Managing Diabetes Plus Celiac Disease

It's not uncommon to have both type 1 diabetes and celiac disease, both of which are autoimmune diseases (as are lupus and rheumatoid arthritis.) Both type 1 diabetes and celiac disease require an extra measure of dietary vigilance in order to stay healthy and feel good.

"In general, if you have one autoimmune disease, it increases the chances of your having another," says Benjamin Lebwohl, MD, of the Celiac Disease Center at Columbia University in New York City. "Celiac disease is more common in those with Type 1 diabetes than in the general population."

About eight percent of individuals with Type 1 diabetes have celiac disease as well, he says, while about one percent of the non-diabetic population has celiac disease.

Celiac disease is a digestive condition triggered by the consumption of gluten, found in bread, pizza, pasta, and a variety of other foods. When individuals with celiac disease eat gluten-containing food, they experience an immune reaction that leaves them with damage to the small intestine as well as with an inability to absorb vital nutrients. Once gluten is eliminated from the diet, the intestine begins to heal and the person feels better.

Still, it can be tricky to eliminate gluten from the diet, and when you must simultaneously manage your blood sugar, eating can get downright complicated.

The good news is that some studies suggest that type 1 diabetics who are later diagnosed with celiac disease tend to see an improvement in their blood sugar readings if those readings had previously been erratic, Lebwohl says.

To live well with both celiac disease and type 1 diabetes, keep in mind:

  • Gluten-free baked goods tend to be more caloric and to have more carbs and even more fat than baked goods prepared with gluten, says Suzanne Simpson, RD, a dietitian at the Celiac Disease Center at Columbia. "Don't just assume how many carbs are in a slice of gluten-free bread," she cautions. "The numbers vary a lot. Since they tend to be higher in calories, this can result in weight gain."
  • Looks can be deceiving when it comes to gluten-free baked goods. They tend to be smaller and denser than ordinary baked goods, so don't get tricked into thinking they are lower in calories just because they are smaller.
  • Your insulin needs may increase as you heal and start absorbing carbohydrates again, Simpson says. Be extra vigilant about testing your blood sugar, she says.
  • Stick to eating whole, unprocessed foods as much as possible. This means choosing unprocessed meat, fish, chicken, legumes, and low-fat dairy products, Simpson says.
  • Since packaged gluten-free foods tend to be low in fiber, it's important to get your fiber from other sources. Try gluten-free oatmeal, buckwheat, or millet. And, of course, eat plenty of fruits and vegetables.
  • Be sure to carry a gluten-free carbohydrate that you can consume in case your blood sugar drops too low. Plan ahead and make sure the snack you carry to treat low blood sugar does not contain gluten.