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Type 1 Diabetes and Addison’s Disease: What’s the Connection?

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Doctor holding sign saying Addison's disease -- Type 1 Diabetes and Addison’s Disease: What’s the Connection?
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Type 1 diabetes is considered to be an autoimmune disorder, which means that the body’s immune system attacks and destroys healthy cells and tissues by mistake. People who have type 1 diabetes are more likely to have another autoimmune disorder, as well, such as celiac disease, Graves’ disease or rheumatoid arthritis.

Another type of autoimmune disorder is Addison’s disease. You may not be that familiar with this condition, but the risk of getting Addison’s is significantly higher in those with type 1 diabetes compared to the general population.

What is Addison’s disease?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Addison’s disease “is a disorder that occurs when the adrenal glands don’t make enough of certain hormones.”

The adrenal glands are small glands that sit on top of each of your kidneys. They make two essential hormones: cortisol and aldosterone. With Addison’s disease, the adrenals don’t make enough of these two hormones. Here’s a bit more about cortisol and aldosterone:

∙ Cortisol: Also called the “stress hormone,” cortisol helps the body respond to stress, helps control blood pressure, blood sugar and metabolism, and reduces inflammation.

∙ Aldosterone: This hormone keeps a balance of sodium and potassium in the blood, which, in turn, helps to maintain blood pressure. Sodium and potassium also help nerves and muscles function properly.

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Addison’s disease, which is also called primary adrenal insufficiency, can occur due to a number of factors:

· An autoimmune response

· Injury to the adrenal glands

· Infection, such as tuberculosis and HIV/AIDS

· Cancer

· Surgical removal of the adrenal glands

· Amyloidosis

· Genetic defects

How common is Addison’s disease?

Addison’s disease is pretty rare. In the United States, it’s estimated that 1 in 100,000 people have this condition. Women are more likely than men to develop Addison’s disease, and it occurs most often in people between the ages of 30 and 50.

According to research published in 2018 in The Journal of Clinical Endocrinology & Metabolism, while the incidence of Addison’s disease in those with type 1 diabetes is pretty low, the risk of developing Addison’s disease is more than 10 times higher in people with type 1 diabetes compared to the general population.

What are the risk factors for Addison’s disease?

There are several risk factors for the “autoimmune type” of Addison’s disease. These include:

· Type 1 diabetes

· Graves’ disease (also called overactive thyroid)

· Chronic thyroiditis (inflammation of the thyroid gland)

· Dermatitis herpetiformis (an itchy rash with bumps and blisters)

· Pernicious anemia (not enough healthy red blood cells)

· Myasthenia gravis (a condition that affects nerves and muscles)

· Vitiligo (loss of color, or pigment, from areas of the skin)

What are the symptoms of Addison’s disease?

For the most part, symptoms of Addison’s disease develop gradually over the course of several months. That’s because damage to the adrenal glands usually develops slowly. For this reason, you and/or your healthcare provider may attribute your symptoms to other causes or issues.

The most common symptoms of Addison’s include any of the following:

· Abdominal pain

· Nausea and/or diarrhea

· Loss of appetite and weight loss

· A craving for salt or salty foods

· Feeling very thirsty

· Lightheadedness or dizziness when standing up

· Irritability

· Feeling extremely tired

· Muscle or joint pain

· Depression

· Low blood pressure

· Low blood sugar

· Darkening of the skin, or darkened lips or gums

· Loss of body hair

· Sexual dysfunction in women

Because there may be other reasons for the above symptoms, such as uncontrolled high blood sugars, for example, you may not seek medical help for them. However, an injury, illness or a time of intense stress can cause symptoms of Addison’s to appear suddenly. This is called acute adrenal failure, or Addisonian crisis, and if not treated immediately, can lead to life-threatening shock. Get medical help immediately if any of the following symptoms occur:

· Severe weakness

· Confusion or fear

· Sudden pain in your lower back, stomach or legs

· Fever

· Feeling faint or losing consciousness

How is Addison’s disease diagnosed?

Having any of the symptoms above should prompt you to see your healthcare provider. Be sure to let him or her know about all of your symptoms. Your provider should do a physical exam and order blood work. If Addison’s disease is suspected, you will have labs that measure the amount of sodium, potassium, cortisol and ACTH (adrenocorticotropic hormone). ACTH stimulates the adrenal glands to produce cortisol. You might also have antibodies measured, as well.

The presence of Addison’s disease will likely show high potassium, low sodium, low cortisol, low pH, and a high eosinophil count, which is a type of white blood cell. Blood pressure may be low, especially when going from a sitting to a standing position.

Other tests may be ordered, too, such as:

· Imaging tests: An X-ray or CT scan of your abdomen to check your adrenal glands, and an MRI of your pituitary gland may be ordered to determine if you have another type of adrenal insufficiency.

· ACTH stimulation test: You may be given an injection of synthetic ACTH to see how much cortisol is made by your adrenal glands.

You have Addison’s disease – now what?

Addison’s disease, like type 1 diabetes, is treated with hormone medication. Remember that Addison’s disease means that the body isn’t producing enough of steroid hormones, so you will need to take hormones that are similar to what the adrenal glands make.

Specifically, treatment of Addison’s consists of taking oral forms of these steroids:

· Hydrocortisone, prednisone or methylprednisolone to replace cortisol

· Fludrocortisone acetate to replace aldosterone (if you’re lacking in aldosterone)

You will need to take medication for life, and it’s important that you don’t miss any doses of your medication; missed doses can lead to Addisonian crisis.

In addition, you will need to be prepared to:

· Carry a medical alert card or wear a bracelet to alert medical personnel that you have Addison’s disease.

· Have a glucocorticoid injection kit available, which contains an injectable form of corticosteroids in case of emergency. Make sure someone close to you knows when and how to give you an injection.

· See your provider regularly. An endocrinologist who helps you manage your diabetes can also help you manage Addison’s.

When the weather is hot and humid, and/or if you exercise heavily or have diarrhea, you will likely need to make sure you get plenty of sodium (salt) in your diet.

Stress management is important for everyone, but it’s especially important if you have Addison’s. Life events, such as the death of a loved one or losing your job raise your stress level and can affect how your medications work. Make time in your schedule to “de-stress.” Exercise, practicing yoga or meditation, or using deep breathing are all ways to lower stress levels.

Speaking of stress – if you experience any type of stress in your life, such as an injury, illness or a death, let your healthcare provider know right away. You may need a dose adjustment to your medication.

Possible predictors of Addison’s disease

Because of the higher risk of Addison’s disease among people with type 1 diabetes, Swedish researchers wondered if there might be telltale signs and symptoms to alert healthcare providers. In a study of 36,515 adults with type 1 diabetes, 66 patients also had been diagnosed with Addison’s disease. The researchers observed that, compared to the control group (the people without Addison’s):

· There was no difference in hemoglobin A1C levels (HbA1c; a measure of glucose control over the previous 2–3 months).

· The patients with both conditions had a greater frequency of infections requiring hospitalization.

· The patients with both conditions had more prescriptions for thyroid medication and glucagon.

· They also had a higher frequency of diabetic retinopathy.

The researchers published their findings in The Journal of Clinical Endocrinology & Metabolism in 2018. Their conclusions? Healthcare providers should suspect possible Addison’s disease in a person with type 1 diabetes who has had more infections requiring hospitalization, has more prescriptions for thyroid medication and glucagon, and/or who has diabetic retinopathy.

Keep in mind that the presence of these factors does not definitively predict the presence of Addison’s disease; more research is needed to explore these findings further.

More information about Addison’s disease

To learn more about Addison’s disease, get support, or learn about clinical trials, visit the following websites:

· National Adrenal Diseases Foundation (NADF)

· National Organization for Rare Disorders (NORD)

Want to learn more about type 1 diabetes? Read “Type 1 Diabetes Questions and Answers,” “Six Type 1 Diabetes Symptoms You Need to Know” and see our type 1 diabetes videos.

Amy Campbell, MS, RD, LDN, CDE

Amy Campbell, MS, RD, LDN, CDE

Amy Campbell, MS, RD, LDN, CDE on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

 

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