Since going on the pump, I have noticed that I will often be high six to eight hours after eating a relatively high fat (i.e., 12 -15 grams of fat), high protein (same amounts) dinner. I will fall low in the immediate post bolus period, then go high in the middle of the night. I know both celiac disease and gastroparesis can do strange things with fat and carb absorption, and I just don’t want to panic if it’s only a bolusing issue. Are there warning signs of either celiac disease or gastroparesis that I should be aware of?

First, I would talk with the physician managing your diabetes about this issue. You bring up a very good point, one that requires a response. There are tests than can be performed to diagnose gastroparesis and celiac disease celiac syndrome. If this is present, you must know about it. There are also several therapeutic interventions to treat this that may make your symptoms better. You do have additional bolus options. Most of the insulin pumps now sold have a square wave (extended) bolus feature. This allows your meal bolus to be given over several hours instead of within five minutes. Second, you could also delay your bolus until after the meal. However, the lows right after the meal are a tell-tale sign that you need to address this question.

JTL