Authors: Dr Viveka Kaul, Dr Anupriya and Dr Heena Gupta, Apollo Centre for Obesity Diabetes and Endocrinology
There seems to be a link between type 1 diabetes and celiac disease. Some studies suggest that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 3-8 % of people with type 1 diabetes will have biopsy-confirmed celiac disease, thus individuals with type 1 diabetes would benefit from routine celiac disease screening.
Normally type 1 diabetes is diagnosed first because this type of diabetes tends to strike early in life and its diagnosis is certain. Also, celiac disease associated with diabetes is usually silent, showing no symptoms, and may only be found upon screening. Signs and symptoms, such as abdominal pain, gas, bloating, malabsorption, weight loss, and abnormal liver function tests may also be seen and easily confused with poor glucose control of type 1 diabetes or gastroparesis – when the muscles in the wall of the stomach do not function normally. Untreated celiac disease may also contribute to irregular blood glucose swings. Unexplained hypoglycemia, or low blood sugar, can be a sign of malabsorption related to celiac disease and should be investigated, particularly in small children. Both celiac disease and diabetes require dietary modifications for proper management, so the control or elimination of certain foods will keep the individual with either disease healthy.
No link between Type 2 diabetes and celiac disease
Yet 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.
A look at the possible treatment
There is only one known treatment of this disease and that is lifelong total avoidance of gluten from diet.
Once treatment of celiac disease has begun and nutrients are better absorbed, insulin doses may need to be adjusted. Treating celiac disease should make it easier to keep diabetes under control. A study published in the July 2002 issue of the journal Diabetes Care found that in children with Type 1 diabetes and celiac disease, 12 months of a gluten-free diet not only improved their growth but led to a significant reduction in HbA1c level (indicating improved blood glucose control).
For people with diabetes and celiac disease, starting a gluten-free diet requires learning the carbohydrate content of new, gluten-free foods, so they can be introduced into a meal plan.
Straying from a gluten-free diet – even just a little bit – can trigger the immune system reaction that damages your intestines, whether or not you experience symptoms. Just as adjusting to diabetes requires changing eating patterns and lifestyle habits, learning to prepare and enjoy gluten-free foods – and avoid gluten – can be a challenge at first, but it doesn’t have to mean a lifetime of tasteless meals. The variety and availability of gluten-free foods is greater now than ever before, and food manufacturers and restaurants are becoming increasingly sensitive to the needs of people with food intolerances. Moreover, omitting gluten may introduce you to a rich variety of “alternative” grains, nuts, and seeds that are not only flavorful, but also rich in vitamins, minerals, protein, and fiber. In the end, better health, higher energy, and improved blood glucose control are worth the effort of adjusting to your new meal plan.
Overall goals of nutrition therapy
The most important goal is to achieve or maintain optimal glucose control. This is achieved more easily by frequent self- monitoring of blood glucose levels. Nutritional intake may variable due to symptoms associated with Celiac Disease such as anorexia, early satiety and bloating and can often be inconsistent from meal to meal and day to day. Also, depending on the level of malabsorption (if present) in the patient with Celiac Disease. Learning to follow gluten free guidelines for someone newly diagnosed with Celiac disease is an overwhelming experience and combining it with diabetes management can be daunting. The patient will benefit from a series of appointments with the dietician and other health care team members during the transition to combining both diets. Transitioning to the gluten free diet may occur over a few weeks to months depending on the patients’ age, symptoms, other medical issues, support and resources.
- There is no known cure for the disease at present. The only treatment modality is dietary.
- Eliminate the obvious foods that must be avoided for the greatest impact on blood glucose control.
- When the patient is able to recognize these foods and avoid them with good success, refine the diet by eliminating hidden sources of gluten.
- The disorder can be controlled extremely well with avoidance of foods containing gluten.
- Small amount of gluten ingestion may or may not produce immediate symptoms, but over the period of time adverse affect will become apparent and hence must be avoided.
- Always read the label carefully before buying any commercial food item.
- Be careful when you eat out. Better to eat something from home or carry some food with you.
- Before going to the party, inform your host about your inability to take wheat and suggest some options which they can have.
- Major meals should be taken at least 3 three times a day combined with 2-3 minor meals
- Shrine or temple offerings, such as Prasad, pudding, sweets, halwa etc. are not permitted. However patients can have fruits which have not come in contact with halwa etc.
- Family cooperation and continuous encouragement and checks are required for successful treatment of celiac disease.
- Older children or adolescents may be rebellious or defiant because of peer pressure. At this time supervision, support and encouragement is very crucial.
- 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.
- Narayan S, mittal SK, Celiac disease: A guide for mailies: new delhi: Celiac support organization. 2014