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.