How to manage celiac disease and T1D at 19?

Question

Hi doctor,

I am a 19-year-old male, and I was diagnosed with type 1 diabetes at the age of 11. I take basal-bolus insulin Glargine at night and Lispro with meals, but my sugars are still not well controlled.

My recent HbA1c was 9.1%, and my fasting blood sugar levels are usually between 180 and 220 mg/dL. I sometimes miss doses because of my college schedule, and that leads to high readings.

Recently, I have also been diagnosed with celiac disease after I had persistent diarrhea, bloating, and weight loss. My anti-tTG antibody level was very high at 65 U/mL, and my endoscopy showed villous atrophy. Since starting a gluten-free diet, some symptoms have improved, but I still feel weak and fatigued most of the time.

My hemoglobin is 10.6 g/dL, which shows anemia, and my vitamin D was only 14 ng/mL. My weight is 119 pounds, and my BMI is 17.8, which is underweight for my height. I have noticed more episodes of hypoglycemia, especially at night, with sugars sometimes dropping below 60 mg/dL. Managing insulin doses has become very confusing with my irregular meals due to celiac disease.

I am worried about long-term complications from uncontrolled sugars and poor nutrition. Should I be shifting to an insulin pump or continuous glucose monitoring to improve my control? Also, how do I balance my gluten-free diet with the calorie requirements of diabetes?

Lastly, what supplements or lifestyle changes can help me improve my weight, energy, and overall health while managing both diabetes and celiac disease together?

Please help.

Answer 1

Hi,

Welcome to icliniq.com

Thank you for sharing your problems. You are facing a very challenging but manageable situation: type 1 diabetes, celiac disease, and being underweight, along with nutritional deficiencies. It will be better if we understand step by step. I want to discuss food choices along with insulin dose adjustments. This is a better way to deal with your problems.

I will recommend the following diet chart for you.

For breakfast, you can take two boiled eggs along with a slice of gluten-free bread and peanut butter. This will give you 0.7 ounces of carbohydrates. Adding a small banana will add an additional 0.5 ounces. Also, include a cup of lactose-free or fortified gluten-free milk (0.4 ounces of carbohydrates).

Total carbohydrates consumed in breakfast will be around 1.68 ounces.

Now, regarding your insulin Lispro, the dose has to be according to your insulin-to-carbohydrate ratio, that is, one unit is to be taken for 0.5 ounces of carbohydrates. Therefore, you have to take three units of Lispro.

Next, you must consume a mid-morning snack, which includes a handful of almonds or walnuts. This is high in calories with no carbohydrates. Along with this, take a small apple, which will give approximately 0.5 ounces of carbohydrates. So the total carbohydrates consumed in the mid-morning snack are only 0.5 ounces.

After this, you must eat lunch, which can include a cup of rice (1.6 ounces of carbohydrates), along with a cup of cooked lentils, which gives another 0.5 ounces of carbohydrates. With this, you must include grilled chicken or fish to complete the protein requirement with no additional carbohydrates. Also, add any salad with steamed vegetables.

So the total carbohydrates consumed in lunch will be around 2.14 ounces.

Now, if we calculate the insulin Lispro dosage and adjust it with the carbohydrate taken, it will be 4 units (required intake is 1:15).

After this, at snack time, you can take gluten-free oats porridge with milk (1 ounce of carbohydrates) along with a boiled egg or a cheese slice as snacks. This will add 1 ounce of carbohydrates.

The next meal, you can take a medium baked potato (1 ounce carbohydrates), and two gluten-free chapatis (1.4 ounces of carbohydrates), Chicken curry or grilled meat, and cooked vegetables.

The total carbohydrate count in dinner will be around 2.8 ounces.

The insulin Lispro has to be adjusted accordingly.

You can take a bedtime snack before you sleep, which can include a cup of yogurt (0.3 ounces of carbohydrates), along with flax or chia seeds and a small pear or peach of around 0.5 ounces of carbohydrates.

When we calculate the daily total, it will be approximately 8.8 ounces of carbohydrates and around 2,200-2,400 calories. This diet is balanced for celiac disease and type 1 diabetes.

I hope this helps answer your query.

Thank you.