Children with coeliac disease & diabetes Posted by Jackie MOT on 27/4/2008
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........If you would like more support over diabetes/coeliac/thyroid issues and to talk to other parents of young children with diabetes and coeliac there is a mailing list for UK parents. You can find info by going here.
www.childrenwithdiabetes.com/uk/ If you want to subscribe, but have problems doing so, contact me on jackie.jacombs@childrenwithdiabetes.com and I can give you more info or subscribe you manually
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CELIAC-DIABETES is a support List for all persons with Celiac Disease and Diabetes. Gluten intolerance, lactose intolerance etc. are also included along with Insulin Resistance, Syndrome X and the various types of Diabetes.
www.enabling.org/ia/celiac/index.html#cel-dia***************
Diabetes Team questions www.childrenwithdiabetes.com/dteam/index_celiac.htm*************
ncomplete gastric metaplasia in children with insulin-dependent diabetes mellitus and celiac disease. An ultrastructural study.
Conclusions
The present work suggests that patients with IDDM/CD may represent a subgroup in the context of the CD population. Intestinal biopsies of such individuals often show accumulation of electrondense granules in the apical cytoplasm of enterocytes that can be interpreted as incomplete gastric metaplasia.
www.biomedcentral.com/1472-6890/1/2********************
DiabetesFrom Jackie on GF board:
I think that there is a misunderstanding between the two types of diabetes. Type 1 diabetes is an autoimumne disease, usually found in younger people, ages from babies to teenagers and young adults. Type 2 diabetes is more often found in older people who have a weight problem. Though this is not always true. I know several type 2’s that are not overweight at all. You don’t have to be very overweight at all to be at risk from type 2 diabetes, especially if you have a family member with type 2 diabetes. If you are type 1 then you have NO insulin production at all. All your insulin comes from an external source, insulin injections. Therefore, as you are giving insulin to cover ALL foods, as long as you calculate the total carb amount, you can, in theory, eat almost anything you like. Though, of course, from a health point of view, a diet containing lots of unrefined sugars and fats is not a good diet, bad for the teeth as well.
In people who are type 2 the body does produce insulin, but either not enough, or at the wrong times and there is usually insulin resistance, meaning that the insulin is not able to work properly. Type 2's frequently take drugs to combat the insulin resistance. Eventually some having to move on to injections later. During the early stages of this condition, it may be possible to control the blood sugars without pills or injections. Which means using a low carb diet and exercising. In which case low carb/calorie products are probably helpful. But the trouble with some of the sugar substitutes, they are not actually lower in carbs or claories.
For instant “diabetic chocolate” is misleading because the carb count is the same, in most cases . If one was an was a type 2 who was overweight then chocolate of any sort will be just as high calorie in most cases. I think people and relatives are mislead into thinking that diabetic products are OK for diabetics and that they have no effect on the blood sugars. People still buy the twins diabetic chocolate and spend twice as much when it is not necessary.
I don’t know why places sell such a lot of "diabetic" chocolate and sweets still. Thornton’s sell them as well. The twins really don’t like being given chocolate and sweets as presents either, because if you have diabetes you still have to fit them in to a "meal plan" and probably have to eat them at certain times. So if you can't scoff the sweets just when you want or you have to have an injection to cover the carbs, then it’s really not quite the same the same pleasure anymore.
In the past, the labelling has been associated with confectionery foods i.e. sweets, biscuits, cakes and chocolate that contained a bulk sweetener like sorbitol or fructose instead of sugar (sucrose).These products could be labelled sugar-free as the bulk sweeteners are not classed as sugars. However, the products have similar nutritional content as standard confectionery foods and therefore still raise blood glucose levels in a similar way and contain similar calories.
Diabetic chocolate contains a bulk sweetener like fructose or sorbitol in place of sugar. However the nutritional content is similar in terms of fat and calorie content. Both diabetic and standard chocolate will raise blood glucose levels in people with diabetes. Diabetic chocolate has been shown to be more expensive. Surveys in the past have indicated that it can be four times the price of standard chocolate.
Confectionery foods like cakes, biscuits, sweets and chocolates only make a small contribution to the overall diet, so the sort of confectionery foods consumed, as part of a balanced diet will not make that much difference to diabetes control in the long-term. It is best to avoid sugary drinks and regular consumption of confectionery, in terms of dental health as well as blood glucose control when you have diabetes.
Confectionery like chocolate is high in fat and calories as well as sugar and therefore should be limited if people with diabetes need to lose weight
The current status is a Trading Standards issue and in general the labelling of a food as diabetic is still related to bulk sweetener content versus sugar content. This practice is not helpful to people with diabetes, as the so-called "diabetic" product provides no real benefit in terms of nutritional value or effect on blood glucose levels, in the context of the contribution of confectionery to the diet. The focus on sugar content is also not in line with the key aims of dietary management in diabetes care which are weight management,in type 2 diabetes, and to minimise the risk of cardiovascular disease.
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Posted by Charlotte, Oxford on 1/12/2004
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Diabetes: Younger Age at Onset and Sex Predict Celiac Disease in Children and Adolescents with Type 1 Diabetes Diabetes Care 2004;27:1294-1298.
(From Celiac.com 11/29/2004
In an effort to determine the prevalence of biopsy-confirmed celiac disease in Italian children and adolescents with type 1 diabetes, and to determine whether age at onset of diabetes is independently associated with the diagnosis of celiac disease, Dr. Franco Cerutti and colleagues at the Universita di Torino, Italy looked at 4,322 children and adolescents (4-11 years old) who had type 1 diabetes. Yearly celiac disease screening was performed on them by using IgA/IgG anti-gliadin and IgA anti-endomysium antibodies, and those with positive antibody results were given a biopsy for confirmation. Out of 4,322 children screened 292 or 6.8% had celiac disease. In 89% of cases diabetes was diagnosed before celiac disease. Using logistic regression analyses the researchers determined that those diagnosed with diabetes at a younger age, those who are female, and those with a thyroid disorder are independently associated with the risk of having both diabetes and celiac disease.
The researchers conclude: “We have provided evidence that 1) the prevalence of biopsy-confirmed celiac disease in children and adolescents with type 1 diabetes is high (6.8%); 2) the risk of having both diseases is threefold higher in children diagnosed with type 1 diabetes at age <4 years than in those age >9 years; and 3) girls have a higher risk of having both diseases than boys.”
Also in their conclusion is the following advice about screening:
"Therefore, our findings support the recommendation to annually screen asymptomatic children and adolescents at least by 4 years’ duration of diabetes, particularly children with age at onset of diabetes <4 years and girls. Given the cost of tests (approximately $12 per sample for EMA measurement), it is advisable to continue screening asymptomatic children to at least up to 10 years’ duration of diabetes, with intervals depending on local economic resources."
care.diabetesjournals.org/content/27/6/1294.full************
Posted by Jackie Mum of twins on 23/5/2005
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Risk of Celiac Disease Autoimmunity and Timing of Gluten Introduction in the Diet of Infants at Increased Risk of Disease. Full Text available
Context While gluten ingestion is responsible for the signs and symptoms of celiac disease, it is not known what factors are associated with initial appearance of the disease.
Objective To examine whether the timing of gluten exposure in the infant diet was associated with the development of celiac disease autoimmunity (CDA).
Design, Setting, and Patients Prospective observational study conducted in Denver, Colo, from 1994-2004 of 1560 children at increased risk for celiac disease or type 1 diabetes, as defined by possession of either HLA-DR3 or DR4 alleles, or having a first-degree relative with type 1 diabetes. The mean follow-up was 4.8 years.
Main Outcome Measure Risk of CDA defined as being positive for tissue transglutaminase (tTG) autoantibody on 2 or more consecutive visits or being positive for tTG once and having a positive small bowel biopsy for celiac disease, by timing of introduction of gluten-containing foods into the diet.
Results Fifty-one children developed CDA. Findings adjusted for HLA-DR3 status indicated that children exposed to foods containing wheat, barley, or rye (gluten-containing foods) in the first 3 months of life (3 [6%] CDA positive vs 40 [3%] CDA negative) had a 5-fold increased risk of CDA compared with children exposed to gluten-containing foods at 4 to 6 months (12 [23%] CDA positive vs 574 [38%] CDA negative) (hazard ratio
, 5.17; 95% confidence interval [CI], 1.44-18.57). Children not exposed to gluten until the seventh month or later (36 [71%] CDA positive vs 895 [59%] CDA negative) had a marginally increased risk of CDA compared with those exposed at 4 to 6 months (HR, 1.87; 95% CI, 0.97-3.60). After restricting our case group to only the 25 CDA-positive children who had biopsy-diagnosed celiac disease, initial exposure to wheat, barley, or rye in the first 3 months (3 [12%] CDA positive vs 40 [3%] CDA negative) or in the seventh month or later (19 [76%] CDA positive vs 912 [59%] CDA negative) significantly increased risk of CDA compared with exposure at 4 to 6 months (3 [12%] CDA positive vs 583 [38%] CDA negative) (HR, 22.97; 95% CI, 4.55-115.93; P = .001; and HR, 3.98; 95% CI, 1.18-13.46; P = .04, respectively).
Conclusion Timing of introduction of gluten into the infant diet is associated with the appearance of CDA in children at increased risk for the disease.
Link:
jama.ama-assn.org/cgi/content/full/293/19/2343 *******************************
Posted by Charlotte, Oxford on 7/11/2006,
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NB This new Danish study confirms a very high prevalence of CD in T1D (12%) and also that children diagnosed with diabetes at a younger age were the most at risk.
Diabetes Care 29:2452-2456, 2006
© 2006 by the American Diabetes Association
Clinical Benefit of a Gluten-Free Diet in Type 1 Diabetic Children With Screening-Detected Celiac Disease A population-based screening study with 2 years’ follow-up
Dorte Hansen, MD, PHD1, Bendt Brock-Jacobsen, MD, DMS1, Elisabeth Lund, MD2, Christina Bjørn, MD3, Lars P. Hansen, MD4, Christian Nielsen, CS5, Claus Fenger, MD, DMS6, Søren T. Lillevang, MD, PHD5 and Steffen Husby, MD, DMS1
1 Department of Pediatrics, Odense University Hospital, Odense, Denmark
Address correspondence and reprint requests to Dorte Hansen, Department of Pediatrics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. E-mail: dorte.hansen@dadlnet.dk
OBJECTIVE—This study was performed to 1) determine the prevalence of celiac disease in Danish children with type 1 diabetes and 2) estimate the clinical effects of a gluten-free diet (GFD) in patients with diabetes and celiac disease.
RESEARCH DESIGN AND METHODS—In a region comprising 24% of the Danish population, all patients <16 years old with type 1 diabetes were identified and 269 (89%) were included in the study. The diagnosis of celiac disease was suspected in patients with endomysium and tissue transglutaminase antibodies in serum and confirmed by intestinal biopsy. Patients with celiac disease were followed for 2 years while consuming a GFD.
RESULTS—In 28 of 33 patients with celiac antibodies, an intestinal biopsy showed villous atrophy. In 5 patients, celiac disease had been diagnosed previously, giving an overall prevalence of 12.3% (95% CI 8.6–16.9). Patients with celiac disease had a lower SD score (SDS) for height (P < 0.001) and weight (P = 0.002) than patients without celiac disease and were significantly younger at diabetes onset (P = 0.041). A GFD was obtained in 31 of 33 patients. After 2 years of follow-up, there was an increase in weight SDS (P = 0.006) and in children <14 years old an increase in height SDS (P = 0.036). An increase in hemoglobin (P = 0.002) and serum ferritin (P = 0.020) was found, whereas HbA1c remained unchanged (P = 0.311) during follow-up.
CONCLUSIONS—This population-based study showed the highest reported prevalence of celiac disease in type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a GFD. We recommend screening for celiac disease in all children with type 1 diabetes.
care.diabetesjournals.org/content/29/11/2452.abstract***************
Type 2 Diabetes & general refs for coeliac/diabetes dietsPosted by Charlotte, Oxford on 25/9/2008
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NB Re diagnosis with Type 2 diabetes: bear in mind that most info on the GF diet for diabetics relates to Type 1 Diabetes (basically for parents managing the diet in diabetic children who have just got an additional CD dx). Not only are all T1Ds on a regular insulin regime from diagnosis (whereas most T2Ds will only progress to this at a later stage) but the dietary requirements may also slightly different as most T2Ds will be wanting to limit calories and lose weight.
This (for children with T1D) is excellent:
www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/KupperArticle.pdf Also general info useful for coeliacs:
www.gluten.net/downloads/print/DiabetesandCDflat.pdf Also useful if interested in food and cooking are some of the many websites on low glycaemic diets. Although these are not specifically GF much of the info is relevant and very interesting: some facts are logical (unripe banana better than ripe) but some may seem counter-intuitive eg new potatoes have a lower GI than baked; Uncle Ben's rice has a lower GI than brown rice. It's all quite complex and requires detailed reading. The whole glycaemic thing is not straight forward as there's Index and Load. This is excellent:
www.mendosa.com/gilists.htm (which includes the Revised International Table of Glycemic Index (GI) and Glycemic Load (GL) Values of 750 foods 2002 By David Mendosa)
Sometimes complications such as gastroparesis (slow stomach emptying) may be more common in coeliac diabetics so should also be considered:
digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/ It may also be important to ensure that pancreatic insufficiency is not a factor. This is more common in T1D but since it is one of the most common (and undiagnosed) complication of adult dx CD, should perhaps be tested for, if not already done:
www.pharmaceutical-int.com/categories/coeliac-disease/coeliac-disease-and-pancreatic-exocrine-insufficiency.asp Above all, for recently diagnosed T2D, the most important thing is to have a good endocrinologist and be regularly monitored for all complications of diabetes and to keep eg blood pressure and cholesterol under very good control (statins are one of the most important therapies for many diabetics). However recent research suggests that individuals with T2D "over monitoring" themselves (blood sugar tests) may not be useful and cause unnecessary anxiety. (My husband is involved in this type of research).
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Genetic Link Between Type 1 Diabetes, Celiac Disease Seen Posted by Jackie MOT on 11/12/2008
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Genetic Link Between Type 1 Diabetes, Celiac Disease Seen
WEDNESDAY, Dec. 10 (HealthDay News) -- Researchers have identified common genetic mutations between type 1 diabetes and celiac disease, suggesting that the two inflammatory disorders may stem from a shared underlying mechanism.
The finding also suggests that the two diseases may be triggered by similar environmental factors.
"Our results spotlight that much more research needs to go into investigating the environmental factors involved," said study senior author John Todd, of the Cambridge Institute for Medical Research at the University of Cambridge in the U.K. "Additionally, research investigating whether there are benefits for type 1 diabetics knowing they are positive for celiac is important. There needs to be clinical research to see if this information could help them."
Type 1 diabetes is a disease in which the body doesn't produce insulin, a hormone needed to convert blood sugar (glucose) into energy for cells.
Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People with celiac disease can't tolerate gluten, a protein that's found in wheat, rye and barley, according to the U.S. National Institutes of Health.
Researchers had previously seen genetic links between type 1 diabetes and celiac disease, which, together, affect about 1 percent of the population, Todd said.
But the new research shows there is "considerable overlap, and much more than we anticipated" he said. "Almost every celiac disease susceptibility gene had an effect in type 1 diabetes."
These similarities "suggest there's an important crisscross in both these diseases," said Dr. Robert Goldstein, chief scientific officer of the Juvenile Diabetes Research Foundation (JDRF). "What's missing is how do you relate that finding to biologic function or biologic dysfunction. That's the next step."
Knowledge on biological function could one day help spur treatments or cures for the diseases, the researchers suggested.
The study, released early online Wednesday by the New England Journal of Medicine, which will publish it in the Dec. 25 issue, was co-sponsored by the JDRF.
Both type 1 diabetes and celiac disease are autoimmune disorders, meaning they both result when the body mistakenly turns on itself. In type 1 diabetes, the body attacks the pancreatic beta cells, which produce insulin. In celiac disease, it's the small intestine that is damaged.
Many people who have type 1 diabetes also have celiac disease, and vice versa. According to the study authors, the small intestine and pancreas share some characteristics.
For this study, researchers analyzed DNA from blood samples from 8,064 people with type 1 diabetes, 2,828 families (both parents and a child) with celiac disease, and 9,339 "controls" -- people who didn't have diabetes or celiac disease.
Seven "loci," or regions of a chromosome, were shared in people with both diseases. These regions may be involved in regulating the processes that cause the body's immune system to go awry.
"Our plans are to understand in more detail what effects these susceptibility genes have on the immune system," Todd explained. "Also, research to identify why the autoimmune diseases are increasing and what environmental factors are influencing this is critical."
Weimin He, assistant professor at the Texas A&M Health Science Center Institute of Biosciences and Technology in Houston, said, "In future studies, it will be interesting to determine whether intake of gluten-free food will significantly decrease the incidence of type 1 diabetes in those who have genetic mutations and are thus more susceptible to type 1 diabetes."
More information
The Juvenile Diabetes Research Foundation has more on the double diagnosis of type 1 diabetes and celiac disease.
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