A Follow-Up

I do have one follow-up on an earlier entry about a young man with diabetes who ended up being diagnosed with celiac disease. As with any medical diagnosis, one cannot be certain that the diagnosis is correct without showing that the treatment has improved things (unless there is no effective treatment for the condition). In this case, the young man, was started on a gluten-free diet in mid-December 2007. By his return clinic visit mid-February 2008, he had gained about 30 pounds! Clearly, celiac disease was the reason for his weight loss. In addition, his diabetes blood sugar control improved (hemoglobin A1c fell from 9% to about 8%, reflecting a large improvement in average blood sugar levels).

I was a bit nervous about the fact that we had initiated treatment with the gluten-free diet before the patient saw the gastroenterologist- gi docs traditionally like to do small intestine biopsies to confirm the diagnosis of celiac disease before recommending a gluten-free diet. In this instance, the gi doc felt that the biopsy would not be useful as the patient was already on a gluten-free diet but that the response to treatment clearly confirmed the diagnosis (remember that the blood tests were strongly positive for celiac disease). So, the gi doc and I are still friends (at least I think so).

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