For the past several weeks we’ve noticed that if we bolus up front, or even immediately after, our son eats, he goes low.
However, about an hour or two later he starts to rise quite precipitously, almost as if all the food he ate is being digested very late. We’ve also noticed that even with simple sugars (i.e. glucose tabs and gummies) it now takes 30 minutes, rather than the typical 10 to 15, for his blood sugar to begin rising. As a result, we now bolus some very small amount 0.1 or 0.2 units for his lunch beforehand, and then the remainder (0.7 or 0.8 units) an hour or even 1.5 hours after he ate, just when he starts rising. Breakfast we still bolus beforehand and he doesn’t go low…but just stays flat for an hour or two and then starts rising.
I’m a little concerned that he could be showing signs of gastroparesis. Or is this a possible side effect of celiac disease? Or just some weird toddler growth spurt thingie? Overall he’s been using less insulin; we’ve had to progressively lower his basal to prevent nasty lows. His TDD has dropped from an average of about 8.4 units per day to 6 units per day most recently. But his carb ratios seem to still be roughly correct, only we have to administer the insulin in this wonky, distributed way. It makes it a lot more difficult to keep him in range at school, because no one wants to go three separate times to bolus for lunch.
The thing is, his BGs are fairly well controlled for a toddler (avg BG currently 135, sometimes lower), and he has had T1D for less than a year – so it would be really strange if he had developed gastroparesis already, right?
I agree with you that development of gastroparesis at this short duration of diabetes is not very likely. My understanding of Celiac disease is that it’s an autoimmune disorder but I think symptoms would be more pronounced and persistent. A food sensitivity, short of an autoimmune reaction may also be the source of your observations.
A toddler’s system is unique in that the body is undergoing many changes related to growth. Your ability to bolus normally, with a pre-bolus, for breakfast does confuse the situation.
I wonder if you son’s decreased need for insulin may be a pancreas that decided to put out more than its usual amount temporarily. Perhaps the best thing would be for you to see his doctor.
Good luck with trying to figure out what is going on. Your detailed observations should help the doctor troubleshoot. I hope your son returns to his “normal” soon.
About 6 to 10% 0f TD1 patients develop celiac disease. A simple blood test can determine is celiac disease may be the cause. Ask for the complete panel and not just the screening as kids can test differently (some adults too – like me).
Some celiacs are do not display any noticeable symptoms at all. Here is more information about testing from the University of Chicago’s celiac website:
Hi Tia_G,
it could be many things…the hallmark of GP (having it myself) is nausea…though many things can cause nausea. It is little known but several of GI dr have told me that GP also has a auto-immune cause, though there are usually other things with it (like pernicious anemia).
With my slow emptying I can go really low hours after eating and then spike up (usually I eat at 11 and test before and every hour after I find that I spike around 3-4.
Normally, fluids will process through quicker than solids, so one thing you could do is do a nutritional shake and see how his numbers are…I also bolus after meals rather than before…
I would suggest a GI workup and note that the diets for each of these diseases is not the same and not diabetic friendly…
@mskdka, thanks for this information it is helpful, as I’m pretty sure my son is not really nauseated, pretty much ever.
I have noticed that, say, an apple juice box raises his blood sugar a little faster than the glucose tabs, but that seems like it could conceivably be the case with celiac as well.
He’s due for his celiac antibody later this month (his 1-year-diaversary is coming up) so we’ll find out shortly. Really hope it’s neither of those and just some wonky late-breaking honeymoon effect.
