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For our new member Laurie,  my name is Sara Jones and I am a pump user with
IDDM and Celiac Disease.  I've only had seven months of  pump experience and
only 19 years with  my own IDDM (although I had a world of experience coping
with IDDM for an additional 10 years by virtue of a brother two years
younger that was diagnosed with IDDM at the age of eight years).  The CS
was not diagnosed for five years after the IDDM.

Now past the initial adjustment period, I've come to love my pump.  But in
the beginning there were times I would become so frustrated I would easily
have returned to the familiarity of the multiple insulin injections and
combinations.  I still don't know all the answers but  today I would not
part  with my insulin pump. I'm still don't have my target Hemoglobin A1C
but  with time and patience I'm sure BG stability and numbers will continue
to improve.

I depend greatly upon carbohydrate counting to juggle gf  carbohydrates and
my insulin bolus requirements.  Perhaps I should be more concerned with the
glycemic index of my gf carbs but  I focus more on whether or not  I can
count the carbs, and whether I am using the appropriate insulin to
carbohydrate ratio and whether or not I should consider taking advantage of
the insulin pump's square wave bolus option  (delaying the programmed dose
anywhere from 30 minutes to 2 hours).  At this point, I avoid carbohydrates
if I cannot reasonably estimate those grams with  either some help from
package labelling,  or by weighing or measuring the food and using ADA food
exchanges as a guide.   Some cookbooks help with serving and nutritional
information for gluten-free foods (such as one authored by Carol Fenster ,
and published last year).

As a pump user who is still in the learning process,  before I eat and
before I program an insulin bolus I try to consider several things:
(a)     What is the time of day (if insulin sensitivity and insulin
resistance commonly vary during the day) and  what do  my BG levels look
like.  Based on that,  what kind of carbohydrates and how many grams do I
feel my body can comfortably manage at  that particular time?
(b)     What are the fat grams (if any) associated with the carbohydrate?
If there is much of any fat I factor those grams in with the time of day and
insulin sensitivity and consider making use of the pump's square wave
insulin bolus option.
(c)     Is the carbohydrate being consumed solo or with a protein?  (another
time to consider the pump's  square wave insulin bolus)
(d)     What has my diet been so far and what does it look like for the rest
of the day or week? Being nutritionally careless for one or two meals or
snacks is only human, but  I try not to  lose sight of  the total
recommended calories or nutritional balance.   I try not to end up with a
meal plan that  properly juggles the carbohydrate to insulin ratios but  is
excessive in calories and offers little or no nutritional value.

Laurie, I personally have not met another pump user who juggles IDDM with CD
but  I would be more than happy to share my limited  experiences to date.
However,  there are several Diabetes Educators who subscribe to this list
and who are familiar with the requirements of the gluten-free diet ; they
might be able to offer you a couple of tried-and-proven tips. Diabetes and
CS management varying so much from individual to individual I was really
struck a couple of weeks ago when my endocrinologist  mentioned a pump-using
patient of his  who had fine-tuned her pump to 20 different basal rates
throughout the day. The result was something like a 5.6 hemoglobin AIC!  As
for myself,  I have programmed only three (unimpressive) basal  rates for
the 24-hour period.....anything less or more drives me too quickly into
hyper- or hypo-glycemia.  I was completely  in awe of this lady's
achievement.

Sara Jones,
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