11—-J Coeliac disease and type 1 diabetes share a common genetic predisposition, and are thus associated diseases. Furthermore, recent studies suggest that the gut may show an increased inflammatory response to gliadin in patients with type 1 diabetes. At this stage, screening for coeliac disease amongst patients with type 1 diabetes is not routinely advocated. However, coeliac disease should be suspected if there is growth or developmental delay, osteopenia or unexplained hypoglycaemia, or even in the presence of non-specific ill health. There is a strong familial predisposition and the disease should certainly be considered in the above patient.

GFD is a major undertaking at the best of times. The restrictions it places on a patient with type 1 diabetes may lead to decreased overall carbohydrate intake, and increased intake of less complex carbohydrate leading to more rapid absorption and, therefore, hyperglycaemia. If diabetic control is difficult, a basal bolus insulin regimen with short-acting analogue insulin might be considered. The dietary considerations with the two diseases combined are complex and often necessitate frequent review.

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