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Type 1 diabetes

  • Coeliac disease is more common in people who have Type 1 diabetes
  • If you have coeliac disease and Type 1 diabetes, you should get guidance from a dietitian about how to manage your diet.

Coeliac disease is more common in people who have Type 1 diabetes because they are both autoimmune diseases. Between 4 and 9% of people with Type 1 diabetes will also have coeliac disease.

There is no increased risk of coeliac disease in people with Type 2 diabetes.

Diagnosis

For most people, Type 1 diabetes is diagnosed before coeliac disease, although it can happen the other way around.

Some people with Type 1 diabetes appear to have mild or no obvious symptoms of coeliac disease, but their gut lining will still be damaged when they eat gluten.

Coeliac disease can be missed in people with Type 1 diabetes as the symptoms of ill health can be attributed to the diabetes.

When coeliac disease is diagnosed before diabetes, the symptoms of diabetes tend to be more severe and there is a higher likelihood of other autoimmune diseases.1

Recurrent hypoglycaemia can be a sign of coeliac disease in people with Type 1 diabetes.2 In children, having diabetes and growth problems may mean they also have coeliac disease.3

Some people with Type 1 diabetes may test negative for coeliac disease early in their diagnosis, but then positive at a later stage. British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) recommended that children with Type 1 diabetes should be retested after three years or if symptoms occur. However, we would refer to the updated NICE guidelines which recommend that people with Type 1 diabetes should be tested for coeliac disease at diagnosis and retested if any symptoms of coeliac disease develop. If you have concerns speak with your GP.

How coeliac disease affects people with Type 1 diabetes

For people with coeliac disease and Type 1 diabetes, following a gluten-free diet can help control their symptoms and reduce the risk of complications.

If you have coeliac disease and Type 1 diabetes, you should get guidance from a dietitian about how to manage your diet.

If you have Type 1 diabetes and are diagnosed with coeliac disease, your blood glucose may change after you start the gluten-free diet. This can happen because taking gluten out of your diet allows the lining of your gut to heal so absorption of nutrients, including carbohydrate, will improve.

You may need to keep a closer eye on your blood glucose levels and talk to your diabetes team about your insulin requirements.

Top ten tips for managing coeliac disease and Type 1 diabetes

1. Eat three meals a day

Eat at breakfast, lunch and dinner and try not to skip meals. This will help control your appetite and blood glucose levels.

2. Include gluten-free starchy carbohydrate foods at each meal

For example:

  • gluten-free breads (especially multigrain or seeded varieties), pasta and crackers
  • naturally gluten-free grains such as rice, rice noodles, polenta (cornmeal), buckwheat, millet and quinoa
  • starchy vegetables such as new potatoes, sweet potatoes, yams, cassava (tapioca) and plantains
  • gluten-free breakfast cereals such as buckwheat flakes and muesli.

Carbohydrate is important to controlling your blood glucose levels. The amount you need to eat depends on your age, weight and how active you are.

3. Cut down on the amount of fat you eat, particularly saturated fats

Fat is the greatest source of calories, so eating less will help you maintain a healthy weight.

  • Use less saturated fat by cutting down on butter, margarine and fatty meats.
  • Choose lower fat dairy foods such as semi skimmed milk, low fat yoghurts (avoid those with fibre), reduced fat cheese and lower fat spreads.
  • Grill, steam or oven bake instead of frying or cooking with oil or other fats.

4. Eat more fish

All plain fish is naturally gluten-free. Oily fish such as mackerel, sardines and salmon are high in omega 3 fats which may help prevent heart disease. Talk to your healthcare professional about how much you should eat.

5. Limit sugar and sugary foods

Sugar is not forbidden when you have diabetes, but constantly having foods and drinks that are high in sugar does not help to control your blood glucose. Choosing sugar free, no added sugar or diet squashes and fizzy drinks can be an easy way to reduce the sugar in your diet.

6. Reduce salt in your diet

We should all aim to have 6g or less of salt each day. More than this can raise blood pressure, which can lead to stroke and heart disease. Reduce the amount of processed foods you eat as these can be high in salt. Try flavouring foods with herbs, spices and pepper which are all gluten-free.

7. Eat more fruit and vegetables

All fresh, frozen, canned, juiced and dried fruits are naturally gluten-free. Aim to eat at least five portions a day.

8. Include more pulses

Peas, beans and lentils are naturally gluten-free. Try adding them to stews, soups, curries and salads.

9. Drink alcohol in moderation

Wine, spirits, cider, sherry, port, liqueurs and gluten-free beers can all be included in a gluten-free diet. You need to avoid beers, lagers, stouts and ales. Remember alcohol can add extra calories. Never drink on an empty stomach as alcohol can increase your chances of hypoglycaemia (low blood glucose levels) if you are taking certain diabetes medication and/or insulin.

10. Avoid diabetic food and drinks

These are often expensive, contain just as much fat and calories as ordinary versions, can have a laxative effect and will still affect your blood glucose levels.

1 Valerio G, Maiuri L, Troncone R, et al (2002) Severe clinical onset of diabetes and increased prevalence of other autoimmune diseases in children with coeliac diabetes diagnosed before diabetes mellitus. Diabetologia. 45(12): 1719-22.

2 Hansen D, Bennedbaek FN, Hansen LK, et al (2001) High prevalence of celiac disease in Danish children with type 1 diabetes mellitus. Acta Paediatrica. 90:1238-43.

3 Bradbury BL & Scarpello JHB (1999) Recurrent hypoglycaemia as the presenting symptom of coeliac disease in a patient with Type 1 diabetes mellitus. Pract Diab Int 16: 89-90.

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