Maya - who has
type 1 diabetes
- started feeling tired and sluggish all the time, but her blood
sugar levels were in a healthy range, so her mom thought she was
doing OK. She didn't suspect that another problem could be
causing Maya's fatigue. But after a visit with Maya's
doctor to talk to him about Maya's symptoms, tests revealed
that Maya had a problem with her thyroid.
Maya's situation isn't uncommon because kids and teens
with type 1 diabetes have a greater risk for certain other health
problems, many of which are also autoimmune disorders. Although
your child's health care team will be monitoring your child for
signs of these problems, it's important for you to learn to
recognize these signs, too, so that you can consult your
child's doctor and get treatment for your child, if
What Are Autoimmune Disorders?
In autoimmune disorders, the
mistakenly attacks the body's healthy tissues as though they
were foreign invaders. If the attack is severe enough, it gets in
the way of the function of that body part. Type 1 diabetes is an
autoimmune disease (in which the pancreas is affected), and kids
and teens with the disease are more prone to having other
autoimmune problems. In type 1 diabetes, the pancreas can't
make insulin because the immune system attacks the pancreas and
destroys the cells that make insulin.
Though doctors still aren't exactly sure why autoimmune
diseases occur, genetic factors probably play an important role
because family members of people with type 1 diabetes are more
likely to have autoimmune diseases.
Autoimmune disorders are not actually
by the diabetes - they're just more likely to happen to people
with the disease.
Although most kids with type 1 diabetes never need treatment for
any other autoimmune disorder, some of the autoimmune diseases that
people with type 1 diabetes are more likely to get include:
- thyroid disorders
- celiac disease
- Addison's disease
Sometimes kids and teens with type 1 diabetes develop one or
more of these disorders before they develop type 1 diabetes, or
sometimes they are discovered when a kid with newly diagnosed
diabetes is tested for them. In other children, the disorder may
not develop until months or years after they've been diagnosed
with type 1 diabetes. These autoimmune disorders aren't caused
by problems with your child's
blood sugar control
Kids and teens with type 1 diabetes are more likely to get
certain disorders that affect the thyroid, a gland located behind
the skin and muscles at the front of the neck, just at the spot
where a bow tie would rest. The thyroid, which is part of the
endocrine system, makes hormones that help control metabolism and
growth. These hormones play a role in bone development, puberty,
and many other body functions.
Thyroid disease is fairly common in kids with type 1 diabetes -
about 15% to 20% of people with type 1 diabetes show some signs of
autoimmune disease of the thyroid gland.
Thyroid disease can cause the thyroid gland to make too much
thyroid hormone (
) or too little hormone (
). Both hyperthyroidism and hypothyroidism can be accompanied by an
enlarged thyroid gland, also called a
, though this might not always be apparent.
Hyperthyroidism can cause nervousness, irritability, increased
perspiration, intolerance to heat, fatigue, difficulty sleeping, a
fast heartbeat, irregular menstrual periods in girls, and muscle
weakness. People with this problem might lose weight even though
they're eating more than usual. The eyes may feel irritated or
look like they're staring. Sometimes the tissues around the
eyes become inflamed and swollen, and the eyes appear to bulge
A child with mild hypothyroidism may feel just fine - in fact,
the condition might cause no symptoms at all. However, symptoms can
become more obvious if the condition worsens. People with
underactive thyroids might feel depressed and sluggish. They might
gain weight, even though they're not eating more or getting
less exercise than usual. Kids with hypothyroidism also might have
slow growth in height, slow sexual development, irregular menstrual
periods in girls, muscle weakness, dry skin, hair loss, poor
memory, and difficulty concentrating.
To check for thyroid disorders, the doctor may ask your child
about whether he or she has had symptoms of a thyroid problem
during regular checkups. He or she may also feel your child's
neck for an enlargement of the thyroid gland or order blood tests
to check for thyroid problems.
To treat hypothyroidism, kids and teens may need to take pills
that keep their thyroid hormone levels normal. Kids and teens with
hyperthyroidism may receive pills or other treatments to bring
their thyroid hormone levels back down to normal and keep them
Another type of autoimmune disorder that's more likely to
occur in kids with type 1 diabetes is celiac disease. About one in
20 people with type 1 diabetes has celiac disease, which affects
the intestine's ability to tolerate a protein called gluten.
Gluten is found in grains like wheat and barley, and when kids and
teens eat foods containing gluten, their immune system reacts to
it, causing gastrointestinal symptoms. Over time, exposure to
gluten damages the small intestine and prevents it from properly
absorbing nutrients from food.
Some kids and teens with celiac disease have no symptoms, but
others may have frequent diarrhea, abdominal pain, gas, bloating,
weight or appetite loss, or fatigue. Some kids and teens with
celiac disease have
because they aren't getting enough nutrients. If it's not
treated, celiac disease can lead to
, osteoporosis (a disease that causes brittle, fragile bones), and
certain types of
If your child has type 1 diabetes, your child's doctor may
do a blood test to check for celiac disease, even if your child has
no symptoms. If your child's doctor suspects celiac disease,
your child might require a small bowel biopsy (which involves
removing a piece of tissue from the small intestine and examining
it under the microscope) to confirm the diagnosis.
Kids and teens who have celiac disease need to eat a diet
that's free of gluten-containing foods, such as wheat, rye, and
barley products. Your child will still need to eat a balanced diet
to stay healthy and maintain good control of blood sugar levels,
though, so the doctor may recommend that you meet with a registered
dietitian to learn about choosing and preparing gluten-free foods
for your child.
Addison's disease, a type of adrenal insufficiency, is an
autoimmune disease that affects the adrenal glands of the endocrine
system. These glands, which are above the kidneys, produce
hormones, including cortisol and aldosterone. These hormones help
control many body functions, particularly those related to its
response to stress. They impact blood pressure, fluid balance,
heart function, the immune system, the body's response to
, and a person's sense of alertness and well-being. If a person
has Addison's disease, the adrenal glands don't produce
enough cortisol and may not produce enough aldosterone, as
Signs and symptoms of Addison's disease start slowly. People
might have fatigue, muscle weakness, appetite loss, or weight loss.
Sometimes people experience nausea, vomiting, and diarrhea, too.
Some people have dizziness and low blood pressure, skin
discoloration (a darkening of the skin, especially in areas where
the skin creases, like the elbows), irritability, depression, or
For about one in four people with Addison's disease,
symptoms don't appear until they're triggered by a
stressful event, such as illness or an accident. These symptoms can
be more severe and come on suddenly. This is called an addisonian
crisis, or acute adrenal insufficiency. If this happens to your
child, it's important to get medical help immediately.
When doctors think that a kid or teen has Addison's disease,
they can perform tests, including urine and blood tests, to
diagnose it. Addison's disease is treated with pills that bring
adrenal hormone levels up to normal.
What You Can Do
Although you can't prevent these health problems related to
type 1 diabetes, the good news is that thyroid disorders, celiac
disease, and Addison's disease can all be treated successfully
most of the time. Being aware of the signs and symptoms of these
health problems and making sure your child gets the checkups and
tests recommended by your child's doctor will minimize or
prevent the effects of these disorders on your child's
Steven Dowshen, MD
Date reviewed: September 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.