According to the Celiac Disease Foundation, about 6% of people with type 1 diabetes also have celiac disease. Among the general population, celiac disease prevalence is about 1%. Because people with type 1 diabetes may not have symptoms of celiac disease or mistake the symptoms for diabetes symptoms, the latter condition often goes undetected.
If you or your child has a dual diagnosis of celiac / diabetes type 1 disease, learn why these diseases may occur together and how to manage both conditions to optimize health and well-being.
Understanding celiac disease
An autoimmune disease such as celiac disease causes the body’s immune system to attack healthy cells. Celiacs, ingesting a substance called gluten, cause immune cells to damage the small intestine, preventing the body from properly absorbing nutrients. Gluten is a protein found in common grains we eat, including barley, rye, and wheat. Without treatment, celiac disease can lead to neurological problems, malnutrition, inflammation of the small intestine, anemia, osteoporosis, and lymphoma.
According to Beyond Celiac, celiac disease is about 1% of the population or 1 in 133 adults. In addition to type 1 diabetes, risk factors for this condition include the presence of Addison’s disease, Down syndrome, autoimmune thyroid disease, or a family member who also has a celiac disease diagnosis. Celiac disease patients may also have one of these coexisting conditions.
Reviewing the facts about type 1 diabetes
Like celiac disease, type 1 diabetes is an autoimmune condition. In patients who have diabetes disease type, the immune system attacks the insulin-producing cells in the pancreas. Insulin is a substance that transports blood glucose to the body’s cells, giving them the energy to function.
Usually, the symptoms of type 1 diabetes first arise during childhood or adolescence and may include:
- Numbness, pain, or tingling in the extremities
- Unexplained weight loss
- Slow-healing bruises and wounds
- Excessive thirst and hunger
- Blurred vision
- Frequent urination
Only about 5% of diabetic patients have type 1; the majority have type 2 diabetes, which more commonly affects adults and is not associated with celiac disease. However, both type 2 diabetes and celiac share obesity as a risk factor.
Making the connection between diabetes type 1 and celiac disease
Beyond Celiac, the advocacy organization notes that these conditions share similar genetic mapping, which naturally results in a certain amount of overlap among patients who develop the disease type. According to Gluten Intolerance Group, a nonprofit organization, families who have more than one child with type 2 diabetes have an increased risk for celiac disease among all members.
WebMD reported a study conducted by the Pacific Northwest Research Institute in Seattle screened 6,000 children in the United States and Europe for celiac disease and type 1 diabetes autoantibodies, substances that appear in the blood when someone has an autoimmune disease.
The researchers found that 1.5% of the children, all younger than six, had both types of autoantibodies. This group usually developed diabetes-related autoantibodies first. About 13.5% had celiac autoantibodies, and just over 6% had type 1 autoantibodies.
However, study authors note that type 1 diabetes does not necessarily cause celiac disease to develop. The former may trigger the latter, or overlapping factors in the environment and genes may cause both diseases independently.
If you or a family member receives a diagnosis of type 1 diabetes, ask your doctor about screening for celiac disease. Without treatment, this condition can impact your blood glucose levels and make it difficult to control your diabetes, resulting in complications. Treatment involves the initiation of a gluten-free diabetes diet.
Screening is crucial for young children who show signs of low blood glucose despite managing type 1 diabetes. Doctors use a blood test to look for autoantibodies in patients with suspected celiac disease or type 2 diabetes.
Managing type 1 diabetes and celiac disease
Many individuals who have celiac and type 1 diabetes are asymptomatic, but some have celiac disease symptoms such as irritability, weight loss, fatigue, bruising, low blood sugar, abdominal pain, bloating, nausea and diarrhea. Beginning a gluten-free diet will often resolve these uncomfortable issues. Adult celiac disease patients who have had type 1 diabetes since childhood need to adjust their eating habits to care for celiac disease and diabetes.
The population of children who have gluten intolerance may also experience slow growth and delayed puberty. Early diagnosis of celiac disease and immediately adopting a gluten-free diet can prevent these complications from causing lifelong issues.
After receiving a dual diagnosis, a certified nutritionist can help you create a gluten-free diet that also meets the dietary requirements of type 1 diabetes. He or she will help you monitor your blood glucose and celiac symptoms on the new eating plan and make adjustments as necessary. A 2015 study published in the journal Current Diabetes Reports found that avoiding gluten can also positively affect type 1 diabetes.
Most people who have type 1 diabetes also require supplemental insulin. The doctor may recommend either injections or an insulin pump implanted under the skin. In 2016, the Food and Drug Administration approved an artificial pancreas to treat people ages 14 and older who have type 1 diabetes mellitus.
Nutrition tips for celiac disease and type 1 diabetes
Use these strategies to help keep these conditions under control:
- Look for gluten-free flour substitutes in your local health food store or grocery store. Standard options include flours made from potatoes, corn, quinoa, almond meal, coconut, and rice.
- Ask your server when dining out at a restaurant about gluten-free options on the menu. Some foods may seem flour-free but include wheat derivatives that can irritate the intestines.
- Keep carbohydrates on hand if you need them to balance your blood sugar but cannot find anything gluten-free. Good choices include dried soybeans, meal supplement shakes, rice crackers, protein bars, and granola bars.
- Choose complex carbohydrates that offer rich nutritional value. Incorporate fruits, veggies, legumes, beans, and gluten-free whole grains such as brown rice into your daily meals.
- Monitor your blood sugar to keep it within a healthy range. Doing so reduces your risk for complications associated with diabetes mellitus.
- Get plenty of physical activity if your doctor gives you the OK to exercise. You should get about 150 minutes a week for optimal health.
While the Celiac Disease Foundation stresses that we need more research to establish a scientific link between type 1 diabetes and celiac disease, the organization echoes the need for routine screening for celiac disease after a type 1 diabetes diagnosis.
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Click here to read about COVID-19 and type 1 diabetes.