The first job of the immune system is to distinguish between “you” and “non-you,” and then react to that distinction. Immune cells are on constant alert looking for a foreign marker- the antigen- that marks bacteria, viruses, parasites, and other substances that invade the body. There is a built-in tolerance for your own cells and tissue so that they are passed over in this vigilance.
What happens when this balance goes wrong and this immune system mistakes the “you” and “non-you”? The system begins to identify tissue or protein or some other part of “you” as an intruder, a foreigner, and the immune cells attack to rid the body of this menace. The whole arsenal of the immune system comes into play, and the body begins to destroy itself, cell by cell. End results can be minor or major.
In rheumatoid arthritis the immune system causes painful swelling and stiffness of the joints, while in lupus, which affects mostly young women, the immune system attacks many organs causing rashes, kidney damage, fluid around the lungs, and inflamed lungs.
Those of us with type 1 diabetes know the result of a body which turns on itself thinking it is defending our pancreas, but in reality it is slowly killing beta cells so that we are unable to manufacture insulin and we are forced to replace this hormone with multiple injections on a daily basis.
Auto-immune illness: those of us with type 1 diabetes have one; are we are at greater risk for others? The answer is yes, but before you kick the dog, put your head in the oven, or eat a chocolate cake, read on, because you can be treated for these other hormonal diseases and they are controllable. You are reading an article written by someone who was diagnosed with one of these auto-immune diseases when she was 19 years old, 20 years before being diagnosed with diabetes, and has never had any complications, symptoms or thoughts about it except replacing thyroid hormone at a very low dose.
Now down to the nitty gritty. If you have type 1 diabetes you are greater risk for developing two types of thyroid auto-immune illnesses, gastric parietal cell disease, and adrenal gland disease. Why these diseases cluster is under research, but it is thought that the immune system of some people attacks related tissues and the lining of the stomach and intestines, related glands and organs, the pancreas, thyroid gland and gastric parietal cells, all in the embryo from a layer of cells called the endoderm. Your risk for each of these diseases varies.
People with type 1 diabetes are about five times more likely to develop thyroid disease than are non-diabetics. From 8% to 19% of children and adolescents with diabetes have thyroid auto-antibodies. Women with diabetes develop thyroid disease twice as often as men with diabetes. About 10% of diabetic women will develop thyroid disease soon after giving birth versus only 5% for non-diabetic postpartum women. Half of the people with auto-antibodies in their blood will develop thyroid disease over time.
About 6% of type 1 diabetics are positive for parietal cell auto-antibodies which is three times greater than the risk for the general population. Women are twice as likely to be positive for this antibody. If you are positive for thyroid auto-antibodies you have a 20% chance of being positive for parietal cell auto-antibody cells.
Adrenal auto-antibodies, markers for an auto-immune attack against the adrenal gland, are five times more common in type 1 diabetics than in the general population. Once again, women are more likely to have this condition, 4 to 1. Half the people who are positive for this auto-antibody will develop adrenal disease. If thyroid auto-antibody cells are present, then the risk for having adrenal auto-antibody cells more than triples to 6 %.
The thyroid gland is a butterfly-shaped gland just below the Adam’s apple. This gland is especially important to brain and bone development in childhood. If your immune system attacks the thyroid and you have too little thyroid hormone in you system, you will develop an inflamed thyroid.
This is called Hashimoto’s Disease. Over time you may develop symptoms of goiter, tiredness, constipation, intolerance to the cold, weight gain, dry skin and hair, and very light menstrual flow or missed menstrual cycle. Since thyroid hormone affects how quickly other hormones, including insulin, are cleared from the blood, when you have too little thyroid hormone, insulin stays longer which can lead to insulin reactions. The thyroid gland can also be over-stimulated by the auto-immune system causing Graves Disease.
This causes trouble sleeping and concentrating, increased heart rate, diarrhea, smooth and shiny hair and skin, erratic behavior, heat intolerance, weight loss, and very light or absent menstrual cycles. It can produce insulin resistance which can worsen your ability to control blood glucose levels. How to treat for these two diseases is a snap.
Just have your blood tested when you have your checkup if you have not been screened before. Most doctors will test when you are diagnosed with diabetes. If you are positive but do not have symptoms have your hormone tested each year when your blood work is done. Treatment is straightforward for low thyroid levels or Hashimoto’s Disease. Your doctor will help you reach a normal level of thyroid hormone and test for it routinely. If you have Graves Disease, your treatment will try to suppress the extra hormone you are secreting. This is done with meds, radioactive iodine, or surgery.
Gastric parietal cells are located in the lining of the stomach and allow you to absorb vitamin B12. This vitamin helps to keep your nervous system working and in involved in normal red-blood cell development. When this factor is attacked over the years you can develop pernicious anemia which can damage the nervous system and spinal cord. Gastric parietal cell auto-antibodies are produced during this auto-immune reaction. About half of the people who are positive for this test will have low gastric parietal cell function. It may be worth a question to your physician about being tested for these antibodies if you also have thyroid auto-antibodies. Treatment is again straightforward–injections of vitamin B12.
The two adrenal glands are located above the kidneys, and are composed of an inner core ( the medulla), and an outer core (the cortex). The medulla produces epinephrine and the cortex produces aldosterone, which helps to prevent dehydration and low blood pressure, and cortisone which helps to retain normal blood pressure and health. It protects against hypoglycemia and the development of shock when you are under severe stress.
When your adrenal glands fail because of auto-immune destruction, you develop Addison’s disease. If cortisone and aldosterone levels fall too low, you can develop low blood pressure, acidosis, and coma. Other symptoms include weakness, lethargy. nausea, vomiting, diarrhea, salt craving, mottled skin color, decreased hair growth, dehydration, anemia and pallor.
Adrenal auto-antibodies are less common than thyroid auto-antibodies. You probably don’t have to be tested for them unless you are positive for thyroid auto-antibodies as 1 in 16 of those people will also have adrenal auto-antibodies. If you develop Addison’s disease you can replace cortisone by taking oral medication.
One last suggestion to you and your family. You know now that these diseases run in clusters in type 1 diabetics. But, if you are positive for thyroid auto-antibodies your most immediate relatives may wish to share this with their physicians. If they are positive but do not have symptoms of the disease, they will need yearly blood tests.