Celiac disease is a digestive disorder that appears to be more common in people with type 1 diabetes than in the general population.
Celiac disease is found in 4 to 9% of children with type 1 diabetes but, 60 to 70% of these children have no symptoms (‘silent’ celiac disease). Children with type 1 diabetes are at increased risk for celiac disease during the first 10 years of diabetes.
Celiac disease is an autoimmune condition in which the body cannot handle gluten – a protein found in wheat, rye, barley and triticale. Gluten is widely used in the production of many processed and packaged foods.
If you have celiac disease and eat food with gluten, your immune system responds by damaging the small intestine and preventing your body from properly absorbing nutrients from food, including protein, fat, carbohydrates, vitamins and minerals.
Celiac disease is an inherited condition. First degree relatives (parents, brothers, sisters and children) of people with celiac disease are at the highest risk of having unrecognized celiac disease and it can appear at any time in their life. Environmental factors such as emotional stress, pregnancy, surgery, or an infection (e.g., travellers’ diarrhea, pneumonia) can sometimes trigger the onset of symptoms.
Many people with celiac disease don’t have any symptoms at all, which is why the disease is often undiagnosed. In people who do experience symptoms, they can vary from obvious digestive problems such as severe diarrhea to more vague emotional or behavioural symptoms (the latter are especially common in children).
These are some of the more common symptoms:
- Recurring gastrointestinal symptoms such as:
- Abdominal pain, cramps, bloating
- Indigestion and nausea
- Chronic diarrhea and/or constipation
- Foul-smelling stool
- Poor weight gain
- Anemia – iron, folate or B12 deficiency
- Extreme weakness and fatigue
- In people with type 1 diabetes, unexplained frequent low blood sugar (hypoglycemia)
- In some people, the development of an intense burning and itching rash (dermatitis herpetiformis)
- Canker sores
Additional symptoms in children:
- Delayed growth
- Irritability and behavioural changes
- Delayed puberty
- Dental enamel abnormalities
Diagnosing celiac disease
Small intestinal biopsies are the ONLY definitive means of diagnosing celiac disease. A gluten-free diet should not be started before the blood tests and biopsies are done, since it can interfere with making an accurate diagnosis.
Excellent blood tests are available to screen for celiac disease. These tests detect antibodies that cause celiac disease - endomysial (EMA) and tissue transglutaminase (tTG). Such tests may suggest that a person has celiac disease, but they do not replace the need for an intestinal biopsy.
Without treatment, celiac disease can lead to malnutrition, anemia, osteoporosis, infertility and, in people with type 1 diabetes, recurrent episodes of low blood sugar.
The only treatment for celiac disease is a strict adherence to a gluten-free diet for life. This means completely avoiding products that contain gluten, including bread, pasta and most baked goods. Some medications also include gluten; be sure to tell your pharmacist if you have celiac disease. You may also need to take a daily vitamin supplement.
A dietitian can help you learn how to select food, read labels and create a healthy meal plan. If possible, ask to see a dietitian who also specializes in diabetes. A gluten-free diet will affect your carbohydrate options, which may impact your blood sugar levels. You will need to carefully monitor your blood sugar levels and adjust your insulin doses as you change your eating habits.
If you have diabetes, you are already very aware of what you eat. Adjusting your meal plan for celiac disease may initially seem like a double burden, but you will soon notice an improvement to your overall health.
For more information, please visit the Canadian Celiac Association.
Managing other medical conditions
Many people living with diabetes also deal with other medical conditions. Your health-care team will provide the right advice for you. These links can provide additional support and information.