<<Disclaimer: Verify this information before applying it to your situation.>> Greg: I have an 8 yr. old daughter Brittany, who has been a celiac for 7 years and was diag. with juvenile diabetes in Jan. of '98. The first and foremost thing is that this mom needs to work very closely with a "informed" dietitian who has a real understanding of celiac disease. Many do not. The diabetes complicates the issue because now carbohydrate is an issue. It is important to try to stay within the carb guidelines the dietitian gives. Of course, kids are usually not going to eat every calorie indicated on the suggested menu. Many times this demands a call to the pediatrician for adjustments in insulin. Brit was given a 2000 calorie diet when she was in the hospital - I have a child that is a very good, healthy eater but there is no way she is ever going to eat 2000 calories at this age (maybe 1200-1500). So I called the dr's. office and we made adjustments in her insulin for less food. I have a degree in nutrition (worked in product development for General Mills) so I am able to make the dietary adjustments. Until the mom is familiar with what she needs to do, she really needs to heavily rely on the dietitian for info. The book for diabetic kids that I have found most helpful for myself is: "Sweet Kids," by Betty Page Brackenridge and Dr. Richard Rubin. Dr. Rubin's son was diag. with dm at age 7. The book is very supportive and reinforces the fact to not battle over food. I have always felt this is important in diabetes control (and parenting in general). If food becomes a major issue on how much, when, etc. as a parent you are in for a nightmare. Granted you do have to follow the rules (schedules) pretty close, but there is room for flexibility, it is that no one tells you this when you are in the hospital with a new diagnosis. The main trouble with celiac/dm is that the rice, corn and potatoes you are allowed to have on the celiac diet create a nightmare for those blood sugar readings. Now, this does not mean this child should never eat these foods, it just means some adjustments must be made. With dr. approval (actually nurse approval) I asked if it would be o.k. to increase Brit's Humalog 1 unit at suppertime if we have potatoes, rice or corn. We do not do these foods often because Brit has seen the skyrocketing bg's even when we have towed the line perfectly, exercised more, increased the insulin a little. She does not like it when her sugar is high because it affects her stamina. There is no way that we would ever have potatoes and rice or potatoes and corn at the same meal or even on the same day. Unfortunately - it just doesn't work for us. The gluten-free breads are pretty high in carbs and the Energy Rice Bread that has 16 carbs per slice sends the sugar up because it is so dense. This does not mean the daughter can't have bread just prepare and plan carefully for it. Tell this mom to learn everything she can about carb counting. This is much easier when you have a celiac/diabetic (in my opinion) because then you will eventually learn when and how much insulin to adjust things for. A tip for breakfasts - especially if her child tends to not be a morning eater or prefers cereal. Cereals can be tough on the bg's too (lots of carbs then add milk carbs on top of it. We use Van's Gluten-Free Waffles and each waffle is 16 carbs. Brit (not a morning eater which is scary after she injects her insulin) will eat one of these and does fine - no low bg's in the morning. I know this sounds like I don't feed my child breakfast in the morning. Some mornings she will drink some juice or fruit with it and some mornings not. We just don't do battle. Brittany is real good about eating her snacks and other meals throughout the day and her sugars are just fine. She recently has had bg's running higher than normal and I finally figured out that her allergy medicine (Claritin) appears to have done it. After going off the claritin her sugars are better - but of course it could be the stress of starting the new school year and an adjustment of a new schedule. We will be seeing a ped. endo. next week and will ask questions. Counting carbs is the key and give the child many healthy food choices then this isn't such a big deal. A word if warning - if this child is in elementary school - the birthday parties may make her child unhappy even if she has supplied alternatives. Brittany has always been a trouper about the celiac disease but last year (in 2nd grade) it really got to her that she shouldn't eat the tons of candy and cookies these other children were eating. My personal opinion is that the teachers let the parents get out of control on this issue. These kids didn't need all that stuff anyway. This year her teachers have a much more simplistic approach to birthdays. Brittany wouldn't eat the stuff but she would be very unhappy (if I happened to be there - which I tried to do) or when she came home from school there were tears about it. This does get better and I tell Brittany and eating healthy like we do (which is what we did even before the celiac/dm diag.) and exercising regularly we will be ahead of the game compared to these other people down the road. They are going to create other health problems because of their bad habits and they will eventually have to change how they eat whether it is heart disease, diabetes, etc. Brittany is very accepting of this fact and it is a reasonable answer for her. Hope I helped. Pam I would like to know how old this child is? As far as snacks Brit eats Hain's Ranch Mini Rice cakes a lot, with peanut butter, cheese or some other form of protein. Brittany also eats a wide variety of fruits, so have plenty on hand so the daughter will reach for the right thing. For example, if the daughter would like to have some "Fritos" as part of her snack. Let her have the "Fritos" (count the carbs - 32 Fritos equals 15 carbs). I don't usually hand out 32 because I don't want Brit to get into a habit of eating tons of junk food. Brittany knows if she eats something like that she has to eat something healthy with it. She is very accepting of this and we don't do battles. Trust me - there will be a time that her daughter has been injected with insulin and refuses to eat. A PARENT'S WORST NIGHTMARE! This has happened to us a couple of times and I just stayed very calm and tried to talk her into eating dinner. She flatly refused! The next best option was to offer Regular Pepsi or something with sugar in it she liked. I don't like doing this because I don't want to set an example for her if she won't eat she will get a "treat." So far this hasn't been the case and later in the evening she does decide to eat dinner - this of course makes her bedtime bg higher because of eating so late and then the morning bg may be a little higher because you have changed the eating schedule some. But if this is only done once in a while it is no big deal. As adults there are times we don't have an appetite and force-feeding someone isn't going to get you anywhere. As far as more snack info. just stay with very healthy snacks, gluten-free crackers (Brittany likes the WASA CORN - 2 crackers = 15 carbs, Holgrain Rice Cracker - 8 crackers = 15 carbs, etc). Now we have not had any problem with rice or corn based crackers raising the bg. It just tends to be potatoes (baked, mashed, fries and if a product contains a lot of potato starch), corn (on the cob or off), and rice (brown, long grain, etc). If you go out to eat once in a while let her have fries if you can find out if they are gluten free. Some places make fresh fries and don't fry anything else in that fryer. But try not to let her "pig out" on them, because there will be a price to pay. If she does she will learn that it is not worth it. Brit has "pigged out" a couple of times and I am talking about "pigging out" on carbs as a diabetic not as a regular person. Brit is much more conservative in that area compared to most people. She prefers to not go overboard - it has kind of become a 6th sense in her - she knows how her body feels. Brit is very in tune with her body - many diabetic kids aren't - but I suspect the diabetic/celiacs are more in tune because usually they have had to deal with one disease before the other occurred. Experience helps.