Type 1 diabetes (T1D) is an autoimmune disease, which means your body’s immune system has mistaken the beta cells in your pancreas for something foreign, and has worked to destroy these cells.
If your immune system has turned on you once, you have a higher chance of it happening again – which is why people with T1D are more likely to be diagnosed with another autoimmune condition, such as coeliac disease. It’s thought that about five out of 100 of people with T1D have coeliac disease.
About coeliac disease
People who have coeliac disease can’t tolerate a protein called gluten, which is found in wheat, rye and barley.
When people with coeliac disease eat foods with gluten in them, their immune system responds by damaging the small intestine. This affects how they absorb essential nutrients, such as glucose, as well as vitamins and minerals.
Some people don’t have any obvious symptoms, but common signs of coeliac disease include:
- bloating and gas
- dermatitis herpetiformis (a skin rash)
- diarrhoea
- fatigue
- joint pain
- vomiting
- stomach pain
- weight loss.
Over time, if left untreated, coeliac disease can lead to malnutrition. It can also cause slow growth, anaemia and osteoporosis.
Learn more about the signs and symptoms of coeliac disease.Â
How coeliac disease is diagnosed
You should be tested for coeliac disease when you’re first diagnosed with T1D. You should then be tested every year as part of your annual check-up.
The first step is a blood test that measures certain antibodies. From there, a biopsy of your small intestine can confirm a diagnosis.
Managing coeliac disease and type 1 diabetes
The only medical treatment for anyone with coeliac disease is a strict gluten-free diet.
Cutting out gluten can make managing diabetes harder. For starters, it can be a big change to your diet, as a lot of foods that contain gluten are also high in carbohydrate (such as bread and pasta).
Your blood glucose levels (BGLs) may be harder to manage after starting a gluten-free diet.
Due to the damage caused to your small intestine, you may experience temporary changes in how your body digests and absorbs food. In some cases, this can delay the rise in BGLs after consuming carbohydrates. It’s important to consider this when timing insulin doses and when treating an episode of hypoglycaemia.
When people with coeliac disease stop eating gluten, their gut lining starts to heal. This can improve nutrient absorption, including carbohydrates.
As your body adjusts and gets better at absorbing nutrients, it’s important to closely monitor your BGLs. You may have to adjust your insulin dose. Keep in close contact with your diabetes team for advice.
A dietitian with knowledge of diabetes and coeliac disease will help you with an eating plan to manage both conditions.
Gluten-free diets for people with type 1 diabetes
Gluten is in many foods that are rich in carbohydrate, so it’s important to choose the right foods to maintain both your BGLs and a healthy diet.
Gluten-free sources of carbohydrate include:
- grains, such as rice, polenta (cornmeal), buckwheat, millet and quinoa
- starchy vegetables, such as new potatoes, sweet potatoes, yams, cassava (tapioca) and plantains.
Other foods that are gluten-free include:
- beef
- eggs
- fish
- fruits
- nuts
- poultry
- vegetables.
Gluten can turn up in places you may not expect – it can be used as an additive in meats (such as sausages) and dairy foods (such as flavoured milks). Because of this, it’s important to check the nutrition information and ingredient panels of all food and drinks (a dietitian can show you how to do this if you’re not sure).
Some items you might not expect to find gluten in include:
- soy or teriyaki sauce
- marinades
- mixed spice packs
- meat substitutes
- salad dressing
- lollies (keep this in mind when buying hypo snacks)
- sliced deli meats
- imitation crab.
The good news is that most supermarkets now stock a range of gluten-free breads, pasta, cereals and crackers. Look for the Coeliac Australia endorsement logo on products when you’re shopping.
Eating out might be a bit more challenging, but a lot of restaurants now provide gluten-free alternatives. Coeliac Australia even has a list of accredited restaurants.
Cross-contamination
Cross-contamination occurs when gluten is unintentionally transferred from a food containing gluten to a gluten-free food.Â
If you’ve been diagnosed with coeliac disease, it’s important to replace items such as cutting boards, shared condiment jars, toasters, and air fryers that have been used with gluten-containing foods, as these may be contaminated with gluten.Â
Foods containing less than 20 milligrams of gluten per kilogram (20 parts per million) are generally considered safe for people with coeliac disease. But keep in mind that even small amounts of gluten, including crumbs from gluten-containing foods, can make food unsafe and may trigger symptoms.Â
Read more at Coeliac Australia
Support and resources
There are apps that can help you identify foods with gluten in them, and that list coeliac-friendly places to eat.
Coeliac Australia: The Coeliac Australia app provides detailed information on over 800 ingredients and 300 additives, helping you determine if they’re safe for a gluten-free diet. Note: this only applies to food sold in Australia and New Zealand.
Atly: Atly offers a map of restaurants, bakeries, and cafés organised by their coeliac awareness and gluten-free options, helping you dine out with confidence.
Coeliac disease can be a big change to your diet and lifestyle, but it’s important to remember that you aren’t alone. Approximately 1 in 70 Australians live with coeliac disease, although only around 20% have been diagnosed.
If you’re finding it difficult to adjust to these changes, seeking support from healthcare professionals, support groups, or trusted individuals can be beneficial.
Coeliac Australia provides a helpline designed to support individuals with coeliac disease by answering questions and providing information about managing the condition.
