Diabetes Self-Management Blog

You may recall that I attended the American Association of Diabetes Educators (AADE) annual meeting a few weeks ago.  When I arrived at the conference on Wednesday, I was a little late getting to the 1:30 session that I really wanted to go to and, as a result, got closed out. I then wandered across the hall to another session called "Managing Diabetes with Celiac Disease."

I figured, “What the heck, this will be a good review for me.” I have to say that I’m really glad I attended, and I wanted to share some things that I learned. I know that Jan Chait wrote about celiac back in April (“Exploring the Gluten-Free World”), so I’ll try not to repeat too much of the information that she shared.

Celiac disease is an autoimmune digestive disorder that is caused by eating foods that contain gluten, a type of protein found in wheat, rye, barley, and possibly oats. When a person with celiac eats a food that contains gluten, an immune reaction occurs that results in damage to the villi of the small intestine. Villi are finger-like projections that protrude from the lining of the small intestine and help increase the surface area, allowing nutrients to be absorbed at a fairly fast rate. With celiac, these villi are damaged and flattened out, leading to malabsorption.

If celiac isn’t treated, nutrient deficiencies can result, causing problems with the nervous system, bones, and liver. People with untreated celiac are also at an increased risk for intestinal lymphoma and bowel cancer.

Facts and Figures
About three million people in the U.S. have celiac disease, but only 5% (150,000) are actually diagnosed. Twenty-five percent of new diagnoses occur in adults older than 60 years of age. And 6% of people with Type 1 diabetes have celiac. In people with Type 2 diabetes, about 1 in 250 have celiac. Having a family history of celiac increases the risk by between 5% and 15%. Celiac disease tends to be more common in people of European ancestry, as well as in people who have autoimmune diseases, including Type 1 diabetes, lupus, rheumatoid arthritis, and autoimmune thyroid disease.

Symptoms
Celiac disease often goes undiagnosed for many years. This is in part due to the malabsorption symptoms that occur, and health-care providers often look for other possible causes, such as irritable bowel syndrome, ulcers, and Crohn disease. Also, some people with celiac never get any gastrointestinal symptoms, which makes celiac even trickier to diagnose. However, some of the more common symptoms of celiac are:

  • Diarrhea
  • Abdominal pain
  • Bloating
  • Vomiting
  • Lack of appetite
  • Failure to thrive (in children)

Some less common symptoms include:

  • Anemia
  • Osteopenia (low bone density)
  • Fatty liver
  • Recurrent miscarriages
  • Short stature (in children)
  • Skin rash
  • Unexplained hypoglycemia (in people with diabetes)

In fact, celiac can affect all of the body’s systems, not just the gastrointestinal tract. A particular skin condition called dermatitis herpetiformis (DH) is linked with celiac. DH is characterized by red bumps and blisters that cause intense itching, burning, and stinging. These lesions are symmetrically found on the elbows, legs, buttocks, shoulders, neck, and back. Diagnosis of DH is done by biopsy, and although medicine is prescribed, a strict gluten-free diet must be followed. In most cases, eating foods with gluten will trigger an outbreak of this skin condition, even if the condition has been healed.

More on celiac next week!

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Diabetes and Celiac Disease (Part 1)
Diabetes and Celiac Disease (Part 2)
Diabetes and Celiac Disease (Part 3)


Comments
  1. I would like to know more about Celiac and Diabetes. I know a little girl who has Celiacs and I did’nt know the 2 were connected????????Also Celiacs and diabetes in older people????

    Posted by Gette |
  2. Hi Gette,
    Keep in mind that not everyone with celiac has diabetes, and vice versa. However, both are autoimmune diseases and there definitely seems to be a link. For more information, check out Celiac.com at .

    Posted by acampbell |
  3. Please keep in mind that you don’t go along just fine and one day you wake up with celiac disease (CD). You develop a sensitivity to gluten first before it develops into full-blown CD. So if you have some of the symptoms of CD, such as anemia, bloating, etc., but your doctor says you don’t have the flattened villi (which is indicative of full-blown CD), you may have a gluten sensitivity. In this case, you should eliminate gluten from your diet immediately, to prevent CD from developing. Some experts have estimated that as many as 30% of our population have gluten sensitivity which may eventually develop into CD.

    Posted by slstanley1 |
  4. I was told my by Dr. that the bumps were a part of diabetes (and I thought myself - wacko mutant roseacea), not part of being a celiac sufferer (10 years). I have something else to ask my Dr at the next visit.

    Having European ancestry is becoming a hindrance with Rosecea and Celiac. Now with diabetes type 2 I have hit my medical Trifecta?

    Posted by joywinter |
  5. Hi joywinter,
    Actually, your “skin bumps” may still be due directly to your diabetes, and not necessarily your celiac. But either way, please ask your doctor about this at your next visit.

    Posted by acampbell |
  6. Hi slstanley1,
    There is a condition called gluten sensitivity that is similar to celiac in terms of its symptoms, but apparently doesn’t cause damage to the small intestine. Some medical professionals are doubtful as to the existence of gluten sensitivity. It’s true that symptoms of celiac don’t just appear all of a sudden. However, symptoms such as anemia, bloating, and diarrhea should be properly diagnosed by a healthcare professional, as these can be due to other health conditions. One doesn’t necessarily have gluten sensitivity or celiac just because these symptoms are present. If causes of these symptoms (including celiac) are ruled out, it’s certainly not harmful to go on a gluten-free diet, as long as it’s nutritionally-balanced. Again, if celiac disease is at all suspected, it’s important to get it properly diagnosed, especially before going on a gluten-free diet on one’s own.

    Posted by acampbell |
  7. Hi,

    I am a 61 year old female with Celiac Disease and Hepatitis C. Since last retested about a year ago, the Hepatitis has not progressed past stage one…knock on wood. The Celiac Disease was not diagnosed until I was put on Inferreron / Rivoviron treatment in my late 40’s for the Hepatitis, which I had to be taken off of due to the celiac which became full blown.

    Up until then the main symptoms I had was Dermatitis Herpetiformis and migraine like headaches that started in my 30’s which got more frequent and lasted longer as I got older; and I always had a bloated stomach until I was put on a celiac diet. The only medication that helps the headaches is Dihydroergotamine Mesylate Injection, USP commonly known as D.H.E. 45. It has to be taken inter-muscular as soon as I feel a headache coming on. I still get these headaches even though I adhere to a strict celiac diet but they seem to be getting a little less frequent with age.

    Now I have a new skin problem which is also related to the immune system called granuloma annulare. The dermatologists don’t have a cure only steroid cream which can thin your skin. Not a good thing on aging skin!! Also I just found out that I am borderline diabetic.

    I am trying an alkalizing diet with no sugar. I grind my own grains (millet, quinoa, flax seed, almonds, and sesame seeds) and add sea salt and water to make pancakes. I also drink ionized pure water with fresh lime and green tea. I was using soy milk for the pancakes but it has sugar in it.

    If you think any of these grains contain any danger please let me know.

    Thank you.

    Posted by owka4u |
  8. Hi owka4u,

    You certainly have had a lot on plate! Fortunately, millet and quinoa are gluten-free grains so feel free to enjoy them. Flax seed, almonds and sesame seeds aren’t grains and therefore don’t contain gluten, either. Best wishes for all of your efforts!

    Posted by acampbell |
  9. The quote you gave, that 1 in 250 people with type 2 diabetes also have celiac disease sounds correct to me. The problem? About 1 in 133 people have celiac disease. This would mean celiac disease is only half as prevalent among type 2 diabetics as the general population.

    However, the comparison is extremely misleading. Celiac disease is one of many gluten-caused autoimmune diseases. In my opinion type 2 diabetes, all type 2 diabetes, is a gluten sensitivity disease.

    Type 2 diabetes represents a direct attack by antigens which gluten gut permeability places into the bloodstream. The antigens mimic endorphin, and plug into pancreas transduction nerves, causing them to flood the blood with insulin.

    Type 1 diabetes has the same gluten permeability cause. In type 1 diabetes, the immune system responds by killing pancreas islet cells. In type 2 diabetes the immune system fails to respond. Like celiac disease, type 1 diabetes is an autoimmune disease. Type 2 diabetes is not.

    Posted by veggienft |
  10. Whoa! owka4u I’m keeping you in my prayers, You will do well and have a Great rest of your life! Hugs & Love!!!! If you ever fell like writing or talking, write me!!!!!!!!!
    Yeah Celiac disease sucks and all that goes with it! LOL It’s awful sometimes!…geeze I wonder G-d I can’t have this, what kinda freak of nature am I? I was such a naturalist 100% whole wheat lol! That’s probably what brought it to the suface when I trien to be “Totally Healthy” Everything was whole grain :) can’t do that, can’t eat this, want that, can’t have,,,,I forget, learning, nah, shouldn’t have that (Unless you wanna get sick-lol) The brusing, the diarrhea, the dermititis, then diabeties!, just trying to find something to eat sometimes is impossible…. It’s like you are starving, going into hypoglycemia, you can’t pull into a McDonald’s anymore….It’s fricken hard! Then (Tho I’m Thankful in my most desparate times for the lump in my throat rice bread) have you ever tried to eat gluten free bread or buns?! OMG! My husband tried one, he couldn’t hardly swallow it, then he couldn’t poop for a day lol! They can actually be okay if you are drunk lol! I have to try to make some of the bread myself, what I have bought so far has sucked! I did find a wrap I like!!! :) I’m not moanin’ about this, it could be worse-G-d forbid! We are here to learn life, we have to learn what we have to to do, to do Our Best for Our Selves, Our Families and Everyone else here :) But Plz, all I ask can I have some Freakin’ bread, that Tastes like bread!?! LOL! Oh! and…One more thing? While I’m wishing! A drive though, when I am hypoglycemic, I can pull in and get something to eat that is gluten free!!!!!!! Bithing and Moaning I guess we all feel we have to do it at times :) I just did, feel a bit better! Hope McD’s is listening!!!!! All the Best To Everyone here with this Celiac Disease! We can and Will Do It!!!!!!! We know “We Will Survive”!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Even if it tastes bad lol!!!!!!!!!! ;)

    Posted by Ranay |
  11. Thank you for your blog post. I am glad you went to that seminar and posted about it as well. I have Type 2 diabetes and was diagnosed with celiac disease six months ago. I knew there was a connection with Type 1 diabetes but the frequency in connection to Type 2 was a surprise and makes a lot of sense.

    Posted by Bet |
  12. I have had Type 2 Diabetes for over a decade, now I have Celiac disease, do I need to be concerned with Pancreatic cancer as the diabetes messes with the pancrease. I have IBS and have had polyps removed 5 times. Last two times, I have had mutated cells. There has never been anyone in my family diagnosed with Celiac, however my mother had colon cancer. Where does this leave me. I know the nurse said something about Pancreatic cancer as I was coming out of the anethesia the last colonoscopy

    Posted by Brenda S |
  13. Hi Brenda,

    To my knowledge, the main type of cancer that is linked with celiac disease is non-Hodgkins lymphoma. Having Type 2 diabetes does increase the risk for some types of cancer, including liver, pancreas and uterine cancers. You should talk with your doctor about your concerns, any screenings that you should have on a regular basis, and ways to lower your risk (which include actively managing your celiac disease and diabetes, controlling your weight, getting regular physical activity, and possibly taking certain medications, such as metformin).

    Posted by acampbell |

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