Required total daily insulin dosing (TDD) is dependent on age at presentation, pubertal stage, and the presence of acidosis at diagnosis. Typically a long-acting basal insulin-such as glargine (Lantus, Toujeo, Basaglar), detemir (Levemir), or degludec (Tresiba)-along with premeal boluses of rapid-acting insulin-such as lispro (Humalog, Admelog), aspart (NovoLog, Fiasp), or glulisine (Apidra)-is instituted. Intensive insulin therapy has become the standard of care for patients with T1DM. Insulin is the mainstay of treatment for T1DM. Kellerman MD, in Conn's Current Therapy 2021, 2021 Type 1 Diabetes Mellitus (Without Ketoacidosis or After Ketoacidosis Has Resolved) A gluten-free diet may reduce gastrointestinal complaints, metabolic symptoms, and hypoglycemia. Once the diagnosis is confirmed, children with celiac disease should be placed on a gluten-free diet and be referred to a dietitian experienced in managing both diabetes and celiac disease, because the nutritional management of a person with both T1DM and celiac disease can be complex and burdensome.
391 In symptomatic individuals with high antibody titers, some providers may prescribe dietary changes without a confirmatory biopsy. Typically, a biopsy is done to confirm the diagnosis of celiac disease, especially in asymptomatic children. If screening tests are positive, referral to gastroenterology is recommended before prescribing a gluten-free diet. More frequent screening may be necessary if symptoms develop or in children who have a first-degree relative with celiac disease. 381,384 Screening labs include immunoglobulin A (IgA) tissue transglutaminase antibodies, with documentation of normal total serum IgA levels if an individual is found to be IgA deficient, send immunoglobulin G–specific antibody tests. 390 The ADA and ISPAD recommend screening for celiac disease in children with T1DM soon after diagnosis and at regular intervals after diagnosis (ADA: rescreen within 2 years and again after 5 years ISPAD: screen every 1–2 years). 389 Individuals with T1DM and celiac disease may experience increased glycemic variability and unexplained hypoglycemia. 383,387,388 Introduction of gluten-containing foods between 4 and 6 months of age (compared with introduction in the first 3 months of life or in the seventh month or later) in infants at increased risk for celiac disease and T1DM appears to mitigate the risk of celiac disease. Shlomo Melmed MB ChB, MACP, in Williams Textbook of Endocrinology, 2020 Celiac DiseaseĬeliac disease is the second most common coexistent autoimmune disorder in patients with T1DM, is diagnosed in 2% to 8% of youth with T1DM and is more prevalent in those who were younger at T1DM diagnosis and those of white race.
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