With the recognition that type I diabetes is an autoimmune illness, it is now understood why there is a group of illnesses which occur with greater frequency among patients with type I diabetes and their family members. A number of these diseases have relatively simple treatments but, if left untreated, result in irreversible damage and, in a few instances, death. Excellent, simple blood tests are now available to diagnose and even predict most of these disorders. At the Barbara Davis Center, routine screening for many of the disorders has been instituted. If seen at the Center, you can discuss this screening with your health care provider. If seen elsewhere, we recommend sharing this list with your primary care provider. The screening intervals refer to individuals without symptoms, as a number of these illnesses can be asymptomatic.
Addison's Disease: Loss of appetite, weight loss, hypotension, tanning of the skin, low insulin requirement, death in hypotensive Addisonian crisis. Addison's Disease is easily treated by taking the missing hormone orally.
This illness occurs in 1/200 to 1/1,000 individuals with type I diabetes, while it is extremely rare in the general population. A simple autoantibody screening test: determination of autoantibodies reacting with the enzyme 21 hydroxylase, is now available, which will detect the majority of individuals developing the illness. We recommend screening for such autoantibodies every five years (1% of those patients screened at the Center have expressed such autoantibodies).
Graves' Disease: Weight loss, feeling hot, bulging eyes, palpitations, bulging thyroid gland.
This illness occurs in approximately 1/100 individuals with type I diabetes. It is caused by an overactive thyroid gland and oral treatments are available. Annual screening with a sensitive TSH assay is recommended.
Hypothyroidism: Weight gain, feeling cold, feeling tired, hoarse voice, bulging thyroid gland.
This illness occurs in as many as 1/20 patients with type I diabetes. Simple replacement oral therapy with thyroid hormone corrects the disease. The illness is screened with a TSH assay, similar to Graves' disease.
Celiac Disease (anti-transglutaminase): Weight loss, diarrhea.
Most often this illness is asymptomatic but over the long term, it can result in failure to absorb nutrients, resulting in bone loss. A subset of patients with long-term disease develop gastrointestinal tumors.
There is a related skin disorder called dermatitis herpetiformis. Approximately 1/20 patients and, of note, 1/20 relatives of patients (even very young children) have this illness. The treatment is avoidance of wheat and related grain proteins. A simple screening autoantibody test is available, namely determination of anti-endomysial autoantibodies. If autoantibodies are found, we recommend a small bowel biopsy (performed as an outpatient) to diagnose the illness, followed by gluten free diet. Annual testing for autoantibodies is currently recommended.
Pernicious Anemia: Loss of coordination, anemia, severe nerve damage.
Occurs primarily in older individuals with diabetes (over age 30 and, particularly, greater than age 60). Approximately 1/50 individuals with type I diabetes will develop pernicious anemia. We recommend determination of vitamin B12 levels every five years.
Myasthenia Gravis: Severe muscle weakness particularly worsened by repetitive activity.
This illness is very rare.
Vitiligo: White skin patches.
Should raise suspicion of associated illnesses listed above. No specific test.