Type 1 Diabetes; It often occurs in childhood and adolescence. In general, 10% of diabetes cases in the population are Type 1 diabetes. Type 1 diabetes occurs when the insulin-producing beta cells of the pancreas are damaged for an autoimmune reason. Diagnosed people should take insulin hormone externally for life, as there is an absolute or relative insulin deficiency. Like all autoimmune diseases, Type 1 diabetes is a genetic disease in which environmental factors also play a role in the etiology of the disease. Individuals with type 1 diabetes have a 10% to 30% increased risk of developing other autoimmune diseases. These diseases are mainly autoimmune thyroid disease, celiac disease, autoimmune gastritis, vitiligo and adrenal autoimmunity. Patients with type 1 diabetes, who are considered high-risk individuals for celiac disease, often present the disease in an atypical or potential form. The presence of celiac disease in patients with type 1 diabetes in both forms may complicate the clinical management of the disease. In type 1 diabetes, the immune system, which takes action for an unknown reason, destroys the pancreatic beta cells that produce insulin. In celiac disease, the triggering factor is gluten. The metabolisms of celiac disease are better known than type 1 diabetes. However, apart from gluten, different infectious agents such as viruses (adenovirus type 12, hepatitis C virus, rotavirus) have also been shown as risk factors for celiac disease. Similarly, viruses such as enteroviruses and herpesviruses are also cited as trigger factors for type 1 diabetes. Genetic factors are of great importance in the etiology of both type 1 diabetes and celiac disease.
The clinical features of celiac disease may not be seen clearly in patients with type 1 diabetes. It is very important to detect celiac disease in patients with type 1 diabetes, in the presence or absence of symptoms, as the application of a gluten-free diet improves blood glycemic control and also has a positive effect on biochemical parameters. Therefore, it is strongly recommended that patients with Type 1 diabetes be screened periodically for celiac disease. Findings to be evaluated for the diagnosis of celiac include abdominal pain and bloating, weight loss, fatigue, growth retardation, unexplained infertility, low bone mineralization, vitamin-mineral deficiency, anemia, changes in liver enzymes or thyroid enzymes, and rarely lymphoma-associated T cell with enteropathy. . People with celiac type 1 diabetes have a higher propensity for hypoglycemic episodes and are also at increased risk for diabetic retinopathy and nephropathy. Gluten-free diet, which is the only treatment for celiac disease, can reverse growth retardation, osteopenia, anemia and hepatic dysfunction. First-degree relatives at high risk can also be evaluated in terms of risk by screening. If a diabetic child or adolescent develops intestinal or extraintestinal symptoms consistent with celiac disease, they should be screened.
Low glycemic index foods are recommended for patients with type 1 diabetes. Type 1 diabetes patients with undiagnosed or newly diagnosed celiac usually have poor glycemic control, lower total cholesterol, lower high-density cholesterol, lower diastolic blood, higher prevalence of nephropathy, and retinopathy. In these patients, height, weight, bone mineral density, and body mass index are often impaired. In addition to the gluten-free diet, these points should be considered in the nutrition program. Few recent studies show that these parameters improve within 1 year upon adherence to a gluten-free diet. Recommendations for treating type 1 diabetes with celiac are the same for all patients with celiac. A strict gluten-free diet should be initiated in those with serological and histological evidence. Patients should consult with a dietitian for gluten-free diet instruction and start a daily multivitamin due to deficiencies of certain vitamins and minerals that may develop. Treatment of celiac disease can affect the course of type 1 diabetes. Although more studies are needed, it has been reported that gluten-free diet will also have positive effects on type 1 diabetes. When planning nutritional therapy, blood sugar regulation should be kept in mind, taking into account the principles of diabetes. From gluten-free foods, it is absolutely necessary to add fiber-rich vegetables, fruits, legumes to the diet, and especially gluten-free products with enriched fiber content should be preferred.
Dietician Dilara Tuygan
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Alas, Celiac! What will happen now?
The only cure for celiac disease is a gluten-free diet. Patients need to maintain strict gluten-free meals for life. People diagnosed with celiac disease as a result of clinical symptoms, serological tests, and small bowel histology should immediately start a gluten-free diet. He should stay away from the consumption of wheat, barley, rye and oat foods and beverages that should eliminate gluten from his life. Gluten-containing and iced tea such as white bread, whole wheat bread, bran bread and pasta, bulgur are not consumed in the gluten-free diet. It should be used with gluten-containing foods, which we call cross contamination, which do not contain gluten, but in this utility, attention should be paid to gluten contaminated contents.
Serological, hematological and biochemical tests (complete blood count, iron profiles, thyroid tests, calcium, magnesium, zinc, B12, folic acid and vitamin D) density and dietary compliance should be monitored. It is also important in follow-up in children.
Transglutaminase needs to be measured in a certain way to observe the effect of gluten-free treatment. If there are serological findings that do not improve at the end of a year, it should be considered that there is contamination in the diet. Serological tests are considered as a symptom of reaching normal levels, and it is known that the fastest serological tests in celiac disease reach their normal values in the 6th month and the slowest at the end of the 1st year.
A gluten-free diet should be followed very strictly. Very low amounts of gluten can cause clinical symptoms to persist. Celiac patients and their relatives should be well aware of the free, unfavorable foods that are included in the gluten-free diet and which should be controlled.
Dietician Armoni Yılmaz
Guide to Diagnosis, Treatment and Follow-up for Family Physicians in Celiac Disease, 2019
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Öztürk, Y. E., Uyar, G. Ö., Serin, Y., & Gürkan, Ö. E. (2018). Gluten-Free Diet Treatment in Celiac Disease: A Case Report. Journal of Nutrition and Diet, 46 (3), 320-324