Diabetes and other autoimmune conditions

Autoimmune diseases vary in their severity and symptoms but, essentially, they’re conditions where the body’s immune system mistakenly attacks itself. Type 1 diabetes is classed as an autoimmune disease – which causes damage to the pancreas – and to add fuel to the fire, having one autoimmune condition means you have a higher chance of developing another.

Research shows that the gene changes associated with Type 1 diabetes are also connected with coeliac disease and autoimmune thyroid disease, while there’s also a family link to consider. Any family history of an autoimmune disease can mean there’s a higher chance of developing any autoimmune disease.

Here is an overview of some common (and lesser-known) autoimmune conditions to consider when you have Type 1 diabetes.

 

Addison’s disease

This is a condition that occurs when your adrenal glands don’t produce enough of the cortisol and often aldosterone hormones. These hormones have various roles within the body – including controlling blood sugar levels, regulating metabolism, growing tissue, regulating mood, responding to stress, and helping to maintain blood pressure.

Having both Addison’s disease and Type 1 diabetes is known as Schmidt syndrome. It’s not common – less than 1% of people with Type 1 diabetes have it; however, the risk of developing it is higher with Type 1 than the general population.

People are generally around 30–50 years old when signs and symptoms appear, which include muscle weakness or pain, skin hyper-pigmentation, fatigue, mood swings, salt cravings, weight loss and lack of appetite, low blood pressure, nausea and/or diarrhoea, abdominal pain, and lower back and/or leg pain.

If you show signs of Addison’s, a blood test can measure hormone and mineral levels – you may even have a CT scan or MRI of your adrenal glands. If Addison’s disease is confirmed, you’ll be treated with hormone medication.

 

Coeliac disease
Coeliac disease affects 1 in 100 people and, according to Coeliac UK, between 4 and 9% of people with Type 1 diabetes will also have the condition. There’s no link with Type 2 diabetes, though that doesn’t mean you can’t have it or won’t develop it, so it doesn’t hurt to be aware of the symptoms.

Coeliac disease is not a food allergy or intolerance. It’s an autoimmune reaction to gluten. It causes damage to the lining of the small bowel, which makes it hard for the gut to absorb nutrients and lead to nutritional deficiencies.

Symptoms include bloating, diarrhoea, nausea, wind, constipation, tiredness, sudden or unexpected weight loss, hair loss, joint or bone pain, pins and needles, infertility or repeat miscarriages and anaemia. With Type 1 also in the mix, you may also have frequent hypos, and may even find that any of these symptoms only become noticeable once insulin treatment has started. To add to the complication, some people with Type 1 don’t experience any symptoms of coeliac disease – a ‘silent’ form of the condition and it’s only picked up by screening.

Clinical guidelines state that all children and young people with Type 1 diabetes are screened for coeliac disease when they are diagnosed and that adults with Type 1 are assessed for coeliac disease. Testing should also be offered to anyone if showing signs and symptoms of coeliac disease.

So, if you think you could have coeliac disease, see your GP to discuss your symptoms. A blood test can check for antibodies that the body makes in response to eating gluten. A gut biopsy then confirms the condition. Ongoing treatment includes following a strict gluten-free diet and support from a registered dietitian.

 

Thyroid disease
The thyroid – a small gland underneath the Adam’s apple – controls our metabolism and, in our early years, our growth. There are two types of thyroid disorder – hypothyroidism, where the body doesn’t produce enough thyroid hormones, and hyperthyroidism, where the body produces too many.

Problems with the thyroid – mainly hypothyroidism – are more common when you have diabetes – particularly Type 1 because the body’s cells can attack the thyroid and destroy the cells in the same was as insulin-producing cells in the pancreas. Fortunately, thyroid disorders can be managed ­– but not cured – with medication. But as thyroid diseases affect the metabolism, it can be problematic when you have diabetes, so it’s good to be aware of the symptoms and see your GP as it may affect your blood glucose control.

 

  • Hyperthyroidism: Producing too many thyroid hormones causes a fast metabolism, often called overactive thyroid. The autoimmune form is called Graves’ disease. Symptoms include feeling nervous or anxious, weight loss, insomnia, mood swings, increased thirst, increased urination, fatigue, muscle weakness, diarrhoea, feeling itchy and lack of sex drive.

 

  • Hypothyroidism: Not producing enough thyroid hormones causes a slower metabolism and is also sometimes called myxoedema or underactive thyroid. The autoimmune form is known as Hashimoto’s disease. Symptoms are generally the opposite of hyperthyroidism and include weight gain, tiredness, cold sensitivity, muscle aches and depression.

  

Vitiligo

Again, rare yet more common with people who have Type 1 diabetes, vitiligo damages the cells that make pigment in the skin – called melanocytes – the mucous membranes, and the retina. This causes white patches on the skin, which is usually the first symptom people notice, particularly sun-exposed areas. While it’s not life-threatening, people can be affected by cosmetic changes and affect their confidence and wellbeing.

Traditional medical therapies include topical steroid creams that encourage repigmentation, and medication alongside ultraviolet A photochemotherapy (PUVA) – controlled exposure to ultraviolet A (UVA) light.

Surgery is sometimes an option for people with localised areas of depigmentation that haven’t responded well to other therapies. This can include normal, pigmented skin being removed from one part of the body and attached to the depigmented areas, or micropigmentation (tattooing) to ‘colour in’ the depigmented areas.

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