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 OK. She didn't realize that another problem could be causing the fatigue until medical tests revealed that Maya had a thyroid problem.
Maya's situation isn't uncommon — kids and teens with type 1 diabetes have a greater risk for certain other health problems, many of which also are autoimmune disorders. Although their diabetes health care teams will monitor kids for signs of these problems, parents also should know what to watch for so that they can alert doctors and seek treatment, if necessary.
About Autoimmune Disorders
In autoimmune disorders, the immune system mistakenly attacks the body's healthy tissues as though they were foreign invaders. A severe attack can get interfere with the function of that body part.
Type 1 diabetes is an autoimmune disease in which the pancreas can't make insulin because the immune system attacks it and destroys the cells that produce insulin. Kids and teens with type 1 diabetes are at risk for other autoimmune problems, but these disorders are not actually caused by the diabetes.
Doctors still aren't exactly sure why autoimmune diseases occur, but genetic factors probably play an important role because relatives of people with type 1 diabetes are more likely to have autoimmune diseases.
Most kids with type 1 diabetes never need treatment for any other autoimmune disorder. But those who do might develop:
- thyroid disorders
- celiac disease
- Addison's disease
These disorders, which aren't caused by problems with blood sugar control, can develop before a child is diagnosed with type 1 diabetes or months or years after the diabetes diagnosis.
Kids and teens with type 1 diabetes are more likely to get disorders affecting 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 people with type 1 diabetes, affecting 15% to 20% of them.
Thyroid disease can cause the thyroid gland to make too much thyroid hormone (hyperthyroidism) or too little hormone (hypothyroidism). Both hyperthyroidism and hypothyroidism can be accompanied by an enlarged thyroid gland, also called a goiter, though it's not always 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 out.
Someone with mild hypothyroidism may feel just fine, and in fact, might have no symptoms at all. However, symptoms can become more obvious if the condition worsens. People with underactive thyroids might feel depressed and sluggish, may 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 about symptoms and feel your child's neck for an enlargement of the thyroid gland or order blood tests.
Kids with thyroid problems might be prescribed medication to bring their thyroid hormone levels back to normal.
Celiac disease is another autoimmune disorder that's more likely to occur in people with type 1 diabetes, affecting about 1 in 20. It interferes with the intestine's ability to tolerate the protein gluten, which is found in grains like wheat and barley.
When kids with celiac disease eat foods containing gluten, their immune systems react to it, causing gastrointestinal symptoms. Over time, exposure to gluten damages the small intestine and prevents it from properly absorbing nutrients from food.
Some people 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 growth problems because they aren't getting enough nutrients. If not treated, celiac disease can lead to hypoglycemia, osteoporosis (a disease that causes brittle, fragile bones), and certain types of cancer.
If your child has type 1 diabetes, your doctor may do a blood test to check for celiac disease, even if there are no symptoms. If the doctor suspects celiac disease, your child might undergo a small-bowel biopsy (the removal of a piece of tissue from the small intestine for examination) to confirm the diagnosis.
Kids and teens who have celiac disease must follow a gluten-free diet (no wheat, rye, and barley products). They'll 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.
Addison's disease, a type of adrenal insufficiency, is an autoimmune disease that affects the adrenal glands of the endocrine system. These glands, located just above the kidneys, produce hormones, including cortisol and aldosterone, that help control many body functions, particularly those related to its response to stress. They affect blood pressure, fluid balance, heart function, the immune system, the body's response to insulin, metabolism, and a person's sense of alertness and well-being. If someone has Addison's disease, the adrenal glands don't produce enough cortisol and also might not produce enough aldosterone.
Signs and symptoms of Addison's disease start slowly. These can include fatigue, muscle weakness, appetite loss, or weight loss. Some people experience nausea, vomiting, diarrhea, dizziness and low blood pressure, skin discoloration (especially in skin creases, like the elbows), irritability, depression, or irregular periods.
For about 1 in 4 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 suspect Addison's disease, they'll run tests, including urine and blood tests, to diagnose it. The condition is treated with medication to bring adrenal hormone levels back 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.
Knowing which signs and symptoms to watch for and making sure your child gets regular checkups and the tests recommended by your doctor will help reduce or prevent the effects of these disorders.
Reviewed by: Steven Dowshen, MD
Date reviewed: August 2013