Answer:Coeliac disease, like type 1 diabetes, it is a chronic autoimmune disorder where the lining of the small intestine is damaged due to sensitivity to gluten, the protein remaining in wheat once starch is removed. Coeliac disease affects food absorption in the intestine and sometimes many other body systems. Coeliac disease may not cause specific signs and symptoms so it can be mistaken for other problems. It is rare, occurring in 0.5−1.0% of the population.

The link between type 1 diabetes and coeliac disease is currently being investigated. Some experts think HLA genes, associated with other autoimmune disorders such as thyroid disease, might be involved. Others believe environmental factors play a role and could predispose individuals to coeliac and other autoimmune diseases. People with type 2 diabetes may have gluten sensitivity but there is no known link between the two conditions (type 2 is not an autoimmune disease).

Coeliac disease is caused by an immune response to gliadin, the soluble subprotein of gluten in wheat. Rye, barley and oats also contain gluten but in smaller amounts. Coeliac disease is often diagnosed in children aged 3−5 years and in people in their 40s. It affects more women than men. If it is not treated, coeliac disease can affect growth and development in children and can lead to long-term health problems such as anaemia, osteoporosis, infertility, miscarriage, tooth decay and increased risk of gastrointestinal cancers. It can also affect blood glucose control and might increase the risk of hypoglycaemia if food is not absorbed properly.

Signs and Symptoms
Coeliac disease causes many vague symptoms but common symptoms include:

• A family history of coeliac disease
• Chronic tiredness
• Poor appetite
• Weight loss
• Failure to thrive and delayed growth in children
• Abdominal symptoms such as bloating, discomfort, malabsorption syndromes, pot belly, diarrhoea if most of the intestine is involved
• Irritability
• Skin disorders
• People with diabetes might have unexplained hypo or hyperglycaemia.

Diagnosis
Telling the doctor about the symptoms you notice and when they occur is important. Blood tests for antibodies, such as transglutaminase and endomysial antibodies, and a bowel examination are usually needed to make a diagnosis. A small amount of the lining of the small intestine might be removed and examined to detect changes in the lining.

The International Society for Paediatric and Adolescent Diabetes (ISPAD) recommends screening all children at diagnosis with type 1 diabetes, then annually for the first five years and then every two years.

Management
Wheat, rye, barley and oats need to be eliminated from the diet but it is important to eat a healthy balanced diet to manage blood glucose and lipids. It is also important to make sure the diet contains enough vitamins and minerals to prevent anaemia, osteoporosis and other nutritional deficiencies.

Grains such as buckwheat, chia and millet can be used instead for wheat, rye and barley.

A wide range of gluten-free foods is available, which makes it easier for people to follow a gluten-free diet. Reading food labels to identify hidden gluten is essential. Many gluten-free foods have a high GI and high fat content so consulting a dietitian with expertise in coeliac disease can be helpful.

Managing a gluten-free diet as well as balancing carbohydrate intake, insulin and activity levels to prevent hypoglycaemia can be challenging and stressful. Thus, testing blood glucose regularly and carrying appropriate glucose to treat hypoglycaemia is important.

Some studies investigating coeliac disease are the Disease Autoimmunity Research (CEDAR) study and the Diabetes Autoimmunity Study in the Young (DAISY).

Professor Trisha Dunning AM, RN, PhD, MEd, FRCNA, is the Chair of Nursing at Deakin University and Barwon Health, and Vice-President of the International Diabetes Federation.

This article was originally published in Conquest Magazine published by Health Publishing Australia