Celiac disease and Diabetes
The link between type 1 diabetes mellitus and celiac disease was first established in the 1960s. The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 8%, and about 1% in the general population. Most patients with both conditions have asymptomatic celiac disease, or symptoms that may be confused for symptoms of their diabetes. For this reason, and the significantly higher prevalence rate of celiac disease in diabetes patients, many doctors recommend getting screened for celiac disease after a diagnosis of type 1 diabetes, as well as celiac patients getting screened for type 1 diabetes.
A recent study in 2013, contributed to by Dr. Peter Green, a member of Celiac Disease Foundation’s Medical Advisory Board found that there were no standard uniform practices for screening type 1 diabetes patients for celiac disease. Of the facilities in the study that did screen for celiac disease, 60% of them only did so if there were symptoms present. The authors of the study suggested that a uniform protocol for screening should be in place, as well as a need for further education on the gluten-free diet in patients with type 1 diabetes for dietitians.
There is no established link between type 2 diabetes and celiac disease. Type 2 diabetes does have genetic components, but they are not associated with celiac disease genes.
The gluten-free diet may improve glycemic control for diabetic patients, although that is still controversial, as some studies support the idea and others suggest there is no difference in glycemic control between normal diabetic patients and diabetic patients with celiac disease on a gluten-free diet.
Untreated celiac disease, leading to a damaged small intestine, can increase risk of hypoglycemia because the small intestine may no longer be able to absorb nutrients such as sugars properly, making diagnosis even more imperative.
Many individuals diagnosed with type 1 diabetes only discover they have celiac disease through routine screening because of the known relationship between the two conditions. Most report having no symptoms of celiac disease, and that the diagnosis is sometimes seen as an after-thought to the diabetes. Whether or not individuals have symptoms, if a celiac disease diagnosis is confirmed, it is absolutely essential to follow a strict gluten-free diet to avoid the same health. Perhaps most important is that the earlier a gluten-free diet is initiated, the lower the chances are of a person developing additional autoimmune disorders.
It can be very difficult to evaluate the effectiveness of a gluten-free diet in a person without obvious symptoms, and equally as difficult for that person to find the motivation to strictly follow it. Follow-up care with your physician is essential in these cases for monitoring blood antibody levels for celiac disease; a follow-up endoscopy may be indicated to confirm that intestinal healing has occurred. Weight gain or loss, fatigue, neuropathy, and gastrointestinal problems can all be related to either celiac disease or diabetes, so it can be difficult to differentiate between the causes without probing further with your healthcare providers.
General Guidelines and Advice
Work with a knowledgeable and credentialed dietitian (registered dietitian and/or certified diabetes educator). You may get the most personalized advice and successful life changes from working one-on-one with someone you trust.
Many gluten-free flour substitutes are much higher in carbohydrate content than their gluten-containing counterparts. Gluten-free products may be highly refined and contain added sugars or starches to mimic the mouth-feel and texture of gluten.
Additional insulin and/or smaller portion sizes may be necessary to counteract these effects when enjoying such products.
Some gluten-free alternatives are made with very low-carbohydrate substitutes, and thus standard carbohydrate counts are not appropriate. Administering standard estimations of insulin may result in dangerously low blood glucose levels. Instead, read ingredient labels when possible for carb counts, or count the food as a vegetable that is very low in carb and correct with insulin at the next meal if your estimation was too low.
Example: cauliflower “mashed potatoes” or pizza crust
Example: almond flour cookies or bread
Always keep gluten-free carbs on-hand for managing blood glucose in instances where gluten-free foods may be difficult to find.
For the average person with celiac disease, a salad may be a reasonable option at a restaurant that doesn’t have a gluten-free menu. However, for someone with both diabetes and celiac disease, a salad comprised only of vegetables, meat, and dressing is likely too low in carbohydrate to meet standard meal recommendations for carbohydrates. Always come prepared with additions, or use a beverage (like a smoothie or a latte) as your source of carbohydrate if necessary.
Non-perishables like granola bars, protein bars, crackers, meal supplement drinks, and dried soybeans are great to keep in your car, pocket, or purse.
Advise a manager or authority of your medical needs if you need to eat in an establishment that prohibits outside food and cannot accommodate your gluten-free needs. Keep a doctor’s note on-hand for places like the airport, movie theaters, sporting games, conference centers, and amusement parks
Follow general dietary advice for health on a gluten-free diet to maximize the nutritional quality of your carbohydrates. Whole grains and unrefined, unprocessed complex carbohydrates will deliver maximum health benefits while helping you to maintain your blood sugar.