Adjusting to life with type 1 diabetes — an autoimmune disorder in which the immune system attacks and destroys the insulin-producing cells in the pancreas — comes with its own lessons and trials. In some cases, people with type 1 diabetes may be diagnosed with a second autoimmune disease, such as celiac. For those with type 1 diabetes, the chances of developing celiac disease range from 2% to 16%, compared to 0.3% to 1% in the general population.
What’s the link between type 1 diabetes and celiac?
These two disorders are linked by genetic predisposition but are triggered by a number of environmental causes. Due to the increased prevalence of celiac in people with type 1, experts recommend screening for the disorder in this population. While there are several frequent symptoms of celiac, it is also possible that symptoms may not occur. Although a person is born with the genes for celiac disease, it is currently unknown what factors trigger development of the condition. The American College of Gastroenterology recommends screening yearly for celiac, while the American Diabetes Association recommends:
- screening at or soon after diagnosis of type 1 diabetes;
- repeat screening within two years of type 1 diagnosis;
- repeat screening after five years of type 1 diagnosis and more frequently if there are suggestive symptoms (such as diarrhea, abdominal pain, osteoporosis) or a first-degree relative with celiac disease.
Drawing blood for specific antibodies is the first step. The diagnosis should be confirmed through an endoscopic biopsy. In this procedure, a specialist guides a long thin tube (endoscope) through the mouth, into the stomach and to the small intestine to take a tissue sample. (The sample is evaluated for the flattening of fingerlike nutrient-absorbing projections in the intestine known as villi, which are damaged in people with celiac.) Prior to biopsy, a normal diet containing gluten should continue so that the diagnosis is as accurate as possible.
Managing type 1 diabetes and celiac sounds relatively straightforward: eat gluten-free foods, count carbohydrates and take insulin. Some people find that blood glucose improves once switching to a gluten-free diet. Removing gluten from the diet (resulting in less inflammation in the body) allows for proper absorption of nutrients. In some cases, less hypoglycemia (low blood glucose) occurs because glucose is properly absorbed. Insulin resistance, caused by inflammation of the gut, may resolve. By removing processed food items and focusing on naturally gluten-free foods (fruits, vegetables, low-fat dairy, beans and legumes, lean protein, etc.), blood glucose spikes are less likely. On the other hand, if consumption of gluten-free processed products (such as pasta, pizza crust, bread and crackers) is increased, blood glucose may be higher because these items generally contain more carbohydrate, less fiber and less protein than similar products with gluten. In either scenario, insulin doses may need to be adjusted.
Diabetes management is complex and multifaceted, and the same goes for celiac disease. Together, this can make even the smallest care task feel overwhelming. The truth about managing multiple autoimmune diseases is that, while unique hurdles exist, you can overcome them. These obstacles may present themselves at any life stage, and there is no single approach to overcome every obstacle. But with the right healthcare team, knowledge and resources, a person with type 1 diabetes and celiac disease can thrive and enjoy a happy and healthy life.