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The Gluten-Free Diabetes Diet

Special Issues for Diabetics with Celiac Disease

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Updated June 15, 2014

Learning to live on a gluten-free diabetes diet is harder than learning to live with either celiac disease or diabetes alone. People with celiac disease and diabetes need to maintain blood glucose control and keep gluten out of their diet. If you do have both conditions, it would be extremely worthwhile to consult a dietitian with expertise in both diets. (Ask your doctor to recommend one, or see How to Find a Celiac Disease Dietitian.)

In the meantime, review the information below about special dietary issues for diabetics with celiac disease. I also recommend that you read Diabetes: A Symptom of Celiac Disease.

  • At first, it will be harder to manage your diabetes, because as your body recovers from celiac disease, it will absorb food differently.
    When celiac disease is untreated, eating gluten sets off a cascade of processes that ultimately damage the lining of the small intestine. As a result of that damage, the intestine doesn’t properly absorb food. But then, as the person with celiac disease sticks to a gluten-free diet, the intestine gradually heals, and its ability to absorb food increases. In other words, from the same amount of food you were eating before you became gluten-free, you’ll now absorb more nutrients, more sugars, more starches, etc. The problem for diabetics is that the increase in absorption is unpredictable in the beginning.

  • With improved absorption of food through your healing intestine, you’ll need more insulin, and your hemoglobin A1c levels may get worse for awhile.
    Your hemoglobin A1c levels reflect your glucose control (or lack of it) over a long term period. At least one study has shown that hemoglobin A1c levels rise when diabetic children find out they have celiac disease and start the gluten-free diet.

    The improved absorption of food also means that you'll gain weight and have higher cholesterol levels -- but this is true even for celiacs without diabetes (see Side Effects of the Gluten-Free Diet).

  • Gluten-free food has different carbohydate/fat/protein ratios than “regular” foods.
    The carbohydrate levels in gluten-free foods are often not the same as higher than in similar gluten-containing foods, which will affect your carbohydrate counting. That’s because without the gluten, extra amounts of other ingredients are added in order to make the food palatable. Also, prepared gluten-free foods may be higher in calories than “regular” foods. For example, an average slice of whole wheat bread has 70 calories, while an average slice of gluten-free bread can contain more than 100 calories.

    If you’ll be buying gluten-free breads and pastas, look online for low-carbohydrate products. If you’re new to the gluten-free diet, baking with a variety of gluten-free flours can be overwhelming at first – but there are quite a few low-carb gluten-free flours, particularly the bean flours. Here on About.com, our Low-Carb Diets site and our Gluten-Free Cooking site are both tremendous resources for celiacs.

  • Always have a gluten-free snack with you in case your blood sugar drops.
    Most likely you’re already carrying some kind of glucose tablets or other remedy for episodes of hypoglycemia. If the product isn’t labeled gluten-free, check with the manufacturer. Also, be sure to keep lots of gluten-free snacks at home, or in your desk at work, or your locker at school. For everyone with celiac disease – diabetic or not – when you have low blood sugar you are more likely to make a mistake and accidentally eat something with gluten.

Other Internet Resources for Celiac Disease and Diabetes

Double Diagnosis: Living with Type 1 Diabetes and Celiac Disease, from Juvenile Diabetes Research Foundation International.

Celiac and Type 1 Diabetes Mailing List: A mailing list that offers families living with type 1 diabetes and celiac disease a forum for email support.

Diabetes and Celiac Disease, by Lara Rondinelli RD, LDN, CDE

Sources:

Simell S, Hoppu S, Simell T, et al. Age at Development of Type 1 Diabetes and Celiac Disease-Associated Antibodies and Clinical Disease in Genetically Susceptible Children Observed from Birth. Diabetes Care. 2010 Jan 7. [Epub ahead of print]

Mohn A, Cerruto M, Lafusco D, et al. Celiac disease in children and adolescents with type I diabetes: importance of hypoglycemia. J Pediatr Gastroenterol Nutr 32:37–40, 2001

Sun S, Puttha R, Ghezaiel S, et al. The effect of biopsy-positive silent coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in children with Type 1 diabetes. Diabet Med. 2009 Dec;26(12):1250-4.

Maggie Moon, MS, RD. Double Trouble — Counseling Clients With Diabetes and Celiac Disease. Today’s Dietitian 2009;11:32.

Kupper C, Higgins LA. Combining diabetes and gluten-free dietary management guidelines. Practical Gastroenterology. 2007;31(3):68-83.

Hansen D, Brock-Jacobsen B, Lund E, et al. Clinical benefit of a gluten-free diet in type 1 diabetic children with screening-detected celiac disease: a population-based screening study with 2 years' follow-up. Diabetes Care. 2006 Nov;29(11):2452-6.

Juvenile Diabetes Research Foundation International: Double Diagnosis: Living with Type 1 Diabetes and Celiac Disease

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