Coeliac Disease & Type 1 Diabetes Mellitus
The 14th of November is World Diabetes Day. In this article it will discuss Coeliac Disease alongside Diabetes. There are two types of Diabetes: Type 1 Diabetes and Type 2 Diabetes.
The Difference between Type 1 Diabetes and Type 2 Diabetes:
Type 1 diabetes is usually diagnosed at a young age, and this is where people do not produce enough insulin. Insulin is a type of hormone that is produced in our pancreas. Insulin controls blood sugar levels. By not producing enough insulin, the body cannot control the person’s blood sugar levels. This is why people with type 1 diabetes must take insulin in order to control their blood sugar levels. Type 1 diabetes is completely irreversible.
Type 2 diabetes is usually diagnosed at an older age and the person is usually, but not always overweight. People with type 2 diabetes produce insulin, but the body struggles to use it. They must change their diet and lifestyle to control their blood sugar levels along with medication. For some people, changes to diet and lifestyle can bring type 2 diabetes into remission – this means that their body might be able to use their insulin properly again. It can be quite difficult to do this, and people do need lots of support. It also doesn’t work for everybody. Do ask your doctor to refer you to your dietitian for advice.
Coeliac Disease and Type 1 Diabetes Mellitus
Coeliac Disease is more common in people who have type 1 diabetes as they are both autoimmune disorders. People diagnosed with type 1 diabetes are at a higher risk of having coeliac disease compared to everyone else. Between 4% and 9% of people with type 1 diabetes will also have coeliac disease. This is compared with 1% of the general population. However, there is no increased risk of coeliac disease in people with type 2 diabetes. Coeliac disease can affect blood sugar levels. People with type 1 diabetes and undiagnosed coeliac disease are more likely to have trouble controlling blood sugar (glucose) levels and are more likely to have hypos (very low blood sugar levels).
What if I experience no symptoms?
Symptoms of coeliac disease include stomach pain, bloating, diarrhoea, constipation, anaemia and fatigue. However, not everyone gets these symptoms, and some people may feel quite well. It is not unusual for some people with type 1 diabetes to have mild or no clear symptoms of coeliac disease. However, their gut lining will still be damaged when they eat gluten. Many experts recommend screening for coeliac disease as soon as someone is diagnosed with type 1 diabetes. People with type 1 diabetes who have been diagnosed coeliac disease but who have no symptoms must still follow a strict gluten free diet. It can be difficult to manage both type 1 diabetes and coeliac disease so advice from a registered dietitian is essential. Follow up care with your GP is also important for monitoring coeliac blood levels as well as iron, vitamin, D, vitamin B12 and folate. Some people may need a follow up endoscopy may be used to check that their gut has healed on a gluten-free diet. The earlier the person follows a strict gluten free diet, the lower the persons chances are, of having unpleasant symptoms and for getting related conditions such as osteoporosis and anaemia.
A gluten free diet will help improve the regulation of blood sugar for people with type 1 diabetes who also have coeliac disease. Extensive damage to the small intestine due to untreated coeliac disease can increase the risk of chronically low blood sugar due to the bowel not being able to absorb sugar from food.
How to Manage a Gluten Free Diet:
People with coeliac disease should avoid eating wheat, barley, rye and ordinary oats. People with coeliac disease could eat naturally gluten free foods such as quinoa and buckwheat. Some people with coeliac should also consume gluten free oats as ordinary oats can be contaminated with gluten. Some people with coeliac disease are also allergic to a protein called avenin, which is found in oats. Only 5% react to avenin so not everyone needs to avoid ordinary oats.
People with coeliac disease must also be careful with cross contamination. It is recommended for people with coeliac disease to thoroughly clean down surfaces, utensils and chopping boards containing gluten before preparing foods that are gluten free. If products are being stored, gluten containing products should be kept below the gluten free products. This prevents gluten containing products to fall into your gluten free products.
It is for these reasons it is important that if you have coeliac disease to join the Coeliac Society. The Coeliac Society provides you with multiple benefits to our members. These benefits include speaking with a dietician at a subsidised rate, speaking with a chef about gluten free recipes you can cook at a subsidised rate, viewing articles, recipes and viewing our food list. The food list is one of the most important benefits to our members. It provides a list of gluten free products from manufacturers that are safe for people with coeliac disease to consume. This food list has now been made easier as it is accessible on the Coeliac Society mobile app, where a person with coeliac disease can scan a products barcode in the supermarket and it will tell them whether it is on the food list or not. This then tells them immediately if they can purchase this item or not.
Type 2 Diabetes and Coeliac Disease
Type 2 diabetes is not an autoimmune disease but can develop for several reasons. Genetics can play a role and diet and lifestyle are also factors. Being obese or overweight is also a risk factor for developing type 2 diabetes, so working towards a healthy weight can help to reduce your risk. This can be done through eating healthy and exercising more regularly. Try get out for a walk for 30-40 minutes 5 days a week, as people who exercise regularly are less likely to develop type 2 diabetes.
If you think you or anyone you know may suffer from coeliac disease and diabetes:
It is important that if you are diagnosed with type 1 diabetes, you should get tested for coeliac disease whether you have or do not have symptoms. This is because type 1 diabetes automatically puts at a higher risk for coeliac disease.
If you think you may have coeliac disease alongside your type 1 diabetes, it is best to request a simple blood test from your GP. If this test is positive your GP will refer you for a biopsy. You need to have the biopsy to be diagnosed with coeliac disease: the blood test alone is not enough. It is very, very important that you continue to eat gluten until you have your biopsy. If you cut out some or all gluten before you have your test, then it will come back as negative even if you do have coeliac disease.
For advice and support or to make an appointment to see our dietitian, contact the Coeliac Society of Ireland at firstname.lastname@example.org or go to www.coeliac.ie.