood glucose concentrations from time to time, despite identical physiologic conditions (which of course we all find very puzzling and frustrating). This could explain at least part of what you are observing.