Celiac Disease and Diabetes

Type 1 Diabetes

In cases of type 1 diabetes, the immune system attacks and destroys the specialized cells in the pancreas that produce insulin. When the body can no longer produce sufficient insulin (a protein that regulates blood glucose concentration) the resulting chronically high glucose levels in the blood (hyperglycemia) cause blood vessel and nerve damage. This can lead to serious complications, such as: stroke, heart disease, kidney disease, and amputation.

Symptoms for diabetes include: frequent urination, thirst, hunger, weight loss, dry mouth, and fatigue.

The exact cause that starts the autoimmune reaction in type 1 diabetes is still not understood. There are genetic and environmental factors that can increase the risk of developing diabetes, as well as certain drugs that lead to the specific destruction of the beta cells. The condition is usually diagnosed in children or young adults, which is why it was once called juvenile diabetes.

Diabetes is much easier to test for than celiac disease. A blood test, usually done after a period of fasting, measures how much glucose is in the blood. If it is over a certain threshold, the person has diabetes or pre-diabetes. If caught early enough, the autoantibodies (antibodies that attack the body) can be tested for before the patient actually has diabetes or pre-diabetes.

Treating diabetes typically involves both a change in diet as well as insulin injections. Patients must monitor and control their blood sugar at all times to avoid hyperglycemia as well hypoglycemia (low blood sugar).

Type 2 Diabetes

Patients with type 2 diabetes still have insulin-producing cells in the pancreas, but they don’t produce enough insulin, or their other cells do not respond to insulin. This lack of responsiveness is called insulin resistance. This insulin resistance results in high blood glucose concentrations similar to type 1 diabetes and can cause similar symptoms and complications. The causes of type 2 diabetes are less established than for type 1, but there are certain things that can put someone at higher risk:

• Being overweight
• Being inactive
• Having family members with type 2 diabetes
• Being a certain ethnicity such as African-American, Asian-American, Hispanic, or Native-American
• Being over age 45
• Developing pre-diabetes or gestational diabetes
• Having polycystic ovary syndrome

Diabetes and Celiac Disease

The link between type 1 diabetes mellitus and celiac disease was first established in the 1960s. The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 8%, and about 1% in the general population. Most patients with both conditions have asymptomatic celiac disease, or symptoms that may be confused for symptoms of their diabetes. For this reason, and the significantly higher prevalence rate of celiac disease in diabetes patients, many doctors recommend getting screened for celiac disease after a diagnosis of type 1 diabetes, as well as celiac patients getting screened for type 1 diabetes.

A recent study in 2013, contributed to by Dr. Peter Green, a member of Celiac Disease Foundation’s Medical Advisory Board found that there were no standard uniform practices for screening type 1 diabetes patients for celiac disease. Of the facilities in the study that did screen for celiac disease, 60% of them only did so if there were symptoms present. The authors of the study suggested that a uniform protocol for screening should be in place, as well as a need for further education on the gluten-free diet in patients with type 1 diabetes for dietitians.

There is no established link between type 2 diabetes and celiac disease. Type 2 diabetes does have genetic components, but they are not associated with celiac disease genes like type 2 diabetes’ are.

The gluten-free diet may improve glycemic control for diabetic patients, although that is still controversial, as some studies support the idea and others suggest there is no difference in glycemic control between normal diabetic patients and diabetic patients with celiac disease on a gluten-free diet.

Untreated celiac disease, leading to a damaged small intestine, can increase risk of hypoglycemia because the small intestine may no longer be able to absorb nutrients such as sugars properly, making diagnosis even more imperative.

Having one autoimmune disease puts you at greater risk for developing another. To see other symptoms and conditions associated with celiac disease, check out our Symptoms Checklist, which you can print out and bring to your doctor to help with your, or a loved one’s, diagnosis.

Click here to learn more about managing celiac disease and type 1 diabetes.

References

• Cohn A, Sofia AM, Kupfer SS. Type 1 diabetes and celiac disease: clinical overlap and new insights into disease pathogenesis. Current diabetes reports. 2014;14:517.
• Elfström P, Sundström J, Ludvigsson JF. Associations Between Coeliac Disease and Type 1 Diabetes. Alimentary Pharmacology & Therapeutics. 2014;40(10):1123-1132.
• Lazzarotto F, Basso D, Plebani M, Moscon A, Zanchetta R, Betterle C. Celiac disease and type 1 diabetes. Diabetes Care. 2003;26:248-249.
• Schwarzenberg SJ, Brunzell C. Type 1 Diabetes and Celiac Disease: Overview and Medical Nutrition Therapy. Diabetes Spectrum. 2002;15:197-201.
• Simpson SM, Ciaccio EJ, Case S, et al. Celiac disease in patients with type 1 diabetes: screening and diagnostic practices. Diabetes Educ. 2013;39:532-540.
• Waszczuk E, Kosiara M, Dobosz T, Paradowski L. Celiac disease and diabetes mellitus. ADVANCES IN CLINICAL AND EXPERIMENTAL MEDICINE. 2007

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