People with type 1 diabetes are at a higher risk of developing certain other conditions, including celiac disease. Both celiac disease and type 1 diabetes are autoimmune diseases in which a person’s immune system attacks its own cells. In celiac disease, the immune system attacks and damages the small intestine’s lining. In type 1 diabetes, the immune system attacks and damages the cells that produce insulin in the pancreas.

This article will explain what celiac disease is, why people with type 1 diabetes are at higher risk for it, and what actions people with both conditions can take to improve their health and quality of life.

What Is Celiac Disease?

People with celiac disease have an immune response to eating gluten, a protein that’s found in foods that contain wheat, barley, or rye. While about 1 percent of the general population has celiac disease, approximately 6 percent of people with type 1 diabetes have it. Celiac disease is more likely if someone in your family has it.

If you have celiac disease, eating gluten causes your immune system to attack the small intestine’s lining. Over time, the small intestine’s lining is damaged and can’t absorb important nutrients. This condition is called malabsorption. In children, malabsorption can affect growth and development.

In children, digestive symptoms of celiac disease can include:

• Chronic diarrhea (doesn’t go away)
• Nausea and vomiting
• Constipation
• Bloating (swollen belly) and gas
• Pale, foul-smelling stools

Missing a diagnosis of celiac disease in children, or confusing it with other digestive issues, can lead to severe symptoms. These may include intense diarrhea and dehydration, which can cause lethargy (extreme tiredness), low blood pressure, and low potassium levels.

Symptoms such as diarrhea, nausea and vomiting, constipation, bloating, and gas are also seen in adults. Interestingly, more than half of adults with celiac disease may also develop symptoms not related to the digestive system, including:

• Headaches and fatigue
• Anemia from iron deficiency (because they are not absorbing enough iron)
• Loss of bone density or softening of the bones
• Herpetiformis (an itchy, blistering skin rash)
• Joint pain

Some adults with celiac disease experience only nondigestive symptoms only, making the diagnosis even more difficult and the screening more important in all patients with type 1 diabetes.

A blood test can confirm whether you have the antibodies that attack the small intestine. If the test result is positive, your physician may do a biopsy procedure to see if there is damage to the lining of your small intestine and to confirm the diagnosis.

What Connects the Two Conditions and Who’s at Risk?

People with type 1 diabetes are at a heightened risk of developing other autoimmune diseases. Celiac disease is one of the most common. Others include autoimmune thyroid disease, Addison’s disease, vitiligo, and autoimmune hepatitis.

Both type 1 diabetes and celiac disease share a common genetic background that has been found in the human leukocyte antigen (HLA) genotype. HLA genes help the body to tell the difference between the body’s own proteins and those that are made by foreign invaders, such as viruses and bacteria.

Researchers are actively studying why some people with type 1 diabetes develop celiac disease while others do not. The majority of people who carry high-risk HLA genes will never develop type 1 diabetes or celiac disease. Studies focused on type 1 diabetes and celiac disease have found similar environmental risk factors that may also contribute to developing the conditions. These include infant-feeding practices, exposure to viral infections, breastfeeding, and vitamin D levels.

Screening Is Key

Many people with type 1 diabetes and celiac disease don’t experience symptoms of celiac disease (or chalk their symptoms up to their diabetes). In fact, they often learn they have celiac disease because of routine screening that’s done because of the known connection between the two conditions. Screening is especially important because having both of these diseases increases the rate of certain complications.

One study found that certain complications developed earlier in people with type 1 diabetes who also had celiac disease, as compared to those who did not have celiac disease. These complications included diabetic kidney disease and retinopathy (damage to the blood vessels in the retina of the eyes). This research shows how important it is for people with type 1 diabetes to find out if they also have celiac disease so that they can best manage their health.

Managing Celiac Disease Means Going Gluten-Free

People with celiac disease need to maintain a gluten-free diet for life. Doing so allows the lining of the small intestine to heal and symptoms to go away. Following a gluten-free diet means avoiding foods that contain wheat, barley, or rye, such as traditional bread, cereal, pasta, and pizza. However, there are gluten-free options available for these foods.

Fruits, vegetables, meat and poultry, fish and seafood, dairy products, beans, legumes, and nuts do not contain gluten.

These grains, legumes, seeds, and starchy foods do not have gluten:

• Amaranth
• Chia
• Corn
• Flax
• Kasha
• Millet
• Potatoes
• Quinoa
• Rice
• Sorghum
• Soy
• Tapioca

When shopping, look for foods that are labeled “gluten-free.” Keep in mind that “wheat-free” does not mean “gluten-free.” Also, be sure to check out the freezer section, as many gluten-free breads can be found there.

People with celiac disease have to become “gluten detectives,” carefully reading labels and looking for hidden gluten. For example, wheat is often used as a thickener for store-bought soups and sauces. Even french fries can bring surprises, as some are dusted with flour to keep them from sticking together. Pringles have gluten, and so do Milky Way bars (they also have a lot of sugar, so be extra careful!). Some tomato soups use wheat as a binder. In short, becoming a gluten detective is important if you’re diagnosed with celiac disease.

Gluten-Free Products Can Create Challenges in Type 1 Diabetes

Maintaining a gluten-free diet when you have type 1 diabetes can be tricky. That’s because gluten-free flour substitutes are often higher in carbohydrate content than their flour counterparts that contain gluten. Specifically, gluten-free flour products may contain added sugars or starches to simulate the texture of gluten. As a result, you may need to eat smaller portions or take extra insulin when eating these foods.

One member of the myT1Dteam who also has celiac disease underscored this point when they said, “I have to carefully choose how much insulin to give — and when to give it.”

Alternatively, some gluten-free alternatives are made with very low-carbohydrate substitutes. As a result, using standard estimations of insulin may lead to dangerously low blood glucose (sugar) levels. Doctors recommend that you read ingredient labels, whenever possible, for carbohydrate counts. Or, you can count the food as a vegetable that’s low in carbohydrates. At your next meal, you can then correct with insulin if you estimate too low.

These tips may also be helpful:

• Keep gluten-free carbohydrates handy if your blood glucose drops.
• Bring gluten-free snacks with you when traveling because your food options may be limited.
• Check menus on restaurant websites ahead of time to see if they have gluten-free options (or can accommodate someone with a gluten-free diet).

Raise Concerns With Your Health Care Provider

Whether you have recently been given a diagnosis of celiac disease or suspect you may have it, it’s important to communicate your concerns to your health care team. If you suspect you may have celiac disease, alert your health care provider right away. If you know that you have celiac disease but are having difficulty maintaining a gluten-free diet, ask your primary care physician or gastroenterologist to refer you to a dietitian. Registered dietitians can help you identify foods that are gluten-free and work well for a diabetes diet.

Talk With Others Who Understand

On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,300 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Are you living with type 1 diabetes and celiac disease? What tips do you have for others living with both conditions? Do you have helpful recipes that you can share? How do you make sure you get the health care you need to best manage both conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.