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6 Conditions Related to Type 1 Diabetes: Celiac Disease, Thyroiditis, and More

Medically reviewed by Sarika Chaudhari, M.D., Ph.D.
Written by Emily Wagner, M.S.
Posted on February 7, 2024

People living with type 1 diabetes not only manage their daily blood glucose (sugar) but also face a higher risk of developing certain conditions alongside their diabetes. These conditions are known as comorbidities, and they can affect your overall health if you have type 1 diabetes. It’s important to treat both type 1 diabetes and comorbid conditions to live a healthy life.

The Immune System and Type 1 Diabetes

Type 1 diabetes develops when the immune system attacks the pancreas — the organ responsible for making insulin. People with type 1 diabetes eventually lose their insulin-producing cells and can’t make enough on their own. Doctors classify type 1 diabetes as an autoimmune disease because the immune system mistakenly destroys healthy cells and tissues.

Type 1 diabetes is associated with autoantibodies, which are specialized immune proteins that tag cells for destruction. In type 1 diabetes, the autoantibodies attack the pancreas, insulin, and other related chemicals.

Doctors and researchers have also found that type 1 diabetes is associated with an increased risk of other autoimmune diseases. They believe that these diseases share similar genetic risk factors. Researchers have also found that the autoimmunity affecting the pancreas can also affect other organs.

Keep reading to learn about six conditions related to type 1 diabetes.

1. Celiac Disease

Studies show there’s a strong link between type 1 diabetes and celiac disease. People with celiac disease have an immune reaction when they eat gluten — a protein found in foods made from wheat, rye, and barley. They also have autoantibodies that react to different components of the gluten protein. Inflammation from this immune system reaction damages the small intestine (the gut). Because of this damage, the absorption of nutrients from the gut is disrupted.

Many people with celiac disease experience:

  • Abdominal pain
  • Nausea and vomiting
  • Weight loss
  • Gas and bloating
  • Diarrhea
  • Constipation

According to the Celiac Disease Foundation, around 1 percent of the general population has celiac disease. On the other hand, 6 percent of people with type 1 diabetes have celiac disease. In 9 out of 10 cases, celiac disease develops after a type 1 diabetes diagnosis and is found with screening tests. Doctors rarely diagnose celiac disease before they diagnose type 1 diabetes.

Certain factors increase the risk of having celiac disease alongside type 1 diabetes. Studies from BioMed Research International show that receiving a diabetes diagnosis at an early age and being female may contribute to a higher risk.

There also seems to be shared genetics between the two conditions. Human leukocyte antigen (HLA) genes help your body tell apart your own cells from other cells. People with certain HLA genes are more likely to have autoimmune disorders compared to those without them. Researchers have found that type 1 diabetes and celiac disease are associated with the same HLA genes (genotype).

If you or your child is diagnosed with celiac disease alongside type 1 diabetes, it’s important to work closely with your health care provider or your child’s pediatrician. A gluten-free diet is key to treating celiac disease and should help address your uncomfortable symptoms. However, it’s important to pay attention to carb counts on gluten-free foods. Although many gluten-free options have more carbohydrates (carbs), others might have low carb content. You’ll need to adjust the insulin dose accordingly and closely monitor blood sugar levels. Always have a gluten-free carb with you, in case your blood glucose drops.

2. Autoimmune Thyroiditis

People with type 1 diabetes are also at an increased risk of developing autoimmune thyroiditis — also known as autoimmune thyroid disease. The thyroid gland is part of your endocrine system, which releases certain hormones that regulate your:

  • Metabolism
  • Body temperature
  • Breathing
  • Heart rate
  • Bone and skin health
  • Digestion

People with thyroid autoimmunity have autoantibodies that attack the thyroid tissue. There are two main types of autoimmune thyroiditis that affect those with type 1 diabetes — Hashimoto’s disease and Grave’s disease.

Like celiac disease, type 1 diabetes and autoimmune thyroiditis share common HLA genes. Certain genes are associated with hypothyroidism (underactive thyroid) and others are associated with hyperthyroidism (overactive thyroid).

Hashimoto’s Disease

Hashimoto’s disease — also known as Hashimoto’s thyroiditis — causes an underactive thyroid. This means the thyroid makes lower levels of hormones than it should. Studies suggest that up to 30 percent of people with type 1 diabetes also have Hashimoto’s disease.

People with Hashimoto’s disease often:

  • Have a slow metabolism
  • Feel especially tired and sleep more than normal
  • Have trouble remembering things and concentrating
  • Have a slower-than-normal heart rate
  • Feel sad or depressed

People with Hashimoto’s disease need treatment with synthetic (lab-made) thyroid hormones. It’s important to treat children and teenagers with hypothyroidism, as they’re more likely to have low blood sugar levels (hypoglycemia) and growth disorders.

Graves’ Disease

Graves’ disease is less common in people with type 1 diabetes, affecting only 0.5 percent to 7 percent. However, this rate is still higher than the general population. Graves’ disease can cause:

  • A fast heartbeat
  • Increased appetite
  • Excessive sweating
  • Muscle weakness
  • An enlarged thyroid
  • An increased appetite

Doctors usually treat Graves’ disease with antithyroid medications like methimazole (Tapazole). However, methimazole can cause insulin autoimmune syndrome. Be sure to let your doctor know you have type 1 diabetes so they can adjust your treatment plan.

3. Autoimmune Gastritis

Autoimmune gastritis is a condition that causes inflammation in the stomach lining. As the name suggests, autoimmune gastritis occurs when the immune system attacks the healthy cells lining the stomach. This makes it harder for the stomach to absorb nutrients, which can lead to a vitamin B12 deficiency. Lack of vitamin B12 can cause nerve damage and anemia.

Some people with this condition may not notice any symptoms, while others may experience:

  • Chest pain
  • Mental confusion
  • Weakness or dizziness
  • Numbness or tingling in the arms and legs

Children with type 1 diabetes are more likely to have autoimmune gastritis compared to the general population. Some studies also show people with type 1 diabetes are more likely to have autoantibodies associated with autoimmune gastritis if they:

  • Are older
  • Are female
  • Have had type 1 diabetes longer

However, more studies are needed to confirm these findings. There currently aren’t any recommendations for treating autoimmune gastritis except for vitamin B12 injections and iron treatments.

4. Vitiligo

Vitiligo is an autoimmune condition that causes the skin to lose its pigment or color. Melanocytes are specialized cells responsible for creating melanin or skin pigment. In vitiligo, the immune system attacks and destroys melanocytes so they can no longer make pigment.

People with vitiligo have lighter-colored or white patches of skin affecting different areas of their bodies. These patches usually form first on the face, hands, feet, and forearms, but they can occur on any part of the body.

Around 1 percent of the world’s population has vitiligo, according to Cleveland Clinic. More than half of vitiligo cases are diagnosed in people ages 20 and younger, according to BioMed Research International.

Studies also report that vitiligo and diabetes are more likely to occur together. For example, 16 percent to 20 percent of people with vitiligo may develop diabetes, per BioMed Research International. Having vitiligo or type 1 diabetes also increases the risk of other autoimmune diseases. Researchers believe it’s because these conditions share similar gene changes.

Vitiligo is usually treated with topical medicated creams applied to the skin and light therapy. These treatments likely won’t affect your type 1 diabetes care plan, but speak with your health care provider to be sure.

5. Addison’s Disease

Addison’s disease (also called primary adrenal insufficiency) is another hormonal condition associated with type 1 diabetes. In Addison’s disease, the adrenal glands don’t make enough of the hormones aldosterone and cortisol. Aldosterone is important for balancing fluid levels and blood pressure, and cortisol helps control blood sugar levels and heart function.

Like type 1 diabetes, Addison’s disease is also an autoimmune disease. The immune system attacks the outline of the adrenal glands, preventing them from making important hormones. People with both type 1 diabetes and Addison’s disease at the same time are diagnosed with Schmidt’s syndrome.

Also known as autoimmune polyglandular syndrome type 2 (APS-2), Schmidt’s syndrome is rare — affecting less than 1 percent of people with type 1 diabetes. However, those with type 1 diabetes are more likely to develop Addison’s disease compared to those in the general population. It’s important to note that Addison’s disease tends to affect adults more than children, typically between the ages of 30 and 50 years old.

Addison’s disease is usually treated with prescription hormones taken as pills like hydrocortisone and fludrocortisone. Be sure to let your doctor know you have type 1 diabetes so you receive the right treatment. If your hormone levels fall too low, you may need emergency treatment with steroids to correct your blood sugar and blood pressure levels.

6. IPEX Syndrome

IPEX stands for:

  • Immune dysregulation — This refers to the immune system mistakenly destroying healthy cells.
  • Polyendocrinopathy — This means it involves issues with multiple endocrine glands, disrupting hormone balance.
  • Enteropathy — This refers to intestinal problems affecting the gut’s lining and nutrient absorption.
  • X-linked syndrome — This means it’s an X-linked genetic disorder, which primarily affect males with a mutated X chromosome.

IPEX syndrome is a rare genetic condition that’s associated with type 1 diabetes, thyroid disease, skin rashes, and gastrointestinal inflammation. The condition typically develops during infancy and affects almost only boys, according to Children’s Hospital of Philadelphia. It’s caused by a gene change that affects certain immune cells. Without the healthy gene, the immune system begins attacking the body’s healthy tissues.

Children with IPEX syndrome need to be treated with insulin, thyroid medications, and treatments that calm down the immune system.

People living with type 1 diabetes have a higher chance of experiencing comorbidities. These conditions show how your immune system can affect different parts of your body. To stay on top of things, you’ll need to take proactive steps, work with your health care team, and make sure you’re getting the right treatments. That way, you can keep your overall health in check and manage the challenges that come with type 1 diabetes.

Talk With Others Who Understand

On myT1Dteam, the social network for people living with type 1 diabetes and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with type 1 diabetes.

Are you or a family member living with type 1 diabetes? Do you (or they) have any comorbidities? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on February 7, 2024

A myT1Dteam Member

My blood sugars stay under control the best on a ketovore or even better, carnivore diet.

posted 11 hours ago
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How Do You Test For A Thyroid Disease Or Addison’s Disease?
February 9, 2024 by A myT1Dteam Member 2 answers
Sarika Chaudhari, M.D., Ph.D. completed her medical school and residency training in clinical physiology at Government Medical College, Nagpur, India. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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