Celiac disease is a chronic intestinal disorder in which gluten intolerance interferes with the absorption of many nutrients. Eating foods containing gluten, which is found in wheat, rye oats and barley, stimulates an autoimmune response in the intestines. The immune system then attacks the tissue of the small intestine, destroying the lining that absorbs nutrients. On a gluten-free diet, the small intestine begins to heal and returns to normal or nearly normal

Scientists now suspect that this inherited disorder is also linked to type 1 diabetes. This paper concludes that first degree relatives of type 1s have five times the risk of developing celiac disease. Additionally, the January/February issue of Gluten-Free Living estimates that approximately one in 20 celiacs have type 1 diabetes, and that they have the same risk of developing type 2 diabetes as the general population, roughly five percent.

Celiac disease shows up in children between 2 and 10-years-old. Testing for the disorder allows for early diagnosis and prevention of malabsorption, growth failure and gastrointestinal malignancies - all complications of celiac disease.

"If I had my choice all people with type 1 diabetes would be screened yearly for celiac disease ... there is definitely not enough knowledge about the connection (between celiac disease and diabetes) anywhere," says Catherine Marschilok, MSN, RN, CDE.

Symptoms of celiac disease that people with type 1 diabetes may experience include lactose intolerance, bloating, diarrhea, brittle diabetes, unexplained weight loss and anemia, says Joseph Murray, MD, in Gluten-Free Living. However, the journal also notes that people must rely on clinical diagnosis including a biopsy, rather than self-diagnosis.

Diagnosing gluten sensitivity in a person with type 1 diabetes also improves glycemic control. As the individual's intestines heal on the gluten-free diet, the rate of absorption becomes more predictable, and insulin requirements gradually increase as more carbohydrate is absorbed. Therefore it's important that people with diabetes who are also gluten sensitive be properly diagnosed and treated so that they can achieve better glycemic control.

Individuals with type 1 diabetes who are gluten sensitive must avoid grains and other foods that contain gluten and carefully monitor their intake of gluten-free carbohydrates. They also need to restrict their diet on trace protein (gluten) and control their diet on total carbohydrate. As is the case for most celiacs, this leads to a reliance on rice and corn.

Celiacs with type 1 diabetes should up their intake of starchy vegetables like potatoes, winter squash, peas, beets, carrots, onions, and legumes. Black beans, lentils, dried peas and other legumes are also very useful because of their low glycemic index. Foods with a low glycemic index result in a small rise in blood sugars in proportion to their carbohydrate content.

Healthcare professionals with experience in treating people with diabetes who are gluten sensitive are rare. However, if one is gluten sensitive, a gluten-free diet must be adopted for a lifetime of healthy living.