Living with Type 1 Diabetes & Coeliac Disease - part 3

Here's part 3 of Sally's story about managing coeliac disease and type 1 diabetes...

GF Hypo Management

My first two posts covered breakfast and lunch tips when living with type 1 diabetes and coeliac disease as I do, now that I’m almost a qualified dietitian.

Another really important tip that doesn’t relate specifically to a particular meal is that of choosing a convenient gluten free (GF) hypo treatment since traditional jelly beans contain wheat starch. Of course there’s always the traditional glucose tablets, but you need to have ten of these to make 15g carbohydrate, and Lucozade is GF, but isn’t very convenient to carry around with you just in case you have a hypo. (When I say hypo I'm talking about hypoglycaemia, what can happen to someone with diabetes if their sugar levels become too low.)

A common misconception from a GF perspective is that glucose may contain gluten when it is derived from wheat. You’ve probably heard that it IS GF because the glucose has been so heavily processed so no gluten remains, and this is true. It’s also important to understand that the glucose is critical from a diabetes hypo management point of view. In hypo recovery, the hypo can be treated much faster with pure glucose as the body doesn’t need to break down any more complex sugars to the glucose that is needed by your body.

So you need to go to the confectionary isle at the supermarket and read the labels of lollies that you enjoy the flavour of and would be convenient to carry around in a smallish container with you for those hypo occasions. Remember to choose lollies high in glucose that can be quickly consumed (not those designed for sucking slowly). Of course, not chocolate as it is low-GI so won’t act fast enough.

The next step involves reading the nutrition information panel again and getting out a set of scales to weigh the number of those lollies that it takes to get to 15g carbohydrate. You only need to do this once, so it’s worth taking the effort to get it right. When I’m having a hypo I always remember being told that the body can only absorb 1 gram of glucose per minute, so that’s why we start with 15g of glucose based carbohydrate (CHO) and test the BGL 10-15 minutes after eating it to check for improvements before going overboard with eating (as is very tempting when in a hypo!) and then having to manage the yo-yo post-hypo BGL effect.

My favourite lolly for hypos is Woolworths 'Select' brand of super streeeeetchy snakes that are labelled gluten free as well as containing no artificial colours or flavours. There are other types of lollies under this brand which would be harder to manage as they come in different shapes per pack, so you couldn't be as clear about how many to have for the 15g CHO serve. One snake provides about 9.5g CHO, so 1.5 snakes would make a good gluten free hypo treatment. Afterwards, be sure to follow up with some longer-acting carbohydrates to keep your BGLs from falling again.

Summary

Before I say goodbye, I'd like to sum up my key messages from my last 3 blogs:

• Remember that living with both conditions is more achievable the more you learn about both, and there is a lot of support around if you feel it would help you.

• Join your state diabetes association (Australian Diabetes Council in NSW, Diabetes Australia in the other states) and join Coeliac Australia - their quarterly magazine has great resources in it that will help you to manage the ‘double whammy’ and will improve your understanding of the more technical issues.

• Buy yourself a set of digital scales to help with better carbohydrate counting, especially for your breakfast cereals and carbohydrate-based snacks.

• Learn to read nutritional information panels (NIPs), and understand how to convert what the product calls a ‘serve’ to what you consider to be a serve, so that you count the correct levels of carbohydrates.

• Learn to experiment a bit and keep notes of the products you use the most, as some NIP's estimates of carbohydrate content may react differently in your own system (see my example of the Melinda’s risotto cakes where the label indicates they contain 40g of carbohydrate, yet for me that is too many so I choose to work off 30g.)

• The best diet for someone with diabetes is a low fat, low GI carbohydrate one, so watch out for these issues when choosing gluten free foods. Remember that just because a product is gluten free, doesn’t mean it’s good for you! Try to eat fresh foods in preference to processed ones, even if they are gluten free.

• Remember that if there isn’t a gluten free option available, you can still eat a carbohydrate free meal, such as meat/fish and salad, and just not take any insulin for that meal, checking first that your blood sugar level is within your target range.

• If you would like individualised dietary advice on type 1 diabetes and/or coeliac disease, the best person to speak to is an Accredited Practising Dietitian.  

Editor's note:

Thanks again Sal. You've certainly opened up my eyes into the world of living with type 1 diabetes and coeliac disease. I admire your positive attitude and willingness to help others. There is no doubt in my mind that you'll make a fantastic dietitian.

If you have any questions for Sally, drop us a comment below, or alternatively you can connect with Sally here.

Living with Type 1 Diabetes & Coeliac Disease - part 2

Here's part 2 (of 3) of Sally's story about managing coeliac disease and type 1 diabetes...

Easy GF sandwich alternative

In my last post I spoke about having the ‘double whammy’ of type 1 diabetes and coeliac disease and how it has inspired me to become a dietitian to help others to manage similar conditions. I discussed the importance of understanding how to carbohydrate count (this is something I didn’t fully appreciate until becoming a dietitian!) to improve your diabetes control. I also discussed how I manage my breakfast on a day-to-day basis, so now I’ll share some lunchtime tips with you.

For lunches away from home it is especially important to be organised and have planned to know whether there will be gluten free (GF) carbohydrates available, or be prepared to have a carbohydrate free lunch such as grilled fish/meat and salad. This is an option that I often take when in doubt of the GF quality of where I am eating. In this case, as there is no carbohydrate being eaten, I just don’t take any insulin with the meal.

When it comes to taking my lunch with me, I used to enjoy gourmet sandwiches before I needed GF, and now I find sandwiches to be a poor option due to both quality and size of GF breads for sandwich purposes. So, instead I make up batches of Mediterranean flavoured risotto cakes and savoury muffins with low-fat, high fibre tasty ingredients. These can be frozen (12 in a batch) and therefore make packing a lunch very easy. I tend to use the Melinda’s brand of gluten free pre-mix muffin and risotto cakes and adjust them with the low-fat/tasty ingredients. For instance I use a tablespoon of extra-virgin olive oil in place of butter, I use low-fat cheese options and I try to add high fibre ingredients to lower the GI and improve the texture of the finished product.

Melinda's GF muffin & risotto cakes

My friends are often envious of my tasty and filling morsels. My diabetes tip with the Melinda’s brand is that I have found them to overestimate the carbohydrate/serve on the nutrition information label. The risotto cakes label lists 41.6g carbohydrate/serve (nearly 3 carbohydrate serves), however in my experience it’s closer to 30g carbohydrate/serve (only 2 carbohydrate serves). You will need to be careful, as with all foods, to be familiar with how the product affects your BGL to avoid unnecessary high or low fluctuations in your BGLs.

Editor's note:

Thanks Sally, and great tips on how to make gluten free pre-mixes healthier with a few modifications to the ingredients list! Next week is our last week with Sal, where she'll talk about how to manage hypos and will give you some final take home messages. Stay tuned!

Living with Type 1 Diabetes & Coeliac Disease - part 1

Hi guys,

I have a special treat for you today. Instead of listening to my voice yarn on and on I've recruited the help of someone that has a very special story to tell. Let me share with you a little bit about Sally...

Sally Marchini

Sally is currently studying a Bachelor of Nutrition & Dietetics in her final year at the University of Newcastle. Sally knows what she’s talking about when it comes to gluten free diets as she’s been managing coeliac disease herself for 8 years as well as being diagnosed with type 1 diabetes at a young age. Sally has 12 years business experience as a PR/marketing consultant and now has a goal of becoming a specialist diabetes dietitian. Sally is passionate about helping people live 'normal' lives when they feel they're dealt a health condition such as coeliac disease or type 1 diabetes, and she can certainly lead by
example. Sally’s hobbies are golf, karate and of course, good food!

Connect with Sally on LinkedIn

 
Introduction and my GF breakfast
 
It was my lucky ‘double whammy’ of having both type 1 diabetes and coeliac disease that inspired me to become a dietitian, so I could use my knowledge and experience to help others in similar circumstances. So, now at the end of my four year dietetic degree, the time has come to share some tips on how I manage to enjoy a healthy and delicious gluten free (GF) diet that also balances my diabetes needs.

The most useful tool in managing both diabetes and a gluten free diet is to really understand carbohydrate counting and how the different types of carbohydrate affect your blood sugar. This is true for any diabetes diet, but when adjusting to a gluten free diet the differences can take a little getting used to. Jemma’s outline of low-Glycaemic Index (GI) GF foods will be a useful tool for those starting out. Reading nutrition information labels on foods is always helpful too, for instance the ordinary bread I used to eat was about 15-16g carbohydrate/slice, and the GF (low GI) one I choose now is only 11g/slice, which will change how much insulin I need.

I’ll give you some hints about how I go about balancing the diabetes and GF diet. I’ll start by explaining my thinking for breakfast and out-of-home lunches, as I have the same food nearly every day. I find this helps with stabilisation of my blood glucose levels (BGLs) as it takes on of the many variables that cause fluctuations in diabetes. Later I’ll talk about GF treatments.

For breakfast I start with a coffee made with 140ml of skim milk (providing about 7.5g carbohydrate – half a carbohydrate serve) and a 70g bowl of Carman’s Bircher muesli (as I can tolerate oats in my gluten free diet, and Carman’s products are made in wheat free environment) with another 140ml of skim milk on it (muesli provides 30g carbohydrate plus 7.5g for the milk – two and a half carbohydrate serves), meaning I can just inject/bolus for 45g carbohydrate (3 carbohydrate serves) each morning. Many people with coeliac disease do not tolerate oats, and in this case I would recommend Carman's Deluxe Fruit Muesli (Gluten Free). This breakfast usually lasts me through to an early lunch time, but if my BGL drops before then for any reason, I top up with a medium sized apple. If I’m planning to exercise then I adjust my insulin levels accordingly.


Editor's note:

Thanks so much Sally. We really value you sharing your story with us. 
Stay tuned for Sally's next blog with her lunchtime tips (that extend beyond gluten free bread!).

Traffic Light Food Tracker App - Review

Do you ever wonder when reading a food label what you should be looking for? Is it the fat, saturated fat, the total kilojoules or the sugar? What about whether it's low GI or high GI, or whether it's a good source of dietary fibre?

The answer is, they all count in their own special way.

The Australian Government is currently reviewing what they think is the best way to tackle food labelling by helping people to make informed decisions.

Some organisations such as Choice and the Obesity Policy Coalition have started developing their own criteria for what they think will help consumers. The problem is that although their intentions may be good, their food rating systems are poorly designed and can actually give you misleading and incorrect assessments of foods.

Recently the Obesity Policy Coalition produced an app to help people decide if a food is healthy or not. Read my review of this app before you download it, as you may just want to reconsider your decision.

Traffic Light Food Tracker App - Read my review here 

A big thanks to Catherine Saxelby from Foodwatch for inviting me to guest post on her ever so popular website. 

And if you want to find out the truth, ie. if a food is healthy or not, Accredited Practising Dietitians can help you find the answer.