My son, who has just turned 14 months old, was diagnosed with Type 1 diabetes on the January 26, 2004. He isn’t gaining weight and suffers from foul smelling bowel movements. Yesterday, blood was taken to test for Celiac Disease. My question for you is: If a child’s blood sugar levels are very high (we are giving injections constantly to lower these), the child has foul smelling bowel movements, and there’s been no weight gain since diagnosis, could this be Celiac Disease? My Pediatrician said it was very unlikely to get both autoimmune disorders diagnosed at the same time. I am interested in your comments. My husband has been IDDM for 26 years and currently uses an insulin pump.

Well, your pediatrician is partially right, I think. It is not too common to be diagnosed with celiac disease and Type 1 diabetes at the same time. However, it is not too uncommon to have several autoimmune diseases evolve eventually. This certainly could be celiac disease. Some of the medical literature suggests that near 8% of patients with Type 1 diabetes will develop celiac disease; nearly 20% of Type 1 patients will develop thyroid disease. The blood test for celiac disease is a SCREEN only; it may need to be followed up with more in-depth testing, which could include an endoscopic intestinal biopsy.

Certainly, other conditions can lead to foul smelling stools and your pediatrician will likely want to consider these if the celiac diagnosis does not pan out. Please be aware that not only does the pancreas make insulin, but it also makes special digestive enzymes to help absorb the sugars, proteins, and fat we eat. So, other pancreatic function may need to be assessed. Sometimes this can be done best by an endoscopic procedure whereby an endoscopic lighted tube is passed from the mouth into the stomach and first portion of the intestine to collect digestive juices. First, however, your doctor may ask that a few of the baby’s stool samples be collected for analysis of fat, sugar, and protein content. Stool should be pretty much be devoid of any nutrients so the presence of sugar or fat in the bowel movement may indeed indicate malabsorption.

Finally, you and your pediatrician are very astute: poor weight gain in light of adequately treated diabetes PLUS loose foul-smelling stools should cause a search for something else.

DS