Warning Signs of Co-Morbidities for Type 1 Diabetes
It is difficult enough managing type 1 diabetes mellitus (T1DM). Unfortunately, patients with Type 1 diabetes are at higher risk for a variety of autoimmune diseases. Having any of these can make it much more difficult to maintain the control T1DM requires.
Below is a partial list of possible comorbidities, and the initial symptoms of each.
Autoimmune Thyroid Disease (AIT)
The percentage of children with T1DM and AIT can be significant, and consistently higher than in those children who are not diabetic. The odds of acquiring AIT increase the older the child and the longer they have had diabetes.
Autoimmune thyroiditis can manifest several ways. The most common form (and the most common comorbidity overall for children with T1DM) is Hashimoto’s Disease, with or without goiter (thyroid enlargement)
Symptoms of Hashimoto’s with hypothyroidism include: fatigue; lack of energy; poor growth; poor school performance; loss of appetite; constipation; and cold intolerance.
Hashimoto’s with hyperthyroidism is another disorder that is common with these children. Symptoms include: increased appetite; weight loss; nervousness; tachycardia; palpitations; heat intolerance; and problems with concentration.
Graves’ Disease presents with goiter and any combination of the symptoms listed above. One symptom specific to Graves’ is bulging eyes.
Regular thyroid screening of all children with T1DM is strongly recommended.
Celiac Disease (CD)
Celiac Disease is also known as gluten-sensitive enteropathy. Consuming gluten damages the small bowel, leading to various clinical manifestations. CD causes malabsorption throughout the bowel.
Symptoms of CD include: diarrhea; gas; bloating; swollen ankles; anemia; fatigue; and excessive bruising and bleeding due to vitamin K deficiency. CD is occasionally asymptomatic. However, even if asymptomatic, damage can be occurring.
CD may only be positively diagnosed by biopsy of the small intestine.
Autoimmune Atrophic Gastritis (AAG)
AAG is rare, but more commonly occurs in the presence of T1DM. It is the result of the immune system attacking the cells lining the stomach, damaging the cells that produce the acid needed to digest food. Antibodies also attack intrinsic factor, which is needed for the absorption of vitamin B12, resulting in pernicious anemia (see below.)
Symptoms include: feeling weak and lightheaded; dizziness; palpitations; chest pain; tinnitus.
Diagnosis is primarily through blood tests and physical examination.
Pernicious Anemia (PA)
PA is the result of malabsorption of vitamin B12. This might be the result of AIG, or the failure of the body to produce intrinsic factor (IF), a protein manufactured in the gut to enable the absorption of vitamin B12.
PA is sometimes asymptomatic. Symptoms, when they appear, may be vague, and include pica (the compulsion to eat non-food things); diarrhea; fatigue; loss of appetite; problems concentrating; paleness; shortness of breath; and swollen, red tongue and/or bleeding gums.
Screening for PA should occur when the diagnosis of AIG or thyroiditis is present.
Addison’s Disease (AD)
AD occurs when the adrenal glands produce insufficient amounts of certain hormones, including cortisol and aldosterone.
Symptoms usually come on slowly, over several months, and include: muscle weakness and fatigue; darkening of the skin; weight loss and decreased appetite; low blood pressure; fainting; salt cravings; hypoglycemia; nausea; irritability; muscle and joint pains; and body hair loss.
AD may occur suddenly, and symptoms would include: pain in lower back, abdomen or legs; severe and persistent vomiting, leading to dehydration; low blood pressure; unconsciousness; and high potassium levels.
Diagnosis is through blood tests and, occasionally, a cat scan of the abdomen.
Vitiligo
Vitiligo is a disorder that causes the loss of melanocytes and the appearance of irregular, non-pigmented, white spots on the skin. There have been many approaches to treatment, but most have met with little or no success.
Sources: National Center for Biotechnology Information (NIH) , National Diabetes Education Program (NIH) and Healthline.com
Image courtesy NIH Images
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