Coeliac disease is a common autoimmune disease that affects 1 in 100 people, but only 10–15 per cent are diagnosed. Gluten triggers an immune reaction in people with coeliac disease and gluten damages the lining of the small intestine. Other parts of the body may be affected.
Coeliac disease is more common in people who already have Type 1 diabetes, as both are autoimmune conditions and so are genetically linked. Some people with Type 1 diabetes find it is only after starting insulin that the symptoms of coeliac disease become noticeable. Some people with Type 1 diabetes have a ‘silent’ form of coeliac disease, which means no symptoms are apparent and it is only diagnosed by screening.
There is no link between coeliac disease and Type 2 diabetes.
If you think you may have coeliac disease you should:
- Discuss your symptoms with your GP
- Your GP can then take a simple blood test to look for an antibody made by the body in response to eating gluten
- Your GP can refer you to a gut specialist doctor (gastroenterologist) for a simple test called a ‘gut biopsy’. Small samples of gut lining are collected and later examined under a microscope to check for abnormalities that are typical in coeliac disease.
Current clinical guidelines recommend that all children and young people with Type 1 diabetes are screened for coeliac disease on diagnosis. It is also recommended that adults with Type 1 diabetes are assessed for coeliac disease. Testing should also be offered to anyone if signs and symptoms of coeliac disease are present.
There are two types of thyroid disorder: hypothyroidism (where the body doesn’t produce enough thyroid hormones) and hyperthyroidism (where it produces too much).
Thyroid problems are more common in people with diabetes than those without diabetes, especially those with Type 1, because the body’s cells can attack the thyroid and destroy the cells as they do the insulin producing cells in the pancreas. Adults and children can be affected, and hypothyroidism is more common in people with Type 1. People with Type 2 are more likely to develop thyroid problems too, but it’s not clear why this is.
Neither hypo- nor hyperthyroidism can be cured, but both can be treated successfully with tablets.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) affects about 5–10 per cent of women. It can cause an increased risk of developing Type 2 diabetes and may increase your risk of heart disease. PCOS is associated with insulin resistance and high levels of insulin circulating in the blood. Around 10–20 per cent of women with PCOS will go on to develop Type 2 diabetes at some time.
PCOS is treatable but cannot be cured. Treatment options include maintaining a healthy weight and being physically active, and the drug metformin, which is often prescribed to people with Type 2 diabetes.
Diabetes insipidus is caused when the pituitary gland has a problem producing the hormone vasopressin, also known as AVP, or when the action of AVP no longer works efficiently in the kidneys. This means the body produces increased amounts of urine because the kidneys are unable to retain water.
Diabetes insipidus and diabetes mellitus are separate conditions; very rarely a patient with diabetes mellitus may also develop diabetes insipidus.
Necrobiosis lipoidica diabeticorum
Necrobiosis lipoidica diabeticorum is a skin disorder also known as necrobiosis or NLD and can be associated with diabetes, although not exclusively so. NLD is very uncommon, affecting only 0.3 per cent of all people with diabetes. It most commonly occurs in young adult or early middle age and is three times more common in women as in men. The cause is unknown and it can happen no matter how well the diabetes is managed. NLD usually appears as small, oval, dark red or browny yellow patches with a thick shiny surface, which may be raised above the surrounding skin.
There is no cure, and while there are options for treatment, including steroids, effects can be disappointing.
Camouflaging the condition with specialised make-up may be appropriate; see the Changing Faces website for more information.
Mastopathy is the name given to fibrous (tough) breast tissue, which can develop in people with diabetes. Diabetic mastopathy is uncommon. It is usually seen in women who are pre-menopausal, and who have had Type 1 diabetes for many years. Often diabetic mastopathy is associated with other complications of diabetes. It’s not clear what causes diabetic mastopathy, but persistent high blood glucose levels may play a part.
If you notice any lumps or hardness in your breasts you should visit your GP as soon as possible so that s/he can investigate the cause.
Having diabetic mastopathy does not mean that you are at increased risk of breast cancer.
Muscular conditions can affect anyone, but people with diabetes are at an increased risk of the following.
Limited joint mobility
Limited joint mobility (also known as diabetic cheiroarthropathy) causes the joints to lose normal flexibility. Although most common in the hands, it can affect wrists, elbows, shoulders, knees, ankles, neck and lower back, and it is associated with microvascular complications of diabetes – nephropathy (kidney disease) and retinopathy (eye disease).
It is treated by keeping blood glucose levels as close to target as possible, but physiotherapy and steroid injections may also be helpful.
Frozen shoulder causes pain, stiffness and limited mobility in the shoulder. It is more common in people who have had diabetes for a long time, are of older age, have had a heart attack or who have the microvascular complications of diabetes (retinopathy and nephropathy). It is treated with painkillers, steroid injections, physiotherapy and, in some cases, surgery.
Dupuytren’s contracture causes contraction of the fingers (particularly the ring and little finger) towards the palm so they cannot be straightened. It is most common in people who have had diabetes for a long time, are of older age, or have the microvascular complications of diabetes. It is generally treated by surgery.
Trigger finger (also known as stenosing tenosynovitis) is a painful condition that affects the tendons in the hand. When the finger or thumb is bent towards the palm, the tendon gets stuck and the finger clicks or locks. It is most common in the ring finger. It is more common in people who have had diabetes for a long time, are of older age, or who have retinopathy or nephropathy. It is treated with steroid injections, splinting the finger or, in some cases, surgery.
Carpal tunnel syndrome
The symptoms of carpal tunnel syndrome include pain, numbness or pins and needles in the hand and wrist, particularly the thumb, forefinger and middle finger. The pain (often described as a tingling or burning sensation) is often worse at night. It is treated by splinting the wrist, steroid injections and, in some cases, surgery.
Dental problems are more common in people with diabetes. It is estimated that people with Type 2 diabetes are three times more likely to develop dental problems than people without diabetes, and the risk is also increased for people with Type 1.
Dental problems can include gum inflammation (gingivitis), infection and inflammation of the ligaments and bone that support the teeth (periodontitis), tooth decay (dental caries), dry mouth (xerostomia), fungal infections (oral thrush) and disturbances in taste.
Oral problems can occur in people with diabetes for a number of different reasons, which is why it is especially important to visit a dentist regularly and tell them about your diabetes. People with diabetes who have persistent high blood glucose levels are more likely to have dental problems.