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June 30, 2004

Aches and Pains, Celiac

Question from Hummelstown, Pennsylvania, USA:

My nine year old daughter was diagnosed as type 1 three months ago. Her blood glucoses are in good control, with an occasional high of about 160 mg/dl [8.9 mmol/L]. We are experiencing the honeymoon period, but my daughter very often complains of headaches and cramps in her stomach, and occasionally experiences diarrhea. I am a bit baffled at the symptoms and wonder if it is diabetes related or something else?

Answer:

Certainly, there are many possibilities and you absolutely should talk with your diabetes team physician or nurse specialist. I will presume that you have checked her glucose level during these episodes and she is not low and not high. Nevertheless, I would check her blood or urine for ketones during the episodes as ketosis can certainly lead to headaches and abdominal pains, although not typically with diarrhea.

She should be screened for celiac disease, another autoimmune disorder that has increased frequency in autoimmune, type 1 diabetes. Celiac disease is an intestinal disorder where there is interference with the digestion of certain grains such as wheat and barley (and sometimes oats). Rice, potatoes, and corn are digested normally in celiac disease.

I might also consider autoimmune adrenal gland dysfunction, although I would have this lower on the list.

Certainly, diabetologists have seen physical manifestations of emotional stress in children with diabetes. This could present as more vague, non- specific complaints as you describe.

DS