In people with diabetes, malabsorption of nutrients from undiagnosed celiac disease can lead to frequent, unexplained low or high blood glucose readings.

If your physician suspects celiac disease, you should continue to eat gluten-containing foods until after the biopsy. If the biopsy confirms that you have the condition, the treatment is a lifelong, 100% gluten-free diet.

Celiac disease is an inherited disease that occurs at a higher rate in people with type 1 diabetes. All first-degree family members — parents, siblings and children — of people with celiac disease should be screened for the condition.

If you are aiming for tight diabetes control with insulin or another medicine that creates the risk of hypoglycemia, accept that an occasional low will occur and have a plan for when it does. This is usually better for your long-term health than keeping blood glucose higher than recommended to avoid hypoglycemia.

A variety factors can influence your blood glucose levels, including food, medicines, exercise, stress, infection and normal hormonal variation in the body. A single high blood glucose level is of little concern, but a pattern of high blood glucose needs to be addressed.

If your blood glucose levels are rising despite your best efforts to control them, speak to your physician about adding, increasing or changing your dose of diabetes medicines.

If a difficult situation can be anticipated (for example, a funeral or an exam), and you know how your body typically responds to stress, you may be able to prepare for it by changing your basal insulin or oral medicine dose, or by altering some other aspect of your diabetes regimen.

To treat low blood glucose, or hypoglycemia, eat or drink 15 grams of carbohydrate, wait 15 minutes for the carbohydrate to be absorbed, and check your blood glucose level again. If it has not increased in 15 minutes, eat or drink another 15 grams of carbohydrate and check again in 15 minutes. Using preportioned glucose tablets or gel to treat hypoglycemia instead of food or juice may help you control the amount of carbohydrate you consume.

A good set of records should include blood glucose values, insulin and/or oral medicine doses, the amount of carbohydrate eaten at meals and snacks (with notes about high-fat or extra-large meals), and physical activities.

Substituting foods with a lower glycemic index for foods with a higher glycemic index in your diet may help to reduce your after-meal blood glucose spikes.

Keep a food diary for several days, noting the foods and amounts you eat. Also write down the amount of insulin or other diabetes drugs you take and when you take them relative to your meals. Look for patterns in your records to guide you in making changes to your mealtime routines.

The most practical way to detect after-meal blood glucose spikes is to check your blood glucose level with your meter about one hour after finishing a meal or snack.

Every health insurance and managed-care company has its own policies, so you’ll need to check your plan for specifics on whether it will cover the cost of an HbA1c test — and how often.

Because everyone’s health situation is unique, you need to work with your healthcare team to set an HbA1c goal that will work best for you. Similarly, how often your HbA1c level should be checked depends on your degree of blood glucose control and your physician’s judgment.