After years of living with Type 1 diabetes, you’re a pro at counting carbohydrates and adjusting insulin doses. Over the past year, however, your diabetes has become difficult to control. You’ve experienced weight loss, frequent bouts of diarrhea, and fatigue. You’ve also had fluctuating blood glucose levels — both hypoglycemia and hyperglycemia — and needed frequent insulin adjustments. You don’t know what’s wrong, and what’s worse, your doctor — make that doctors — can’t explain your symptoms, either. They’ve suggested everything from irritable bowel disease to depression, but nothing seems to help.
Then one day, a friend mentions that a colleague of hers has a daughter who has Type 1 diabetes and celiac disease, or intolerance to gluten. Her symptoms were similar to yours until her doctor put her on a special, gluten-free diet. Now she’s fine — as long as she doesn’t eat the wrong foods.
You’ve never heard of celiac disease before, but you’re curious. What is this disease and what causes it? What foods are off-limits? Which are OK to eat? Most of all, how would giving up all gluten-containing foods affect your life and your diabetes control? Before you make another appointment with your doctor, you decide to do some research of your own.
What is celiac disease?
Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is a hereditary, autoimmune disease in which the body launches an immune reaction when a person consumes gluten, a type of protein found in wheat, rye, and barley. For reasons still unknown to researchers, when people with celiac disease eat foods containing gluten, the immune system sees it as a toxin and launches an attack to prevent its absorption into the bloodstream. The effect of the attack is a flattening of the villi, the small, fingerlike projections on the lining of the small intestine through which nutrients are absorbed. This leaves the intestinal surface smooth, with less surface area for absorbing nutrients. In addition, when the villi flatten out, the digestive enzymes normally present on the villi are destroyed, so food passes through the gut unabsorbed.
Common symptoms of malabsorption include gas, bloating, diarrhea, and weight loss. Other symptoms may include fatigue, anemia, irritability, or depression. In many cases of undiagnosed celiac disease, however, there are no symptoms at all.
Malabsorption of nutrients can create serious deficiencies of the fat-soluble vitamins A, D, E, and K; of folate and vitamin B12; as well as of iron and calcium. In children, this can lead to delayed growth or short stature as well as delayed puberty. Long-term complications of untreated celiac disease include osteoporosis, fertility problems, and benign or malignant tumors of the small intestine. Vitamin and mineral supplements are an essential part of treatment when the intestinal damage, or villous atrophy, is first recognized.