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People with type 1 diabetes are at a higher risk of developing certain other conditions, including celiac disease. Both celiac disease and type 1 diabetes are autoimmune diseases in which a person’s immune system attacks its own cells. In celiac disease, the immune system attacks and damages the small intestine’s lining. In type 1 diabetes, the immune system targets cells that produce insulin in the pancreas.
This article will explain what celiac disease is, why people with type 1 diabetes are at higher risk for it, and what actions people with both conditions can take to improve their health and quality of life.
People with celiac disease have an immune response to eating gluten, a protein that’s found in foods that contain wheat, barley, or rye. While about 1 percent of the general population has celiac disease, approximately 6 percent of people with type 1 diabetes have it. A person is more likely to develop celiac disease if a family member has it.
If you have celiac disease, eating gluten causes your immune system to attack the small intestine’s lining. Over time, the small intestine’s lining is damaged and can’t absorb important nutrients. This condition is called malabsorption. In children, malabsorption can affect growth and development.
In children, digestive symptoms of celiac disease can include:
When celiac disease goes undiagnosed or is mistaken for other digestive conditions in children, their symptoms can become severe. These may include intense diarrhea and dehydration, which can cause lethargy (extreme tiredness), hypotention (low blood pressure), and low potassium levels.
Symptoms such as diarrhea, nausea and vomiting, constipation, bloating, and gas are also seen in adults. Notably, more than half of adults with celiac disease may also develop symptoms not related to the digestive system, including:
Some adults with celiac disease experience only nondigestive symptoms only, making the diagnosis even more difficult and the screening more important in all people with type 1 diabetes.
A blood test can confirm whether you have the antibodies that attack the small intestine. If your test result is positive, your doctor may recommend a biopsy to confirm the diagnosis and check for damage to the lining of your small intestine. This procedure involves removing a small tissue sample to be examined under a microscope.
People with type 1 diabetes are at a heightened risk of developing other autoimmune diseases. Celiac disease is one of the most common. Others include autoimmune thyroid disease, Addison’s disease, vitiligo, and autoimmune hepatitis.
Both type 1 diabetes and celiac disease share a common genetic background that has been found in the human leukocyte antigen (HLA) genotype. HLA genes help the body to tell the difference between the body’s own proteins and those that are made by foreign invaders, such as viruses and bacteria.
Researchers are actively studying why some people with type 1 diabetes develop celiac disease while others do not. The majority of people who carry high-risk HLA genes will never develop type 1 diabetes or celiac disease. Studies focused on type 1 diabetes and celiac disease have found similar environmental risk factors that may also contribute to developing the conditions. These include infant-feeding practices, exposure to viral infections, breastfeeding, and vitamin D levels.
Many people with type 1 diabetes and celiac disease don’t experience symptoms of celiac disease (or chalk their symptoms up to their diabetes). In fact, they often learn they have celiac disease because of routine screening that’s done because of the known connection between the two conditions. Screening is especially important because having both of these diseases increases the rate of certain complications.
One study found that certain complications developed earlier in people with type 1 diabetes who also had celiac disease, as compared to those who did not have celiac disease. These complications included diabetic kidney disease and retinopathy (damage to the blood vessels in the retina of the eyes). This research shows how important it is for people with type 1 diabetes to find out if they also have celiac disease so that they can best manage their health.
People with celiac disease need to maintain a gluten-free diet for life. Doing so allows the lining of the small intestine to heal and symptoms to go away. Following a gluten-free diet means avoiding foods that contain wheat, barley, or rye, such as traditional bread, cereal, pasta, and pizza. However, there are gluten-free options available for these foods.
Fruits, vegetables, meat and poultry, fish and seafood, dairy products, beans, legumes, and nuts do not contain gluten.
These grains, legumes, seeds, and starchy foods do not have gluten:
When shopping, look for foods that are labeled “gluten-free.” Keep in mind that “wheat-free” does not mean “gluten-free.” Also, be sure to check out the freezer section, as many gluten-free breads can be found there.
People with celiac disease need to become “gluten detectives,” carefully reading food labels and spotting hidden sources of gluten. For example, wheat is sometimes used to thicken store-bought soups and sauces. Even seemingly safe foods like french fries may be coated in flour to prevent sticking. Some snack foods, including certain chips and candy bars, contain gluten as well.
In short, learning to identify hidden gluten is an essential part of living well with celiac disease.
Maintaining a gluten-free diet when you have type 1 diabetes can be tricky. That’s because gluten-free flour substitutes are often higher in carbohydrate content than their flour counterparts that contain gluten.
Specifically, gluten-free flour products may contain added sugars or starches to simulate the texture of gluten. As a result, you may need to eat smaller portions or take extra insulin when eating these foods.
One member of the myT1Dteam who also has celiac disease underscored this point when they said, “I have to carefully choose how much insulin to give — and when to give it.”
Alternatively, some gluten-free alternatives are made with very low-carbohydrate substitutes. As a result, using standard estimations of insulin may lead to dangerously low blood glucose levels. Doctors recommend that you read ingredient labels, whenever possible, for carbohydrate counts. Or, you can count the food as a vegetable that’s low in carbohydrates. At your next meal, you can then correct with insulin if you estimate too low.
These tips may also be helpful:
Whether you have recently been given a diagnosis of celiac disease or suspect you may have it, it’s important to communicate your concerns to your healthcare team.
If you suspect you may have celiac disease, alert your health careprovider right away.
If you know that you have celiac disease but are having difficulty maintaining a gluten-free diet, ask your primary care physician or gastroenterologist to refer you to a dietitian. Registered dietitians can help you identify foods that are gluten-free and work well for a diabetes diet.
On myT1Dteam, people share their experiences with type 1 diabetes, get advice, and find support from others who understand.
What has helped you manage both type 1 diabetes and celiac disease day to day? Let others know in the comments below.
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