title: Coeliac disease presenting as severe hypoglycaemia in youth with type 1 diabetes.
abstract: BACKGROUND
  Coeliac disease is an autoimmune disorder classically characterized by gastrointestinal symptoms and poor growth. The disease can be difficult to recognize in patients with Type 1 diabetes mellitus. Some clinicians find treatment of the disease in asymptomatic individuals controversial.
  
  
  METHODS
  Two adolescent female patients with Type 1 diabetes experienced recurrent hypoglycaemic seizures. Neither patient reported gastrointestinal symptoms or poor growth. After diagnosis and treatment of coeliac disease, hypoglycaemia resolved.
  
  
  CONCLUSIONS
  These cases illustrate how frequent unexplained severe hypoglycaemia can be an atypical presentation of coeliac disease in youth with Type 1 diabetes. Furthermore, they emphasize the importance of screening and treatment of coeliac disease in asymptomatic patients with Type 1 diabetes. Although controversial, management of coeliac disease in these asymptomatic patients can prevent the vicious cycle of recurrent hypoglycaemia and decrease risk for morbidity and death.
authors.affiliation: Department of Metabolism and Endocrinology, Washington University School of Medicine.
authors.forename: N
authors.initials: N
authors.lastname: Khoury
authors.forename: K
authors.initials: K
authors.lastname: Semenkovich
authors.forename: A M
authors.initials: AM
authors.lastname: Arbeláez
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D012640:Seizures / Q000209:etiology*; D012720:Severity of Illness Index