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Diabetes and Celiac disease

Updated: Mar 19, 2020

How are they related?

Celiac Disease is defined as inflammation, atrophy, and hyperplasia of the small bowel in response to gluten. Luckily, this can be improved with a strict gluten free diet. This is not so easy, however. Many foods can be contaminated with gluten if they are processed with the same equipment or exposed to the same surfaces or utensils.

Symptoms vary from silent to life threatening. “Classic” signs include diarrhea, foul-smelling stools, steatorrhea (fatty stools), and flatulence.  This can be coupled with vitamin deficiencies and malabsorption, especially in children. Other manifestations include psychiatric disorders (headache, depression, anxiety, chronic fatigue), iron deficiency, arthritis, osteopenia/osteoporosis, kidney disease, peripheral neuropathy, ataxia, and epilepsy. Interestingly, peripheral neuropathy precedes diagnosis in 50% of cases.

Celiac disease is often misdiagnosed as gastroparesis (see previous post) as well as IBS, ulcerative colitis, depression, fatigue, diverticulosis, and intestinal infections. Up until recently, it is estimated that 90% of celiac disease went undiagnosed or misdiagnosed and therefore untreated.

Endoscopic intestinal biopsy is the “gold standard” for a Celiac diagnosis, but the disease can also be diagnosed by measuring antibodies in the blood. These blood tests are easy, non-invasive, and should be done first to see if a biopsy is indicated.

Celiac disease and DM1 are both immune mediated disorders and are therefore closely related, although the exact relationship is still unclear. People with type 1 commonly present with positive IgA antibodies (celiac antibodies) at screening and are therefore likely to have or develop Celiac.  Type 1 diabetes and celiac disease also carry similar genetic loci indicating a similar pathogenesis. Many PWD have no presenting symptoms or present with symptoms so similar to diabetes complications that Celiac is not suspected. Peripheral neuropathy, for instance. A celiac panel is therefore indicated in type 1’s if any crossover symptoms are present. It is important to catch this disease early! Talk with your clinician about screening.

St. Croix, USVI. This is where I attended PA school. This is the view from Buck Island, a small island off of STX. My happy place :)

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