This was originally posted to my blog, Diabetes Odyssey.
Many people, diabetic and non, are not aware that having type 1 diabetes puts one at much higher risk of developing other illnesses, especially certain autoimmune diseases/conditions. I am not speaking of diabetic complications such as heart disease, gastroparisis, or neuropathy, I am speaking of diseases not caused by diabetes or one’s level of BG control. I am talking about rheumatoid arthritis, Hashimoto’s, celiac disease, Addison’s, autoimmune gastritis, pernicious anemia, vitiligo, just to name a few.
Before I continue let me point out that I am not a doctor, scientist, or in any way even close to an expert on the subject I have chosen for today’s blog post. I am writing this from a very personal point of view and do not intend to impart much in depth knowledge on any illnesses mentioned.
The points I would like to discuss are as follows:
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Why do so many doctor’s not educate their newly diagnosed type 1 patients regarding their higher risk of developing these other autoimmune disorders?
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Why are diabetics at higher risk? How many type 1’s really do end up with one or more additional conditions and how does that affect their health, lifestyle, and life expectancy?
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What does this say for type 2’s? Are they at the same or similar risk?
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Does level of control of BG affect level of risk one way or the other like it does for diabetic complications?
Let me add in here a quick rundown of definitions/descriptions:
Autoimmune Disorder/Condition/Disease - A disease in which the body’s immune system attacks healthy cells.
Rheumatoid Arthritis - An autoimmune chronic inflammatory disorder. This condition typically affects the small joints of the hands and feet but can affect other parts of the body as well. Anyone can develop this condition. Type 1 diabetics are placed at higher risk than other groups.
Hashimoto’s Disease - An autoimmune thyroid condition. Also known as chronic lymphocytic thyroiditis. Usually results in hypothyroidism. Primarily occurs in middle-aged women but anyone can be affected and type 1’s are placed at higher risk.
Celiac Disease - A digestive autoimmune disorder. When foods with gluten are eaten it causes damage to the small intestine resulting in the inability to absorb certain nutrients. Anyone can develop celiac disease. Type 1 diabetics are at higher risk than many other groups.
Adisson’s Disease - Also known as chronic adrenal insufficiency or hypocortisolism. The adrenal glands don’t make enough cortisol, and in some cases, aldosterone. There are multiple causes for Addison’s disease, about 70% of cases are autoimmune. Anyone can develop Adisson’s (President Kennedy had it). Type 1 diabetics are at higher risk.
Autoimmune Gastritis - Inflammation of the stomach lining. There are many types of gastritis; autoimmune gastritis is caused when the body’s immune system attacks the cells of the stomach lining. Although anyone can develop autoimmune gastritis it is more common in people with other autoimmune disorders, including Hashimoto’s disease and type 1 diabetes. Autoimmune gastritis can also be associated with vitamin B-12 deficiency.
Pernicious Anemia - A decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12. Common causes are from gastritis (any type) or autoimmune disease. Most persons affected by pernicious anemia are over the age of 60 but persons with other autoimmune diseases are at high risk.
Vitiligo - Loss of skin and/or hair color. Occurs when the cells that produce melanin die or stop functioning. Anyone can develop vitiligo. It usually begins before age 20. Persons with autoimmune disease (including type 1 diabetes) are at higher risk of developing vitiligo.
Growing up I have always known about type 1 diabetes. I come from a family of type 1 diabetics. There are six of us; my father, an aunt, two cousins, one of my brothers, and myself. So you would think I would be very much aware of the higher risk of developing other autoimmune diseases. Nope, no one ever told me a thing about it. I may assume that my family was just sparing me, as a young child, from the fear and stress of knowing such a thing, but I find that improbable since we aren’t that kind of family. Good or bad, you need to know what you need to know. I can also assume I just had bad doctors or they assumed I already knew this stuff? Who knows.
As I got older and began to reach out to the diabetes community and do my own research I learned a lot of things. I learned about my increased risk for other autoimmune diseases. And I also learned that many upon many type 1 diabetics were never made aware of this risk by their doctors. Hmmm.
WHY THE HELL NOT?!
In my experience I can say:
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Doctors don’t like to give “bad” news unless they are obligated.
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They often run routine lab tests (like those run regularly on type 1 diabetics that include tests for other autoimmune diseases) without explaining what those tests are for. So even if your doctor never told you about your risk, he/she is still keeping an eye on it for you. They don’t talk unless you specifically ask.
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Most medical practices are very, very bad at educating their clients on illnesses they have or are at high risk for. It’s just diagnose, treat, and bye-bye. No in depth education whatsoever. You are on your own.
In my opinion it should be a regular practice to educate your patients (in depth) on any medical condition they have and how to care for it, especially if it is a chronic illness like type 1 diabetes. Or at least give a packet that includes a list of resources of education (books, websites, classes, support groups, etc). And this education should include letting them know what other illnesses they are now at increased risk of developing. At least give us a list to further research on our own time. So many people feel and are so lost at diagnosis and appreciate any and all information and help. This step would increase the chances that a patients care of their disease will be improved from the start and they won’t give in so easily to the feelings of fear, anger, and being totally overwhelmed that could lead to not even trying.
Type 1 diabetes is an autoimmune disease. Anyone who has an autoimmune disease is at higher risk of developing other autoimmune diseases. Why? This is a difficult question to answer, partly because I have almost no education of it. I can say that there is no known cause for autoimmune disease; some say it could be environmental toxins, some say genetic factors. There are a lot of studies and theories, but no absolute proofs. So, since we don’t know how it begins, it is a bit more difficult to say why one may lead to another or more.
Plain and simple, though, they are all related in the fact that they are all autoimmune diseases. There is something wrong in that specific part of our system.
I might point out also that since we don’t know the cause it is much more difficult to find a cure. In type 1 diabetes it is not as simple as a broken pancreas…it is in our entire system, it is complex, convoluted, elaborate, serpentine (throw in any other synonym you like). I know so many of us want to blame the pharmaceutical companies, insurance companies, and government, for hiding or delaying a cure for the sake of making more money. And this is probably true to a certain extent. But we can not deny that diabetes is not simple in any way shape or form.
From my research I have found that about roughly 20% of type 1 diabetics also have at least one other autoimmune disease. Not a huge number, but notable. How this may affect health, lifestyle, and life expectancy depends on the individual diseases and how well they are controlled. You may live a long, happy, and healthy life, or not.
Type 2 diabetes is generally defined as a metabolic disorder and not an autoimmune disease. Although this is a hotly debated topic. As far as I have found type 2 diabetes is a metabolic disorder that can have autoimmune qualities? Don’t quote me on this, I really am not educated well here at all.
I have found more information on people with other autoimmune diseases being at higher risk of developing type 2 diabetes than type 2 diabetics being at higher risk for developing any autoimmune disease. But honestly I have done tons more study on type 1 than type 2 on this particular subject.
When it comes to one’s risk of developing other autoimmune diseases I have found absolutely zero proof to support that level of control over type 1 diabetes either increases or decreases risk.
I, as always, am open to discussion, education, etc. on this topic.
Bibliography:
I have been researching this topic on and off for a few years. Unfortunately I have not kept any list of information sources. I can promise you, though, that I try very hard to only use information gathered from reliable and reputable sources. I talk to doctors, read books and articles, watch educational programs and check their sources, and, of course use websites.
Some sources I remember checking (but may or may not have used info from for this post) are:
WebMD
Mayo Clinic
Diabetes Journals.org
American Diabetes Association
Kids Health.org
Medscape