Diabetes and the Autoimmune Link

Type 1 puts you at greater risk for two autoimmune disorders

Pediatric endocrinologist Arnold Slyper, M.D., talks with Dylan about his type 1 diabetes during a recent office visit. Dr. Slyper also checked the 8-year-old Stroudsburg boy for autoimmune thyroid disease. Dylan showed no signs of a thyroid problem, but Dr. Slyper will check him regularly to catch changes early.

Your immune system is built to protect you, but if you have an autoimmune disease like type 1 diabetes, it can hurt your body and make you sick.

“With autoimmune diseases, your immune system mistakes healthy cells for harmful invaders and attacks them,” says rheumatologist James M. Ross M.D., of Lehigh Valley Hospital and Health Network. In type 1 diabetes, for example, your immune system mistakenly attacks the healthy cells in your pancreas that produce insulin, shutting down your insulin production for good.

Autoimmune diseases also tend to multiply. If you have one, your immune system could mistakenly attack other parts of your body, too, such as your thyroid. “We don’t know what causes autoimmune disorders, so we can’t prevent them,” says Ross’s colleague, pediatric endocrinologist Arnold H. Slyper, M.D. “We do know that autoimmune diseases tend to run in families.”

Lupus, celiac disease, certain thyroid conditions and Crohn’s disease are all autoimmune disorders. “The two most common autoimmune disorders that pair up with type 1 diabetes are thyroid and celiac diseases,” Slyper says.

Thyroid conditions

People with a thyroid disorder may have an underactive (Hashimoto’s disease) or overactive (Graves’ disease) gland. “In these diseases the body’s own immune system attacks the thyroid, the butterfly-shaped gland in your neck that helps control metabolism,” says Slyper.

Your doctor can check for thyroid disease by asking you about symptoms (see boxes) and feeling your neck to see if your thyroid is normal size. To confirm the disease, he can order a simple blood test—just as he would for many other diseases.

Even if you don’t have abnormal thyroid tests, doctors will check for thyroid antibodies in your blood when you’re diagnosed with type 1 to see whether you’re at risk for developing a thyroid problem later, Slyper says. “When we know antibodies are present, we monitor for the disease more closely.” Twenty percent of people with type 1 diabetes have thyroid antibodies when they’re diagnosed, he says. “And 10 percent of people with type 1 already have thyroid disease at diagnosis.”

Celiac Disease

This disease, in which people can’t tolerate gluten, can occur at any time and sometimes accompanies type 1 diabetes. Gluten is a protein in wheat, barley, rye and oats, so it is often found in breads, cereals, pasta and pastries. It can also hide in gravies, marinades, thickeners, drink mixes and prepared foods. “Celiac disease is controllable if you eliminate wheat products from your diet,” Slyper says.

If you have celiac disease, you may have bowel problems such as chronic diarrhea and abdominal cramping. A blood test confirms your diagnosis. “Celiac also can affect a child’s growth and development during puberty because their bodies don’t absorb nutrients from foods properly. That’s why we routinely check children’s height and weight.”

“Over time, celiac can even cause osteoporosis and anemia, because your body isn’t absorbing enough calcium and iron,” says Slyper’s colleague, internist John Nuschke, M.D. And because food in your system can affect blood sugar levels, celiac disease can also affect how well you can control your diabetes. “Gluten-free products are made of grains that are rapidly absorbed into the bloodstream, causing your blood sugar to rise and fall more rapidly,” Slyper says.

Celiac disease means you enter a whole new world of shopping, preparing food, dining out and caring for your diabetes. “People with the disease, especially children, need support in dealing with both celiac and type 1 diabetes,” Slyper says. “But you don’t have to do it on your own – you can consult with a dietitian and take advantage of many support organizations and online resources that can provide tips and shopping guidelines.” Call 610-402-CARE for more information.  If you or your child has celiac disease and diabetes, talk with your doctor about a referral to a dietitian at the Helwig Health and Diabetes Center.

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