FeaturesAug/Sept 2008 Issue

Diabetes and Celiac Disease

Yale University students Trevor Wagener and Maximilian Goer are suitemates who were both diagnosed with conditions that prompted a dramatic change in lifestyles and diet during their freshman year. Their diseases—type 1 diabetes and celiac disease—also hold a significant connection.

Both are autoimmune diseases that share a genetic link because they fall on the same chromosome. Often, when a person has one disease, there is a higher potential for developing the other, says Cynthia Kupper, executive director of the Gluten Intolerance Group. 

The incidence of Americans with type 1 diabetes also developing celiac disease can range from 6 to 15 percent, while the incidence of people with celiac disease developing type 1 diabetes is between 4 and 6 percent, Kupper says.

“One doesn’t cause the other but when you have both diseases, celiac disease can make diabetes harder to control,” she says.

A challenge of having both conditions occurs with malabsorption, where the body does not properly absorb food. The ingestion of gluten proteins damages the small intestine in someone with celiac disease and can cause malabsorption of nutrients.
Someone with type 1 diabetes who is newly diagnosed with celiac disease and has malabsorption can end up taking an incorrect amount of insulin, Kupper says. The insulin will absorb at a normal rate but the food is not absorbing at the same rate.

“The food and the insulin aren’t there at the same time the way they need to be and you can either get really high blood sugars or really low blood sugars,” Kupper says.

Once the body starts healing from the malabsorption and can better digest food, the insulin and food begin working together. So the insulin will probably need to be adjusted again, Kupper says.

The symptoms of celiac disease, which can be masked or silent in a person with type 1 diabetes, also can add difficulty. The symptoms can initially indicate other common problems with type 1 diabetes, such as gastroparesis, where the stomach takes too long to empty its contents causing dips and spikes in the blood sugar. Gastroparesis can cause stomach pain and diarrhea, also symptoms of celiac disease, Kupper says.

Because the two diseases are commonly linked and the symptoms of celiac disease often are unrecognized, it’s recommended that people with type 1 diabetes get screened for celiac disease.

Wagener, who was diagnosed with type 1 diabetes in October 2007, says despite not having any symptoms of celiac disease, he will be tested for the condition. He did not initially get tested because he first wanted to get used to the routine of managing his type 1 diabetes.

“It would be a bit of a tough blow to deal with both,” Wagener says, adding that the diet for celiac disease is different from the diet he has followed to manage his type 1 diabetes and would be yet another adjustment.

Kupper notes that one difficulty for a person with type 1 diabetes and celiac disease is that gluten-free foods often are concentrated in carbohydrates and lower in fiber, which makes blood sugars rise and fall more quickly. For example, one type of gluten-free hamburger bun that looks like a normal serving size might contain 54 grams of carbohydrates, making it the equivalent of eating four pieces of bread instead of two, Kupper says. It is important to read labels to find out carbohydrates, fiber and serving size because if a person assumes the bun is a smaller serving, he or she might incorrectly estimate carbohydrate intake.

“That creates havoc when you’re trying to adjust insulin,” Kupper says.

According to Kupper, the easiest way to manage type 1 diabetes and celiac disease is to be on a gluten-free diet with a carbohydrate counting system. In this system, the insulin intake is adjusted based on the carbohydrates the person is planning to eat. 

“It’s easier if you know how many carbohydrates you’re going to eat and then adjust your insulin accordingly," Kupper says.

Kupper also encourages anyone with type 1 diabetes and celiac disease to work with a diabetes educator who understands a gluten-free diet.

There are resources available online that can assist in managing both diseases. The Gluten Intolerance Group (www.gluten.net) provides educational materials that can be downloaded for free. For example, Celiac, Diabetes, and Me! is a publication that provides sample diet plans, menus and a list of gluten-free foods and ingredients with carbohydrate information.

College students facing a diagnosis of both diseases could benefit from a support system online or a meet-up group that brings together people who have an understanding of both conditions, Kupper says. It’s also important to get to know the healthcare team and the dining services manager at the college.

Participating in a diabetes education program could also help someone with celiac disease who is newly diagnosed with type 1 diabetes, Kupper says. The programs, which often are offered by hospitals, teach the ins and outs of type 1 diabetes, as well as the potential complications and nuances of a carbohydrate-counting diet. Putting information gained in a diabetes education program together with information about celiac disease can help provide understanding about how to manage both conditions, Kupper says.

When someone faces the challenge of managing type 1 diabetes and celiac disease, “they really shouldn’t think of it as two diets, but one,” Kupper says. “That’s important because then it doesn’t seem twice as overwhelming.” LW

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