I am curious to know if my son’s behavior is related to celiac disease or something similar. Every time my three year old eats pasta, he needs a basal increase for 8 to 12 hours, or an extended or combination bolus (I’ve been trying a lot of ways). He is high with this kind of food all the time. But, lately it is happening with bread and wheat tortillas. The common denominator here is wheat. I don’t know if Mexican food has a special way of affecting someone with type 1, like homemade pizza, but anything could be possible. Can it be that he is having a problem with the wheat? So far, he has had two blood tests to screen for celiac and both were negative. In December, he is due for his annual test for celiac and I wonder if the blood test is missing something, I have read that people with type 1 do not always show symptoms and that a biopsy, not a blood test is the way it is found.

Your son’s behavior, i.e., an abrupt increase in basal as well bolus needs, is the opposite of what might happen in the case of celiac where there is a decreased absorption of nutrients from the gut then a decrease in insulin needs. Actually, pasta, and especially pizza, my national foods as well, require an increase in the basal and bolus needs also in our children. Very recently, a new square wave algorithm has been developed finally to successfully control the long term sudden increase in insulin needs that happen over the night after eating the pizza for dinner. You might want to talk to your diabetes team about adapting your insulin scheme to the new needs. Regarding celiac screening, a yearly screening is nowadays a good standard in the follow-up of children with diabetes. If, in your son’s case, they happen to be negative, this is a definitive exclusion of the disease and there is no reason to suspect celiac disease of any degree.

MS