Common Coexisting Conditions
People with type 1 diabetes may also be at risk for other diseases or medical conditions, often called coexisting conditions. Common coexisting conditions that people with type 1 diabetes should watch out for include depression, eating disorders, arthritis, celiac disease, and thyroid disease. If you, or someone you care for with type 1 diabetes, show symptoms of any of these, speak to a health care provider. Screening for these conditions may be a good idea.
Everyone feels sad, down, or blue once in a while. It's a normal part of being human. When feelings of sadness and hopelessness just won't leave, it could be a sign of depression. Studies have shown that there is a greater risk of depression in people with diabetes than in people without diabetes.
Depression can lead to other problems. It may get in the way of good self-care, such as taking regular blood sugar readings, or keeping up with exercise. Of course, the end result is that diabetes is not managed as well as it could be.
Recognizing the signs of depression
When someone is depressed they may experience
- Lack of interest in things that were once enjoyable
- Trouble falling or staying asleep, or sleeping during the day
- Waking up earlier than usual without getting back to sleep
- A weight gain or loss
- Problems focusing
- Feeling more tired than usual
- Feelings of worthlessness or guilt
- Thoughts of suicide or self-harm
If you are experiencing these symptoms, talk to your doctor. Only a doctor can diagnose depression, and there should never be any shame in asking for help, either for yourself or for the person you are caring for.
People with diabetes can also develop eating disorders. The 2 main types of eating disorders are anorexia nervosa and bulimia.
People with anorexia simply don't eat in order to get and stay thin. People with anorexia see themselves differently than other people do. They can be terribly thin and yet still think of themselves as overweight so they try to lose even more weight.
People with bulimia do the opposite. They will often eat normal or even large amounts of food, sometimes a lot in one sitting, called a “binge.” Then they “purge”—that is, get rid of the food by forcing themselves to vomit or take medicines that will make them go to the bathroom. Over time, bulimia can cause problems with the esophagus (the pathway between the mouth and stomach) and teeth. Both anorexia and bulimia stress the body and deny it the nutrition it needs.
How can you figure out if your loved one with type 1 diabetes has one of these disorders? It’s not always possible to tell, but they are likely to have more episodes of diabetic ketoacidosis (DKA)* and low blood sugar, and their A1C readings tend to be higher. And because their blood sugar is often out of range, the risk for diabetes-related health problems is also greater.
A similar eating disorder, called “diabulimia,” has been found in people with type 1 diabetes who use insulin. People with diabulimia manipulate their insulin doses to lose weight. These people have more episodes of DKA and problems keeping their blood sugar in the target range.
If you, or the person you care for, have an eating disorder, please talk to the health care professionals on your/their diabetes care team immediately.
For more information on eating disorders, visit the National Eating Disorders Association.
* In DKA, very high blood sugar and the lack of insulin to help convert blood sugar into energy cause the body to break down fat for energy. When this happens, acids called ketones build up in the blood and urine where they can be harmful.
If you, or the person you care for, have type 1 diabetes and suffer from joint pain and stiffness, you are not alone. The Arthritis Foundation notes that people with diabetes are twice as likely to have arthritis than other people.
Some of the other signs of rheumatoid arthritis may include:
- Bumps under the skin (also called nodules), especially in the fingers
- Skin that is thick and tight in a particular area
- Carpal tunnel syndrome (a nerve condition that affects the wrist and hand)
- Pain in the shoulders
- Foot problems
If you or the person you care for has any of these symptoms, talk to your or their health care provider. He or she will probably suggest seeing a specialist who focuses on treating rheumatoid arthritis called a rheumatologist. Working together, they can help!
Celiac disease is a condition where the body cannot properly digest a protein called gluten. Gluten is found in certain grains, such as wheat, rye, and barley. In people with celiac disease, gluten damages the gut (intestines) and may make it difficult for the body to absorb certain nutrients.
Celiac disease and type 1 diabetes
In celiac disease, the immune system reacts to gluten by attacking the cells that line the small intestine. Because it is also an autoimmune disease, celiac disease may happen in people who have type 1 diabetes. Note that while most people with type 1 diabetes will not develop celiac disease, some might, so it is worth knowing about. If you have any concerns about your diet and digestive health, talk to your health care provider.
Celiac disease symptoms
Sometimes celiac disease can begin without causing any obvious symptoms (asymptomatic). Most times it causes symptoms, which can include:
- Weight loss
- Poor growth
- Anemia (red blood cells not carrying enough oxygen)
- Itchy skin rashes (dermatitis herpetiformis)
- Bone and muscle pain
- Abdominal (stomach) pain
- Mouth ulcers
Despite being common, the Celiac Disease Foundation says that many people with celiac disease don’t know they have it.
Living with celiac disease
If you think that you, or the person you care for, may have celiac disease, talk to the doctor about getting blood tests to find out for sure. For more information on celiac disease, visit the Celiac Disease Foundation online.
Thyroid disease happens when the thyroid gland produces too much, or too little, of the thyroid hormones the body needs.
Thyroid disease and type 1 diabetes
Having type 1 diabetes greatly increases the chance of getting thyroid disease, so it’s important to watch out for this. A person with one autoimmune disease is more likely to get another. In type 1 diabetes, the immune system attacks the beta cells in the pancreas that produce insulin. In both main types of thyroid disease—Graves' disease and Hashimoto's thyroiditis—the immune system attacks the cells of the thyroid gland.
Hyperthyroidism is the release of too much thyroid hormone into the bloodstream. The most common cause of hyperthyroidism is Graves' disease. Like type 1 diabetes and celiac disease, Graves' disease is an autoimmune disease. In Graves' disease the body's immune system attacks the thyroid gland. To fight back, the thyroid gland starts working overtime and makes too much thyroid hormone. This can speed the body up, causing weight loss, fast heartbeat, sweating, and nervousness.
Hyperthyroidism may cause people to experience:
- Nervousness and irritability
- Excessive sweating
- Heat sensitivity
- Fatigue (tiredness), but also difficulty sleeping
- A faster than usual heartbeat
- Muscle weakness
- Weight loss, even while eating more
- Eye irritation, swelling, or bulging
- Irregular periods (for women)
Hypothyroidism happens when the thyroid gland releases too little thyroid hormone into the bloodstream. The most common cause of hypothyroidism in the United States is Hashimoto's thyroiditis. This is also an autoimmune disease that affects the whole body. People with mild hypothyroidism may not notice any symptoms. Symptoms can become more obvious if hypothyroidism gets worse.
Hypothyroidism may cause people to experience:
- Depression and sluggishness
- Weight gain even with no change in eating or activity
- Slower than usual physical growth and sexual development in teens
- Irregular periods (women)
- Muscle weakness
- Dry skin
- Hair loss
- Trouble remembering or focusing
The good news is that thyroid disease is treatable. If you suspect that you, or the person you care for, may have thyroid disease, talk to the doctor about getting thyroid-stimulating hormone (TSH) levels checked.
For more information on Graves' disease, visit the Graves’ Disease and Thyroid Foundation.
For more information on thyroid disease, visit the American Thyroid Association.
For more information on autoimmune diseases, visit the American Autoimmune Related Diseases Association.