Type 1 & Coeliac disease
Coeliac disease is an immune condition that affects the small intestine. When people with coeliac disease eat gluten their immune system is triggered, causing inflammation that damages the lining of the small intestine. Left untreated, coeliac disease can lead to nutrient deficiencies, problems with the bones, joints and other organs, as well as having an impact on fertility.
People with type 1 diabetes have an increased risk of coeliac disease – it affects up to 10 per cent of people with type 1 diabetes. Having type 2 diabetes does not increase your risk of developing coeliac disease. However, about 1 in every 70 Australians have coeliac disease, so people with type 2 diabetes can still be affected.
Symptoms
Symptoms can vary widely. Some of the most common are:
- Diarrhoea and/or constipation
- Stomach bloating or pain
- Flatulence
- Weight loss
- Tiredness
- Anaemia
- In people with diabetes, unexplained fluctuations in blood glucose levels (BGLs)
Some people have severe symptoms whilst others may have none at all. It is important to realise that the level of symptoms does not indicate severity of the disease – bowel damage can still occur in people who don’t experience any of these symptoms.
Treatment
The only treatment for coeliac disease is a lifelong gluten free diet. Following a gluten free diet allows the lining of the small intestine to recover, so it can properly absorb nutrients.
Gluten is a protein found in the grains wheat, rye, barley, oats and triticale. Processed foods can also contain gluten. Look out for ingredients like wheaten cornflour and barley malt extract in the ingredients list.
It can be challenging to eat a balanced gluten free diet whilst managing your BGLs and diabetes. Below are some tips.
Getting enough fibre
Many gluten free grains are lower in fibre than those that contain gluten. Try these alternatives:
- Eat plenty of fruit and vegetables, legumes (e.g. baked beans, lentils, chick peas) and nuts – these foods are naturally gluten free and high in fibre.
- Use brown rice as it contains more fibre than white rice. Mix your rice with legumes or gluten free grains like quinoa to increase the fibre content.
- Add extra fibre to your breakfast cereal or baked foods by adding psyllium husks or rice bran.
Low glycemic index choices
Many gluten free grains have a higher glycemic index (GI).
Some lower GI gluten free foods are:
- Basmati, Doongara (Clever) rice and other long grain rice varieties
- Gluten free breads labelled as low GI
- Grains such as quinoa, buckwheat and amaranth
- Legumes
- Fruit
- Corn, yams
- Dairy products – milk and yoghurt.
Carbohydrate counting and gluten free foods
Getting diagnosed with coeliac disease can make carbohydrate counting more difficult, as it can mean a big change in the type of carbohydrate foods that you eat.
The amount of carbohydrate in gluten free foods may be different to their gluten-containing equivalent (e.g. rye bread and gluten free bread). Different brands of the same type of gluten free food may also contain varying amounts of carbohydrate.
Because of this, it is important not to rely on standard carbohydrate values. Check each food label to find out the amount of carbohydrate in the specific food type and brand you are eating.
Remember that many carbohydrate foods are naturally gluten free – starchy vegetables, many dairy foods, fruit, legumes and rice. You can continue counting these as you have done before. Read more about carbohydrate counting in the tab above, or read our factsheet.
More information
Children with type 1 diabetes are routinely screened for coeliac disease, usually on an annual basis. There are no set guidelines on how often adults with type 1 diabetes should be screened. However, screening should take place at diagnosis and be repeated every few years. Talk to your doctor if you have not been screened for several years.
If you have type 2 diabetes, experience the above symptoms and are concerned you may have coeliac disease, talk to your doctor about whether you may need to be screened.
Read our factsheet on diabetes and coeliac disease.
Coeliac Victoria & Tasmania provides support and information on living with coeliac disease. Valuable resources include how to manage a gluten free diet, choosing gluten free ingredients, and advice on where to find shops and restaurants that cater for gluten free diets.
All people with diabetes and coeliac disease should see an Accredited Practising Dietitian who specialises in these areas, to assist with balancing the nutrition needs of these two conditions. Contact our Helpline on 1800 637 700 to speak with a Diabetes Victoria dietitian, or go to the Dietitians Australia website to find a dietitian near you.
Diabetes Australia has also produced a booklet on living with diabetes and coeliac disease and it can be purchased from Coeliac Victoria & Tasmania.
Link to Diabetes Victoria Clinic.