Type 1 Diabetes and Celiac Disease

Type 1 diabetes (T1D) and celiac disease (CD) are both autoimmune diseases. According to the Celiac Disease Foundation, the estimated prevalence of CD in people with T1D is approximately 6%. The prevalence of CD in the general population is about 1%.

Due to the seeming connection between T1D and CD, most doctors will screen for CD after a T1D diagnosis and vice versa. Find out the connection between the two diseases, who is at greatest risk, and how to cope.

What Are Type 1 Diabetes and Celiac Disease?

Type 1 diabetes is an autoimmune disease in which the body mistakenly attacks the pancreas, destroying the cells that produce insulin. Insulin is a hormone that has many roles.

One important role is helping glucose get into the cells so that it can be used for energy. Without insulin, the body cannot get energy from food. As a result, the sugar, or glucose, stays in the blood.

Some people with T1D get diagnosed with the disease when their blood sugars are at dangerously high levels and they are experiencing diabetic ketoacidosis (DKA). People with T1D need to take insulin daily to keep their blood sugars in range.

Celiac disease is also an autoimmune disease in which the intestinal villi (tiny structures in the gut that are responsible for nutrient absorption) become damaged due to the immune system's response to the ingestion of gluten.

Gluten is a protein found in wheat, barley, rye, and some oats. It is also found in other products, such as certain cosmetics, vitamins, minerals, and even play dough. People with CD must follow a gluten-free diet to heal the villi and prevent further damage. Even the smallest amount of gluten can be problematic.

Symptoms of Type 1 Diabetes and Celiac Disease

Type 1 Diabetes

When the body cannot use glucose as energy, it finds ways to compensate for the excess sugar that has accumulated in the blood and tries to get rid of it. Symptoms of elevated blood sugars (hyperglycemia) include:

• Excessive thirst
• Excessive urination
• Excessive hunger
• Fatigue
• Bedwetting (in kids)
• Weight loss
• Irritability
• Confusion

Advanced symptoms of hyperglycemia can be a warning sign that the body is going into DKA. These include nausea, vomiting, or abdominal pain (particularly in children), Kussmaul respirations (deep, fast, labored breathing), and a fruity odor on the breath due to exhaled acetone.

DKA is a medical emergency and must be treated in the hospital so that people can receive a correction of high blood sugar and acidosis, volume repletion, and prevention of hypokalemia (low potassium).

Symptoms of Celiac Disease

Celiac disease can be hard to diagnose, as it often presents differently in different people and at different ages. While some people with CD have no symptoms at all, others can experience an array of symptoms that are gastrointestinal or throughout the body. Some common symptoms in kids include:

• Abdominal bloating and pain
• Chronic diarrhea
• Vomiting
• Constipation
• Pale, foul-smelling, or fatty stool
• Iron-deficiency anemia
• Weight loss
• Fatigue
• Irritability and behavioral issues
• Dental enamel defects of the permanent teeth
• Delayed growth and puberty
• Short stature
• Failure to thrive
• Attention deficit hyperactivity disorder (ADHD)
• Symptoms related to vitamin deficiencies (such as vitamin D deficiency)

In adults, the symptoms include:

• Unexplained iron-deficiency anemia
• Fatigue
• Bone or joint pain
• Arthritis
• Osteoporosis or osteopenia (bone loss)
• Liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)
• Depression or anxiety
• Peripheral neuropathy (tingling, numbness, or pain in the hands and feet)
• Seizures or migraines
• Missed menstrual periods
• Infertility or recurrent miscarriage
• Canker sores inside the mouth
• Dermatitis herpetiformis (itchy skin rash)

What Comes First?

If you have one of these autoimmune diseases, it does not mean you will absolutely develop another. And if you do develop one after the other, you may not know you have it right away. Most of the time, people with T1D get diagnosed with CD when they don't have symptoms. Symptoms of CD may also be confused as symptoms of T1D.

Kimberly Avelin, a schoolteacher living with T1D and CD, tells Verywell, "I did not have any symptoms of celiac disease, which is why it was such a shock." Avelin was diagnosed with T1D at age 11 and was checked yearly for celiac markers at her appointments. It wasn't until five years later that she was unexpectedly diagnosed with CD.

How Are They Related?

Type 1 diabetes and CD have overlapping environmental and genetic risk factors. Certain immune-related genes have been identified in both T1D and CD.

In addition, studies are not consistent, but researchers have found an increased risk of developing T1D and CD in people when cereal was introduced at younger than 4 months of age or older than 7 months of age, those who were not breastfed, and those who have had viral infections, particularly rotavirus.

Typically, T1D precedes CD, and one autoimmune disease can trigger the other. Due to genetic, environmental, and immunological factors, people with T1D are generally at increased risk of developing other autoimmune diseases.

Diagnosis

People with T1D should be screened for CD annually for the first four years after diagnosis and then every one to two years for the following six years. The majority of people with T1D will not have symptoms of CD, therefore annual blood work to test for antibodies is warranted. Counseling people who have CD about the signs and symptoms of T1D is also important.

Coping With Two Autoimmune Diseases

Both T1D and CD require dietary management and many other daily tasks, such as blood sugar testing, analyzing data, and insulin requirements. It is easy to get overwhelmed, but with extra planning, it is possible to live a healthy life without feeling restricted.

Avelin says, "My best advice is to be prepared. I am always taking into consideration where I am going, what I am doing, and how that will impact my blood sugar both short- and long-term."

She recommends bringing an appetizer or a snack to parties or social events and using technology (in her case, an insulin pump and continuous glucose monitor) to help figure out how certain foods will impact blood sugar and how to adjust insulin to compensate. Her philosophy about living a full life is not to live in deprivation.

She says, "Living with T1D and CD is overwhelming at times, but you can eat in plenty of restaurants and satisfy your cravings with foods you love. I never feel deprived. I know there are great companies, restaurants, and local bakeries that make gluten-free options.

"I try to find the balance of enjoying myself, but also in moderation," she continues. "For example, instead of eating a giant-size piece of gluten-free cake, I will have enough to satisfy my craving and truly enjoy it. I always keep in mind what works for me and what will keep my blood sugars in a safe range."

Managing Blood Sugars on a Gluten-Free Diet

Many nutritious whole foods are naturally gluten-free. These include vegetables, fruits, gluten-free whole grains (quinoa, buckwheat, brown rice, sorghum, wild rice, amaranth, millet, most oats), most cheeses, yogurt, legumes, nuts, seeds, eggs, chicken, meat, fish, turkey, etc.

Food combinations that help control blood sugar include incorporating foods containing fiber, protein, and fat at every meal. This combo can prevent large fluctuations in blood sugar.

For example, one might eat a taco bowl, which includes one cup of brown rice, two servings of roasted vegetables, three to four ounces of lean protein like grilled chicken, shrimp, or tofu, and some sliced avocado (portions and servings will vary based on an individual's needs).

It is always important to read labels when eating packaged foods to ensure they are gluten-free. And remember that just because something is gluten-free doesn't mean it is a "health food."

If you have T1D, you'll need to know the carbohydrate amounts of all foods and aim to choose options that contain fiber, fat, and protein for blood sugar control. If you need help with meal planning, reach out to a registered dietitian specializing in T1D and CD.

Summary

There seems to be a connection between type 1 diabetes and celiac disease. However, just because you have one doesn't guarantee you will develop the other. Genetics, environment, and immunology are all connecting factors that link T1D and CD. If you have T1D or CD, your physician will likely monitor you for the other with blood work. You will need to manage your blood sugar on a gluten-free diet.

A Word From Verywell

Should you develop a dual diagnosis of T1D and CD, be sure to receive education from a registered dietitian. With support and extra planning, you can live a healthy life without deprivation.