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 doing OK. She didn't suspect that another problem could be causing Maya's fatigue. But after a visit with Maya's doctor to talk to him about Maya's symptoms, tests revealed that Maya had a problem with her thyroid.

Maya's situation isn't uncommon because kids and teens with type 1 diabetes have a greater risk for certain other health problems, many of which are also autoimmune disorders. Although your child's health care team will be monitoring your child for signs of these problems, it's important for you to learn to recognize these signs, too, so that you can consult your child's doctor and get treatment for your child, if necessary.

What Are Autoimmune Disorders?

In autoimmune disorders, the immune system mistakenly attacks the body's healthy tissues as though they were foreign invaders. If the attack is severe enough, it gets in the way of the function of that body part. Type 1 diabetes is an autoimmune disease (in which the pancreas is affected), and kids and teens with the disease are more prone to having other autoimmune problems. In type 1 diabetes, the pancreas can't make insulin because the immune system attacks the pancreas and destroys the cells that make insulin.

Though doctors still aren't exactly sure why autoimmune diseases occur, genetic factors probably play an important role because family members of people with type 1 diabetes are more likely to have autoimmune diseases.

Autoimmune disorders are not actually caused by the diabetes - they're just more likely to happen to people with the disease.

Although most kids with type 1 diabetes never need treatment for any other autoimmune disorder, some of the autoimmune diseases that people with type 1 diabetes are more likely to get include:

• thyroid disorders
• celiac disease
• Addison's disease

Sometimes kids and teens with type 1 diabetes develop one or more of these disorders before they develop type 1 diabetes, or sometimes they are discovered when a kid with newly diagnosed diabetes is tested for them. In other children, the disorder may not develop until months or years after they've been diagnosed with type 1 diabetes. These autoimmune disorders aren't caused by problems with your child's blood sugar control.

Thyroid Disorders

Kids and teens with type 1 diabetes are more likely to get certain disorders that affect 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 kids with type 1 diabetes - about 15% to 20% of people with type 1 diabetes show some signs of autoimmune disease of the thyroid gland.

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 this might not always be 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.

A child with mild hypothyroidism may feel just fine - in fact, the condition might cause no symptoms at all. However, symptoms can become more obvious if the condition worsens. People with underactive thyroids might feel depressed and sluggish. They might 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 your child about whether he or she has had symptoms of a thyroid problem during regular checkups. He or she may also feel your child's neck for an enlargement of the thyroid gland or order blood tests to check for thyroid problems.

To treat hypothyroidism, kids and teens may need to take pills that keep their thyroid hormone levels normal. Kids and teens with hyperthyroidism may receive pills or other treatments to bring their thyroid hormone levels back down to normal and keep them there.

Celiac Disease

Another type of autoimmune disorder that's more likely to occur in kids with type 1 diabetes is celiac disease. About one in 20 people with type 1 diabetes has celiac disease, which affects the intestine's ability to tolerate a protein called gluten. Gluten is found in grains like wheat and barley, and when kids and teens eat foods containing gluten, their immune system reacts to it, causing gastrointestinal symptoms. Over time, exposure to gluten damages the small intestine and prevents it from properly absorbing nutrients from food.

Some kids and teens with celiac disease 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 it's 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 child's doctor may do a blood test to check for celiac disease, even if your child has no symptoms. If your child's doctor suspects celiac disease, your child might require a small bowel biopsy (which involves removing a piece of tissue from the small intestine and examining it under the microscope) to confirm the diagnosis.

Kids and teens who have celiac disease need to eat a diet that's free of gluten-containing foods, such as wheat, rye, and barley products. Your child will 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 for your child.

Addison's Disease

Addison's disease, a type of adrenal insufficiency, is an autoimmune disease that affects the adrenal glands of the endocrine system. These glands, which are above the kidneys, produce hormones, including cortisol and aldosterone. These hormones help control many body functions, particularly those related to its response to stress. They impact 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 a person has Addison's disease, the adrenal glands don't produce enough cortisol and may not produce enough aldosterone, as well.

Signs and symptoms of Addison's disease start slowly. People might have fatigue, muscle weakness, appetite loss, or weight loss. Sometimes people experience nausea, vomiting, and diarrhea, too. Some people have dizziness and low blood pressure, skin discoloration (a darkening of the skin, especially in areas where the skin creases, like the elbows), irritability, depression, or irregular periods.

For about one in four 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 think that a kid or teen has Addison's disease, they can perform tests, including urine and blood tests, to diagnose it. Addison's disease is treated with pills that bring adrenal hormone levels up 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. Being aware of the signs and symptoms of these health problems and making sure your child gets the checkups and tests recommended by your child's doctor will minimize or prevent the effects of these disorders on your child's health.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2007