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On Nov. 23, Karen and Dennis ([log in to unmask]) wrote:
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"... in the past 2 weeks he (their child) has shown a gradual , at first,
and now a now MARKED increase in thirst. Also accompanied by increased
urination and tiredness. He has also started getting grouchy periods again.
He has no fever. ...ANY suggestions about what our doctor NEEDS to know about
the CD in relation to our little boy's symptoms?"
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Karen and Dennis, you and your physician should probably be aware of the
increased frequency of Diabetes Type I among persons with Celiac Disease.
The following is an article from a recent issue of the Westchester (NY) CS
Support Group newsletter. Kemp Randolph has asked that his e-mail address be
included, in case anyone would like to contact him directly:
[log in to unmask]
Sue Goldstein
White Plains, NY 10605 [log in to unmask]
CELIAC SPRUE AND DIABETES - By Kemp Randolph
Of the many immune related disorders linked with the celiac condition, the
best established connection is with Type I diabetes (mellitus). Type I
diabetes occurs at a rate of about 0.5% in the general population, but at a
rate estimated at 5-10% among celiacs. Normally the diabetes is diagnosed
first, both because this form of diabetes tends to strike early in life and
its diagnosis is certain. No connection has been found with the more common
form of diabetes (mellitus= honey , from the sugar laden urine when
uncontrolled), Type II which occurs at a rate of 2-2.5% in the general
population.
In Type I diabetes, the insulin producing cells of the pancreas are destroyed
by the immune system, perhaps in overreaction to some kind of infection.
(The incidence of Type I is highest in the winter.) Normally, insulin is
released into the blood for distribution to nearly all cells in the body so
glucose can be burned for energy. There are indirect connections with
protein and fat metabolism as well which give rise to some of the poisons
that build up in the absence of insulin. For glucose, cells have an insulin
receptor on the surface: once insulin is bound there, glucose can enter and
hence be metabolized.
At diagnosis, the Type I presents with a better defined form of
malnourishment than the celiac: hyperglycemia (high blood sugar), weight
loss, excessive thirst, excessive urination laden with (unmetabolized) sugar
and protein, a fruity smell to the breath and little or no insulin in the
blood. Treatment consists of 1-3 subcutaneous injections of insulin a day
and control of carbohydrate intake.
The recommended diet for diabetes, long before it was recommended for
everyone, consisted of less fat and protein and more carbohydrate. Complex,
that is less quickly metabolized, carbohydrates were recommended to cut down
the peak in blood glucose that occurs about two hours after eating. It was
and is a perfect Jane Brody diet - lots of fresh fruit and vegetables, hence
with lots of fiber. The restriction on sugar is indirect: only the total
carbohydrate must be controlled, so if you have some direct sugar, you
eliminate something else (less carbohydrate rich probably) and (merely?) have
to put up with less on the plate.
Control of Type I is certainly more of a nuisance than celiac disease, but
also one with much better information readily available. Food labels are
nearly adequate for controlling carbohydrate intake; the risks of the various
long term complications versus average blood glucose are well known;
relatively inexpensive, reliable home monitoring of blood glucose is possible
to even out the daily peaks and valleys; a longer term blood test reliably
measures average blood glucose for sufficient monitoring of longer term
risks.
Like celiac disease, Type I diabetes is more common in those of northern
European extraction. Like celiac disease, it is highly linked to the
so-called HLA markers of the immune system, those marking white blood cells.
Celiacs are likely to be positive for both HLA-B8 and HLA-DR3; Type I's are
most linked to HLA-B8 and either HLA-DR3 or HLA-DR4. An English study about
6 months ago found that multiple genes were linked to Type I reflecting the
fact that parents of a Type I are often diabetes free: the interpretation
being that genes were required from both sides. The recent request for
celiac siblings for a study of genetic typing intends to duplicate that one
looking for celiac genes.
References: Gluten Intolerance Group of North America newsletter, V. 13,
Issue 2, 1987;
New York Times, Sept. 13, 1994, genetics study by Dr. John Todd at Oxford.
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