caring for type 1 diabetes and celiac disease
You may have heard that there has been an increase in autoimmune diseases, including type 1 diabetes and celiac disease. We've recently seen an increase in patients having both of these diseases together. We talked with endocrinologist Stacy Meyer, MD and gastroenterologist and division chief of pediatric gastroenterology and nutrition Michael Bates, MD to learn more about the connection between the two, and our clinical nutrition team for tips and resources for families whose children are managing both.
why are we seeing an increase in patients with autoimmune diseases, like type 1 diabetes and celiac disease?
Autoimmune diseases are what we call "two hit" processes. You have to inherit the genes that make it more likely to develop an autoimmune disease, and then something else in the environment must trigger the process. Viruses are often triggers to the start of autoimmune diseases, but we don’t know for sure what the triggers might be for these disorders. Recently, there has been a rise in type 1 diabetes cases that is thought to be associated with COVID infections.
how are type 1 diabetes and celiac disease linked?
Celiac disease and type 1 diabetes share a genetic link. Both celiac disease and type 1 diabetes risks are inherited on HLA genes and share two specific HLA types in their inheritance: DQ8 and DQ2. It appears that a person has to have one of these two HLA types to be at risk for celiac disease or type 1 diabetes.
why might we be seeing an increase in kids having both type 1 diabetes and celiac disease?
It is not currently known why we are seeing an increase in autoimmune diseases, but there are many theories and studies looking into this. We have been seeing a rise in autoimmune diseases overall since the 1980s. We also have better screening tests for celiac disease, which has led to an increase in its diagnosis.
what is the impact on a child if they have both celiac and diabetes? What challenges come with it?
The combination of celiac disease and diabetes can be especially difficult to manage. They both require adjustments to our diet and lifestyle that are independent of each other. Many of the foods safe for kids with celiac disease are higher in carbohydrates. This can make it harder for kids to cover with insulin and to keep their weight in a healthy range.
how can people with diabetes and celiac get carbohydrates?
People with diabetes and celiac disease should include healthy carbohydrates in their meals every day. These can include fruits, vegetables, gluten-free whole grains and gluten-free dairy products. Most kids with diabetes and celiac disease eat around 30 to 75 grams of carbohydrates at each meal, and 15 to 30 grams of carbohydrates for each snack.
how do I choose gluten-free whole grains?
Check the ingredient list on a food label to see if a food is a good source of whole grains. The first words on the list should be “whole grain [name of grain].”
- Do not select foods that list the name of the grain as wheat, rye, barley, or oats (unless specified gluten-free oats) - These grains contain gluten.
- Gluten-free grains include: buckwheat, teff, amaranth, rice, corn, quinoa, sorghum, millet, grits and labeled gluten-free oats. The package should also be labeled as gluten-free.