For as long as I can remember, my uncle, who has had Type 1 diabetes (T1D) since his teens, has focused on controlling his blood sugar to avoid common complications of the disease. He knew that managing his diabetes well could help decrease his risk of developing the vascular, kidney, and eye problems everyone talks about—but he wasn’t prepared for his thyroid to stop working as a result of autoimmune thyroid disease.
My uncle’s experience isn’t unusual. For many people, T1D is only part of their health story. Autoimmune diseases are more common in people with T1D. In fact, a recent examination of the T1D Clinic Exchange Registry revealed that nearly 1/5 of children under the age of 6 with T1D had another autoimmune disease. Older adults were even more impacted. Of those aged 65 and older, nearly half had at least one other autoimmune disease.
The most common autoimmune conditions associated with T1D are Hashimoto’s thyroiditis/hypothyroidism and celiac disease. These two conditions are so common that the ADA recommends early and routine screening for them. Healthcare providers should test people for celiac and thyroid autoantibodies when they are diagnosed with T1D and follow up regularly. Patients and doctors should also be on the lookout for symptoms of the two conditions, such as fatigue, changes in weight or glycemic control, and problems associated with digestion.
Our immune system is designed to keep us healthy by protecting the body from foreign invaders, like bacteria and viruses, that can make us sick. It sends signals—inflammation—that activate immune cells. Certain cells make antibodies which neutralize and flag threats for destruction, while others destroy the threats directly. But sometimes this complex system goes awry and attacks the very organs and tissues it was designed to protect—that’s when an autoimmune disease occurs. Researchers don’t know exactly why this happens, but studies suggest that genetic and environmental factors both play a role.
According to experts, most autoimmune conditions seem to share several characteristics: difference in the DNA of genes that encode the parts of the immune system, inappropriate antibody production, and chronic inflammation.
Studies of individuals with T1D-associated autoimmunity found that risk of T1D, autoimmune thyroid disease, and celiac disease were all associated with “genetic risk factors” or specific genotypes for a handful of immune system genes. Such genetic risks may set the stage for immune system mistakes. Because DNA passes through generations, it’s not surprising that families of people with T1D have increased risk of a variety of autoimmune diseases. My family’s health status reflects this—we all have at least one autoimmune disease that is commonly associated with T1D.
Specific gene sequences may confer risk for developing an autoimmune disease, but it takes inflammation and production of antibodies that recognize harmless substances and even our own cells to cause damage. Let’s take a look at T1D. During early phases of the disease, the body makes antibodies to insulin.Later, the immune system produces autoantibodies (antibodies that recognize self cells) that target pancreatic islets and insulin–secreting beta cells for destruction by T cells. Other autoimmune diseases involve autoantibodies for other organs and tissues. For example, Hashimoto’s thyroiditis involves antibodies for thyroid tissues.
Autoantibodies can be activated by initial inflammation of an organ. When they bind to their target, they turn on signaling pathways that cause even more inflammation. This cycle creates a perfect storm of chronic inflammation and autoimmunity. Unchecked, the chronic inflammation increases immune activity and causes even more damage to target tissues. In T1D, destruction of beta cells means that the body can’t produce its own insulin. In other autoimmune diseases, damage to tissues creates disease-specific symptoms, such as thyroid hormone insufficiency or ulceration of the intestines and malabsorption.
The immune system is so complex that it’s difficult to identify the exact mechanism causing the body to attack itself. Because of this, autoimmune diseases are hard to treat. Hormone replacement, elimination diets, anti-inflammatories, and immunosuppressive drugs may help decrease symptoms, but they’re not a cure. Stopping the cycle of inflammation may be the key to preventing more serious damage or additional autoimmune conditions. But how can one break the cycle? According to Harvard Health, diet can be a powerful tool in managing chronic illness. By avoiding pro-inflammatory foods such as refined carbohydrates, while increasing consumption of anti-inflammatory foods like berries, healthy fats, leafy green vegetables, and fish you might actually decrease chronic inflammation and experience better health.
Knowing that you have an increased risk of developing another autoimmune disease can feel overwhelming, but as they say, information is power. My family tries to use a healthy diet to feel better and decrease our chronic inflammation. This way, we hope that our current diagnoses might be our last.