Celiac Disease and Diabetes

Diabetes Canada and the Canadian Celiac Association are pleased to present this special collaborative webinar for individuals living with and impacted by type 1 diabetes and celiac disease, featuring Nicole Byrom, Brooks Roche, and Emily Kewell. We will be discussing the connections between celiac disease & type 1 diabetes, and key steps you can take for screening & management. Diabetes Canada and the Canadian Liver Foundation are delighted to present a special webinar for individuals living with and impacted by diabetes and liver disease, featuring Dr. Mary Anne Doyle and Dr. Mark Swain. We will define and explore liver disease, its relationship with diabetes, and steps you can personally take to identify and mitigate risk.

welcome everyone uh thank you for being

here my name is brooks roach i'm a

diabetes education specialist with

diabetes canada and uh i'd like to

welcome you and begin by acknowledging

that i am joining this webinar from

traditional and unseated territory of

the migmat people in prince edward

island or ethiques

so wherever you are joining or watching

from i invite you to express gratitude

and reflect on the land on which we live

and

acknowledge the past inhabitants of

these indigenous lands

i am so personally and professionally

excited to welcome you to this really

exciting collaboration between diabetes

canada and the canadian celiac

association

and i'd like to sincerely welcome our

guests from the cca who i will head over

to youtube

hi brox thanks so much for having us

today my name is nicole byrum i'm a

dietitian and health promotions manager

with the canadian celiac association and

i'm coming to you today from rainy and

wet on north vancouver

awesome and my name is emily and i'm the

dietetic and intern at the canadian

celiac association i'm a graduate

student at the university of guelph

currently completing a master of applied

nutrition on route to becoming a

registered dietitian

and today i am joined joining you from

guelph ontario

okay thank you so much for being here

and i will

happily head it over to nicole to walk

us through

some information and answer some some

key questions around the connection

between celiac disease and type 1

diabetes

okay well thank you so much today for

this opportunity this is such a um a

learning experience i think for all of

us so i'm going to share my screen now

and just go through my

uh presentation that we've got prepared

for you so bear with me for two secs as

i share the screen and get it just set

up here

brooks you need to give me

permission to share my screen

okay bear with us everyone

it is not a webinar without some sort of

zoom malfunction

life living uh living life now in the

postpartum world where everything is on

on computers

we go thank you so much

all right

here we go everybody see that okay

you can see that okay yeah yeah you're

good

okay so as mentioned we are uh my name

is nicole byram and i'm from the

canadian celiac association

i'm gonna um

just

okay so what is celiac disease so celiac

disease is a common disorder that is

estimated to affect about one percent of

the population

it is a condition in which the

absorptive surface of the small

intestine is damaged by a substance

called gluten

gluten is a group of proteins presented

present in wheat barley and rye and

their cross-fed grains

celiac disease is an autoimmune disease

and not a food allergy as many may think

here you can see the visual

representation of villis atrophy that

occurs in those with undiagnosed or

newly diagnosed celiac disease

this slide demonstrates the effects of

damage over time on the intestinal

lining you can see how the absorptive

surface becomes flattened and have less

surface area available to absorb

nutrients

here you see at zero we have a normal

intestinal lining and with each new

phase comes further mucosal damage

hindering nutrient absorption as the

stages progress and damage continues

as mentioned in the previous slide

celiac disease is not an autoimmune

disease therefore requiring gluten-free

foods is not a choice

this is not a fad diet and people are

not choosing to be on this celiac

disease is a serious lifelong commitment

with serious health complications

associated with the consumption of

gluten

damage leads to a variety of symptoms

and can result in the inability of the

body to absorb protein fat carbohydrate

vitamins and minerals

as i mentioned celiac disease is an

autoimmune disease

as such celiac disease can run in

families for example my family

in my family my mother and daughter both

have celiac disease and in addition my

husband his sister and his niece have

all been diagnosed

we are living proof of the genetic

predisposition of celiac disease

if you have a first degree relative with

celiac disease you should be screened

for people with no family members with

celiac disease the incidence of

diagnosis is about 1 in 100 and for

those with a first degree family member

the risk increases to about one in ten

i'm now going to introduce you to emily

cuell a dietetic intern working with the

cca emily is going to go over diagnosis

and treatment of celiac disease with you

now

diagnosis of celiac disease happens in

two steps the first step is screening

screening for celiac disease occurs

through a serological test otherwise

known as a blood test

this test will look for elevated levels

of the iga tissue

transglutaminase or ttg antibody

it is important to remember that during

screening individuals must be eating

gluten

if we have celiac disease gluten intake

will trigger ttg antibodies and this

will be visible in our test results

the second step involves a small

intestinal biopsy or possibly a skin

biopsy in the case of dermatitis

herpetiformis which is celiac disease of

the skin

a biopsy is performed by a

gastroenterologist

using a tool known as an endoscope

your doctor will take samples using the

endoscope to identify if there is damage

to the small intestine

this procedure takes around 30 minutes

and is not painful

a diagnosis of celiac disease

must be confirmed by a biopsy

unfortunately there is no cure for

celiac disease

treatment involves following a strict

and lifelong gluten-free diet

since this type of diet is restrictive

it is important that individuals

following a gluten-free diet receive

nutrition education from a trusted

professional

registered dietitians who are trained in

celiac disease can help individuals

ensure they are meeting their

nutritional needs while enjoying their

meals and following a gluten-free smile

while learning the ins and outs of a

gluten-free diet can be challenging the

canadian celiac association is here to

help we are a trusted organization that

provides canadians with an abundance of

free and accessible resources on celiac

disease the gluten-free diet and other

dietary considerations

it is estimated that approximately one

percent of canadians have celiac disease

this is close to 350 000 canadians

however we suspect that this number is

actually much higher

why is this

well

approximately 2.2 to 5 million canadians

are at risk of celiac disease or

gluten-related disorders

on top of this risk it takes an average

of around 10 years to get diagnosed with

celiac disease

celiac disease is common all over the

world and its prevalence is only growing

in fact canada has had an increase of

around 35 percent in celiac disease

prevalence over the past decades

which is the greatest increase recorded

due to the higher risks of celiac

disease in many populations and a

lengthy diagnosis period it is estimated

that 85

of canadians with celiac disease are

undiagnosed

this is a huge proportion of individuals

who are suffering and potentially

sustaining long-term damage to their

health

the best way to improve this number and

advocate for your health is by simply

getting tested for celiac disease

okay thank you nicole ambly and i think

now we're going to veer a little bit

into the type 1 diabetes realm and

what we'll hear about next is actually

how these two are related but type 1

diabetes in essence is an autoimmune

disease so once again the distinction

here is is type 1 diabetes makes up

about 10

of uh cases of diabetes so um the vast

majority being type two and a small

minority also being gestational diabetes

but what we're talking about

specifically is type one um so this is

essentially where the immune system

reacts against the beta cells of the

pancreas which are they have the the

intent of producing insulin uh insulin

is a hormone as as many of our viewers

know that it helps to control the level

of glucose or sugar in the blood

so if a person lives with type 1

diabetes like myself they need to inject

or pump insulin subcutaneously

to regulate their blood glucose and

again as many of our viewers may know

blood glucose is not just impacted by

food it's a multitude of factors food

exercise sleep stress

uh sometimes it feels like the weather

has an impact on it um and it's

essentially this is

you know

a common myth that we actually encounter

and this is again to the point of it

being a really difficult to the point of

celiac disease being a long-developing

disease with a lot of complexity in it

generally speaking type 1 diabetes does

develop in childhood or adolescence but

it can develop at any time because by

its nature it is an autoimmune disorder

um and there's a lot of misconception

around this being somehow caused by an

individual or curable or or easily

treatable it's a again like celiac

requires

lifelong lifestyle interventions

nicole

mute alert

thank you

um i'd like to introduce you now to

annie pettigrew annie is 16 years old

and is a youth ambassador and national

youth champion for the juvenile diabetes

research foundation of canada annie has

done a lot of work in advocacy and

government relations for the jdrf

annie is living with both celiac disease

and type 1 diabetes we'd like to share

her story with you now

my name is ann pettigrew i was diagnosed

with type 1 diabetes almost five years

ago on january 31st 2017.

when i was diagnosed with type 1 i

remember my mother saying in an attempt

to comfort me that at least i didn't

have celiac

i mean i had to have an insulin shot at

every meal sure but at least i could eat

what i wanted

my diagnosis of type 1 definitely made

me think about food a lot more and it

made me more grateful than ever that i

could choose what i wanted to eat

then two years and six months later to

the day i was diagnosed with celiac

disease

it was something i never saw coming

something i never thought to worry about

i didn't know that having type 1 had put

me at higher risk for celiac

but i had known for months before i was

diagnosed that something was wrong

my energy levels gradually declined to

the point where i got breathless walking

up the stairs

everything was exhausting

no amount of sleep made it better

i became aware of how tired i was in

april but i didn't get blood work done

until july so i wasn't diagnosed until

july 31st 2019

it felt like the end of everything

my heart broke for everything i was

losing

my freedom

my control

my independence

which i still have memorized because it

was just that good six inch pizza sub

toasted on italian red with lettuce and

needing 1.5 units of insulin to cover it

for me personally

perfection

and gone

so much was gone and so quickly

and then three weeks later my heart

broke again for my little brother

christopher who was also diagnosed with

celiac

i honestly cried harder for him than i

did for myself

together we said goodbye to the things

we had to leave behind

into a lot of traditions that had

centered around that

it was hard

and it took time

it's still taking time

but two years later we're finding new

traditions and we're looking forward and

we're not taking a minute of it for

granted because we know all too well how

quickly something can disappear

nobody in my family has type 1 except

for me nobody else is celiac except for

we're the first

and hopefully the only

with our new traditions new lifestyle

both being centered around our

gluten-free diet we're thankful for how

far things have come in terms of

gluten-free options

it comes so far from even just two years

ago and new gluten-free alternatives are

coming out all the time so we really do

have a lot to look forward to

the hardest part about managing the

gluten-free diet for us personally is

actually not the food itself but just

making sure that there's no

cross-contamination with gluten

sometimes people just don't understand

how serious it is

with type one too and i didn't

understand either before i was diagnosed

it's why raising awareness for celiac

and for type 1 is so important because

it will only lead to increased

understanding of both diseases

so when people don't understand you have

to be your own advocate

you have to do what you know is best for

you and that can be hard but you have to

believe in your strength

on the hardest days you have to believe

in your strength

if you think you might have celiac but

you're scared to find out for sure or if

you've just been diagnosed it feels like

you've lost everything you have to

believe in your strength and ability to

get through it because you can and you

will

things will get better you are not alone

as someone who has had two life-changing

diagnoses i know how completely awful it

feels to not be in control

but i got it back

and you will too

with the support of friends

family and other people in the celiac

and diabetes communities we're all here

and we all get it

and the canadian celiac association and

diabetes canada are here for us to

keep your head up and stay strong

thank you

i want to thank annie for sharing her

stories

with our communities

i know that each one of us watching

today has our own story to share as well

and as annie said i want to remind

everybody that both the canadian celia

association and diabetes canada are here

to support you and help you in with any

of those needs so please do reach out

so what is the connection between celiac

disease and type 1 diabetes

why have we come together today to

discuss these otherwise apparently

different diseases

or are they so different

here are some facts

both celiac disease and type 1 diabetes

are autoimmune diseases with shared

genetic components

both celiac disease and type 1 diabetes

worldwide incidents are increasing

this suggests that not only do genetic

factors play a role but also

environmental factors

the prevalence of celiac disease and

those with type 1 diabetes is 5 to 7

times higher than the general population

telling us that those diagnosed with

type 1 diabetes

are at increased risk for developing

celiac disease

diet plays a very important role in the

management of both of these diseases

research has shown us that people with

type 1 diabetes when diagnosed with

celiac disease are often asymptomatic

or if symptoms do present they may be

mild in addition some people with type 1

diabetes who have been undiagnosed with

celiac disease will reference

unexplained hypoglycemia as a primary

symptom

this slide demonstrates how celiac

disease and type 1 are genetically

predisposed

but also have an environmental component

this slide also shows that those living

with type 1 diabetes are increased risk

for developing celiac disease however

the inverse relationship does not appear

to be true

those with existing celiac disease do

not appear at this time to be at higher

risk for developing type 1 diabetes

an example of genetic links with both

celiac disease and type 1 diabetes are

shown here

here we examine identical twins

for identical twins where one has celiac

disease the likelihood of the other to

develop the disease is 75

for identical twins with type 1 diabetes

the likelihood of developing type 1 is

42 percent when one

identical twin presents with the disease

this demonstrates that genetics play a

large role in the development of both of

these diseases

on the next two slides i will run a few

comparisons between type 1 diabetes and

celiac disease

here we have some interesting facts

we know the causative agent for celiac

disease this is gluten if you never

introduce gluten into your diet you

won't develop celiac disease

we have not found one

for type 1 diabetes however although

viruses and environmental factors are

suspected and are being examined as

possible causative agents

the clinical presentation of both

diseases vary

celiac disease symptoms may appear

before

histological damage has began

whereas with type 1 diabetes symptoms

appear later in the disease progression

we know that there are overlapping

genotypes in both of these diseases

type 1 diabetes and celiac disease share

some certain common symptoms

this makes diagnosis difficult for some

people with type 1 diabetes as symptoms

overlap they can mask symptoms of celiac

disease and make them appear silent

these overlapping symptoms include

weight loss fatigue reduced bone density

and growth failure

is it also it is also noted that for

those with type 1 diabetes recurrent

hypoglycemia is a common symptom of

celiac disease

i will note one difference diagnosis for

celiac disease can be made at any age

previously working in long-term care

i saw people diagnosed into their 80s

and as a mother who had a daughter

diagnosed at five and a mother diagnosed

in her late 50s and a husband diagnosed

in his 40s i've certainly seen that this

is true

type 1 diabetes peak incidence is in

early adolescence however as brook

mentioned before

it can be diagnosed at any time as well

worldwide incidence for both diseases is

approximately one percent

so all of this being said what do we

recommend

it is suggested that for those living

with type 1 diabetes of all ages who

have symptoms suggestive of celiac

disease be tested regardless of previous

celiac disease screening

remember that unexplained hypoglycemia

may be a symptom of celiac disease

an iga level is recommended as part of

your blood work to rule out an iga

deficiency

now if you have an iga deficiency the

results from your celiac screen can be a

false negative

so be sure to ask your doctor to add

that in

of note most pediatric type 1 diabetic

patients who develop celiac disease

sorry

we'll do so within the first five years

of diagnosis

although celiac disease in adults is

also well recognized

so what's the bottom line

get tested

we suggest that you be tested for celiac

disease when you're first diagnosed with

type 1 diabetes

and annually thereafter for the next

four years

here it gets a bit complicated

after this time you can decrease your

testing frequency to every two years and

do this for the next six years

we suggest you be tested

at any point in time in your lifetime if

you do present with with symptoms

thank you so much to everybody for

watching us today now we have time for

some questions

hey fantastic and thank you both um

nicole and emily for for walking us

through um

i always find it fascinating to learn

just how interconnected the web of

let's call it comorbidies or or how

in this case type 1 diabetes connects so

closely with celiac disease um so we

would like to open floor two questions

so anyone who is watching on facebook

please do feel free to

submit your questions in the chat

and we'll be happy to answer them and

and one that um

you know i'm curious about and i'm

wondering if uh nicole and or emily you

could provide some perspective on this

and it's

you know we we hear a lot about these

sort of this is broadly what the

symptoms look like or this is

um you know when there's a lot of

overlap for example in how symptoms show

up or the fact that this

celiac disease takes so long to to

diagnose i'm curious in you know maybe

nicole in your professional experience

um what should folks look out for as

just sort of

personal

this the feeling that they should look

out for what are what are symptoms on in

the at the real individual scale that

folks might look out for

as a warning sign or that you've seen at

the point of diagnosis

so it's interesting i mean there's i

think there's noted to be about 300

symptoms of celiac disease and they're

very very individual

so for example just from my own personal

family my daughter presented with severe

skin rashes an upset tummy bloated heart

upset tummy my husband who

is a firefighter presented with

dizziness and he was actually really

concerned before he was diagnosed with

celiac disease as to why he was having

these dizzy spells and if it would

affect his career

so was quite happy uh when he was we

found a cause of these dizzy spells that

was his primary symptom

my mom lost an incredible amount of

weight before she was diagnosed she

dropped about 20 pounds over a year and

had no idea why

so presentation of symptoms varies

certainly the gi symptoms are the most

obvious

people who have

upset stomachs bloating gas diarrhea

constipation those ones are are kind of

what we call the typical symptoms our

more atic typical symptoms we see things

like increased liver enzymes uh we see

anemia we see osteoporosis osteopenia so

bone loss um increased risk of bone

fractures so young people in their 40s

having frequent fractures

sometimes that will be

that will be seen in children we see

delayed delayed growth we see delayed

puberty we see um dental enamel defects

so the the

you know we've got something that um you

know we call

the celiac iceberg and if you think of

an iceberg the tip of the iceberg is

above the water and that is about the

people who we have actually diagnosed

the rest of them are under the water the

ones above are with the more obvious

symptoms and the ones the lower with the

more atypical

symptoms so the symptoms vary

and

if you do wonder about celiac disease we

do have a symptom checker on our website

and our website is www.celiac.ca

and on there you can look up our symptom

checker and go through that and see if

maybe you should be tested

yeah that's fantastic and i think

um we do have a question uh so i'll pose

it to you folks and it's

can changes in the blood sugar um

the

can changes in blood sugar uh or trends

be connected to

this combination of celiac and type one

so basically looking at you know you

would mention this this prevalence of uh

hypoglycemic events in in folks who live

with

celiac

does this show up as sort of a change in

trend or if folks are noticing something

that feels dramatically off might that

be uh

a sign of comorbidity

yeah so certainly um you know when we

look at the science

it's showing that unexplained

hypoglycemic events

are one of the fact are one of the

risk factors for celiac disease so if

you're finding that trend then that is a

is a reason to go in and get screened

we're not we have another opposite

direction sorry okay

um there's another question

what percentage of people with type 1

diabetes have celiac disease and this is

you know i can speak to this and it's

that's because the it's about six times

the the likelihood as we were discussing

in preparing for this webinar nicole so

overall in the population

about one percent of the general

population lives with either condition

but if someone lives with type one

about six percent of that population

does live with celiac so it's it's about

six times increased likelihood of

developing celiac in the event that

person lives with type one so uh

short answer six percent of people with

type 1 have celiac

uh another question is wondering around

is there an effect on carbohydrate

absorption with celiac disease

so certainly if you look at if you think

back to the slides that we presented and

i like to describe the gut you know in

kind of layman's terms

if you think of the gut as

a shag carpet right and you've got all

of these

the villi

and you've got a lot of absorptive

surfaces so a healthy gut is like a

really good shag carpet where there's

lots of surface area for all of our

nutrients to absorb

over time those get dulled down and

blunted

and so what happens is we see lactose

intolerance so one of the first symptoms

because lactase lives at the end of the

villi and so when those get dulled down

often we see people have lactose

intolerance so if you do find that's

another symptom to look out for if you

do find that you're becoming lactose

intolerant that's something else that

could be triggering

possibly to go and get screened so over

time these get blunted down and and

eventually as you would have seen in

slide four it becomes more more smooth

because it's been really

really glued down so everything is is

being poorly absorbed at that point

um so this could be

um one of the reasons for that

hypoglycemia because things are not

getting absorbed in so yes that would be

one of the concerns

thank you and that is fascinating the

the metaphor of the shag carpet is is a

really helpful one i don't know if i've

ever heard that from really good shag

carpet before maybe i'll see more on but

it might be

and then and then the linoleum is stage

four generally that's what i say it goes

from shag carpet to linoleum so an

equally

sixties reference

um there's someone wondering about

long-term effects of of undiagnosed

celiac in type 1. so wondering

specifically if someone does live with

type 1 diabetes and they haven't

identified that they also lip celiac

what can that lead to over the longer

longer term yeah so

the risks would be the same as for

somebody uh

i i'm going to just i can speak to the

risks for somebody

without um with long-term undiagnosed

celiac disease i'm not sure i'm assuming

that the relationship with type 1 would

be the same for long-term effects

so certainly we look at

the big ones which are in our anemias so

iron deficiency anemia so exhaustion

fatigue

osteoporosis is the other really big one

and then certain types of cancers is the

other one

okay

um we have someone who's wondering

if celiac disease can contribute to

sensitivities to other foods

as i mentioned definitely we see it with

lactose intolerance

so for somebody with with celiac disease

or early early early stage celiac

disease or undiagnosed celiac disease we

see dairy intolerance quite a bit

because of that lactose and because that

lactase enzyme which which digests

lactose in dairy products is missing or

or diminished we see an intolerance

often to to dairy products

as for other food intolerances

definitely across the board different

people have different experiences but

darius darion lactose

is the big one for our our community but

certainly individual people will have

other experiences

it it's really fascinating to

explore i think just again just how far

this reaches you know from one disease

into into another how different

conditions tend to overlap

um i'm not seeing any more questions but

before we wrap up i would just like to

ask each of you

if there's anything else that you'd

really like to to share or leave

viewers with you know if folks left with

one one new piece of information what

might it be

um i think i would like to speak to

vitamin sorry i'm trusting button here

i'd like to speak to vitamin d just

slightly so vitamin d deficiency is

another one that we see in our community

quite often during you know at diagnosis

my daughter

is was vitamin d deficient continues to

be vitamin d deficient my husband was

also noted to be vitamin d deficient now

vitamin d deficiency across most

canadians is common purely based on our

latitude so

we cannot absorb vitamin d from the sun

between the months of october and may

the angle of those sun's rays don't

allow they're not strong enough to allow

our body to convert vitamin d2 to its

active form d3 which is what we need so

we are often recommending and as a

dietitian we consistently recommending

to the to the canadian population to

supplement with vitamin d

so this rate this is true also for our

celiac population

who often go into this with a deficiency

so what does that supplementation look

like for adults it's about 800 to 1000

ius a day

and for children it's more like 400 to

800 ius a day so between the months

again of october and may we we

suggest if you're not getting enough

through the diet and it can be hard to

get vitamin d in the diet

milk of course is fortified

some orange juices are fortified you can

get vitamin d and salmon bones emily

what am i

forgetting eggs have a little bit of

vitamin d in them did you say margarine

our drink can be fortified so often in

in our foods we've we've developed

fortifications specific to the canadian

to canadian needs for example iodine is

fortified into table salt for specific

needs for thyroid um so vitamin d for

our population

is recommended to be to be if you're not

getting enough in your dietary sources

and you're not outside in the sun

throughout may to october so when you

think well our typical way of getting

vitamin d is through sunshine we go

outside um

but quite often now we're covered in

sunscreen we're wearing hats or we're

working indoors so we're not getting

what we used to get when we were outside

people were more

you know historically people were

gathering food working in fields getting

that sunshine because that vitamin d is

a fat soluble vitamin

so it would store through the winter

whereas now we're not getting those

stores built up through the summer and

so we're suggesting more supplementation

through the winter so something

certainly for both of our communities to

focus on

and then the next thing of course would

just be if you do have any questions

to to connect with us check out our

symptom checker if you're wondering if

um your symptoms may be and you're still

not sure give us a call connect with us

and we're happy to help you

and i'll just add to that um that

there's a lot of misconceptions out

there about a gluten free diet and

nutrition in general so i would just

take this opportunity to remind everyone

that if you do have questions please

trust reliable sources like the canadian

celiac association like diabetes canada

they are providing accurate

evidence-based information

and that's really really important so

trust trust good sources

and i will add to that um please do get

diagnosed in the with the appropriate

channels if you go on a gluten-free diet

just to see how you feel

that is not going to be an official

diagnosis and

the the risk of not getting an official

diagnosis is when you are officially

diagnosed with celiac disease in canada

you can apply for tax credits so without

that diagnosis you're not going to be

eligible for those tax credits and the

other piece of that is

if there's a medication and one day

there will be a medication available

we hope

to not necessarily treat

you know long-term celiac disease but

possibly treat

accidental exposures to gluten

so in our community if there's

cross-contamination from a restaurant or

if you accidentally um if they're if

you're living in a shared kitchen at

home and there's been a

cross-contamination

uh then

and you can get very sick so my daughter

in particular is an extremely sensitive

celiac she will get very very sick from

even the smallest cross-contamination so

if the medication comes out one day you

know it would be wonderful for her to be

able to take something to help just ease

that moment of time

if you don't have that official

diagnosis the wonder is whether you'll

be eligible to receive that medication

so please do go through the appropriate

channels go to your doctor request the

blood work before you stop eating gluten

if you don't if you are eating gluten

and you do the test it will be accurate

if you are not eating gluten the test

can be a false negative

and we don't want you to get that wrong

you we don't want you to get the wrong

results

so please do it through the appropriate

way don't just try the diet to see how

you're going to feel because if you feel

a lot better and you have to reintroduce

gluten the gluten challenge can be can

be difficult for people

yeah thank you folks and i i really

appreciate the idea of you know um

getting tested and doing so

through reliable sources you know to do

so formally if you want to call it that

um and i would just offer a bit of

advice who are specifically to our type

one audience and that is you know it can

be very overwhelming you know i'm

thinking myself if there are as you

mentioned nicole 300 potential symptoms

it can often be well maybe it's you know

who knows what i might be dealing with

it may be just a an offhand bad day bad

week bad month of live life with type 1

diabetes but if you do feel i would

direct people as well to the symptom

checker and we'll be sure to share that

in the video description um

you know check it out and and see if you

if it merits getting getting checked out

formally getting diagnosed because um as

we can see it can really you know spare

you a lot of longer-term difficulties

because um it's it's incredibly hard to

live with one chronic illness a little

let alone two but it can be made easier

if you actually seek help formally

so on that note of you know trusting

veritable sources um

diabetes canada as mentioned is doing a

lot of work to support you this cause in

particular you know we're super happy to

be partnering with

cca on this cause and if you do have uh

questions that you feel are more

specifically diabetes focused you can

visit our website

our social media

and if you want to get specific advice

for yourself or at least that get put

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October 15, 2021 Celiac Disease and Diabetes

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