Maybe your child was already coping with a condition like celiac disease or ADHD, and then along came type 1 diabetes. Or it was the other way around — your child developed type 1 diabetes and, just when you thought you had T1 figured out, a second health condition showed up.

When children have concurrent diagnoses of type 1 diabetes plus another major medical or developmental health issue, there’s no way around it — managing blood sugar can be trickier.

“Just having type 1 diabetes is challenging. When you add a second diagnosis such as celiac disease or ADHD to the mix, it becomes more overwhelming. Celiac, for example, can affect how foods are absorbed, which can cause erratic blood sugars. Having a diagnosis like ADHD can cause a child to forget to bolus or take insulin,” explains Sylvia White, M.S., R.D., L.P.C., C.D.E., a Memphis, Tennessee, registered dietitian, certified diabetes educator, and mother of three children, two of whom have type 1 diabetes.

Still, adds White, there are plenty of strategies parents can use to help their children manage their blood sugar — and their overall health.

Don’t expect perfection.

“Life with diabetes will always have ups and downs, highs and lows. Do what you can and choose what is most important. For example, if your child with type 1 has been diagnosed with celiac disease, then finding gluten-free foods trumps the carb counts. Choose gluten-free options, then learn to count the carbs and adjust the insulin,” explains White. It’s normal for your child’s blood sugar numbers to go through an adjustment period as you figure things out.

Identify suitable foods for lows.

What if your child’s go-to candy or juice is no longer viable due to an allergy or other issue? “Depending on whether your child has a secondary diagnosis of celiac, an allergy, or a food-sensitive ADHD diagnosis, choosing foods for treating low blood sugars becomes more complicated,” says White. “Plan ahead and always keep low blood sugar foods that also fit the food requirements of the additional diagnosis on hand.” If you do switch low supplies, carefully check the nutritional information to verify the food will provide the rapidly absorbed carbohydrates your child needs.

For Mercy, a mom from Alabama, finding the right low supplies for her 6-year-old son Allen after his diagnosis of type 1 last year was challenging because of Allen’s autism. “My son eats limited foods and has patterns and rituals around eating. We learned quickly. If you give him a package of rainbow-colored candies to treat a low, he’s going to sort the candies by color before he will eat them, no matter how bad he might be feeling. Things like this delay how quickly we can treat the low, so we needed to figure out foods for lows that he will readily accept. We consistently use these foods at home and school.”

Find support.

If you are feeling isolated and overwhelmed in caring for a child’s more complex health issues, know that you are not alone. (Celiac disease, for example, affects up to 6 percent of people with type 1 diabetes.) To start feeling more connected, White recommends reaching out to other parents for support. “There are many social media groups that support parents of children with diabetes as well as other conditions. Many parents in these groups have children with multiple diagnoses and can offer tips for living with both conditions. Sometimes just not feeling alone helps,” she notes. Your diabetes care team may also have suggestions for dual diagnosis support groups, or check in with your local JDRF chapter.

Ask questions.

If you feel like an old pro at managing your child’s diabetes, needing to accommodate for a new condition can throw you some curveballs. “I had our type 1 management pretty much down to a science, but then my son developed really bad seasonal allergies, and suddenly his blood sugar was spiking all the time. It was so frustrating,” says Shannon D. of Rhode Island, mom of 7-year-old Noah. What she eventually realized was that her son’s allergy medications were affecting his blood sugar. “I had been thinking of his diabetes and his allergies as two separate things. That was my wake-up call to start understanding how allergies can affect blood sugar.”

Shannon also learned to ask her child’s health care teams more questions about her son’s two diagnoses. “A big mistake I made at first was thinking that I could only talk about type 1 with my son’s endocrinologist and C.D.E. [certified diabetes educator], and I could only talk about the allergies with his allergist. I think this is how the information about the medication [causing high blood sugar] was missed. It was so easy to call our C.D.E. and have her explain how to adjust for the allergies and medication. I also called the allergist and she was able to switch us to a medication that isn’t as likely to cause spikes. Everyone was so eager to help us and make it work.”

Help your child become independent.

Helping kids become more independent in their diabetes management is an important transition for kids in “owning” their T1. How do you help make this happen when there is so much going on with your child’s health? According to LaurieAnn Scher, M.S., R.D., C.D.E., president of the Connecticut American Association of Diabetes Educators, parents can keep overwhelm to a minimum by taking a slow and steady approach. “A gradual transition [to taking on appropriate care tasks] is best and should start as early as possible with simple things like choosing one part of a meal or picking lunch options from a controlled list,” she advises.

As you and your child settle in to your new routines, you’ll likely figure out new ways to keep life balanced and in perspective. “Diabetes life can become your new normal,” says White, “and once you get accustomed to how another diagnosis affects your child’s diabetes, that becomes your new normal too.”

Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.

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