Diabetes & Thyroid disease
People with diabetes experience thyroid disorders more frequently than the general population. Both diabetes and thyroid disease involve the endocrine system, a group of glands that helps to regulate the body's metabolism. The thyroid is a butterfly-shaped gland in the lower neck just beneath the skin in front of the windpipe and weighs about 15 to 20 grams.
It helps to regulate the body's metabolism, a broad term referring to all of the chemical reactions carried out in the body's cells, including digestion. If the gland releases too much thyroid hormone, metabolism speeds up (hyperthyroidism). If it releases too little, metabolism slows down (hypothyroidism).
Almost one-third of people with type 1 diabetes have thyroid disease. This is because type 1 diabetes is one type of autoimmune disease, in which the immune system attacks a gland or organ of the body. Patients with one kind of autoimmune disease are at risk of developing another type.
Thyroid disorders are more common in females, and up to 30% of women with type 1 diabetes have thyroid disease. What's more, the rate of inflammation of the thyroid gland in women with diabetes who have given birth is three times higher than women who do not have diabetes. There also appears to be a higher than normal occurrence of thyroid disorders in people with type 2 diabetes, with hypothyroidism being the most common.
Thyroid disorders can have a significant effect on blood glucose levels and, left untreated, can affect diabetes control. An overactive thyroid may increase insulin requirements, while an underactive thyroid can decrease insulin requirements.
Symptoms of hypothyroidism are common in people with type 2 diabetes and can be misidentified because people with this condition may experience fatigue, weight gain, feeling cold, dry skin and hair, heavy menstrual cycles, constipation and slowed thinking.
There are three treatment options for people with hyperthyroidism:
->anti-thyroid drugs, which slow down the thyroid's hormone production; ->radioactive iodine therapy, which destroys thyroid cells in order to reduce the amount of thyroid hormone produced; or
->surgical removal of the thyroid gland. Hypothyroidism is usually treated with a synthetic thyroid hormone called levothyroxine sodium (taken in pill form once a day). Treatment continues for the rest of one's life. Because hypothyroidism can decrease insulin requirements, insulin regimens may need to be adjusted.
Because of the link between diabetes and thyroid disease, people with diabetes should be tested for thyroid disorders every three to five years. The thyroid stimulating hormone (TSH) test, which measures the amount of TSH produced naturally by the body, is the best test of thyroid function.
A TSH level that is lower than normal may indicate an overactive thyroid, while an elevated TSH level may indicate an underactive thyroid. If you experience symptoms, it is important to consult your doctor, as these may be signs or symptoms of thyroid disease.
Digestive problems are relatively common among people with diabetes. The most common is constipation, affecting nearly 60% of people with diabetes. Diarrhea and other gastrointestinal symptoms may also occur. For instance, diabetes is also one of the most common causes of gastroparesis (delayed emptying of the stomach).
Gastroparesis occurs when nerves to the stomach become damaged or stop working. The vagus nerve controls the movement of food through the digestive tract, and when damaged, the muscles of the stomach and intestines no longer work normally, and the movement of food slows or stops.
High blood glucose levels associated with diabetes can damage the blood vessels that carry oxygen and nutrients to the nerves. Over time, this process damages the vagus nerve and disrupts its normal functioning. The erratic stomach emptying and poor absorption associated with gastroparesis make blood sugar levels harder to control.
Gastroparesis affects up to 75% of people with diabetes, causing bloating, loss of appetite and, in some cases, vomiting and dehydration. Symptoms include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, reflux and spasms of the stomach wall. Symptoms may be mild or severe, depending on the individual, but gastroparesis tends to be a chronic condition.
The main treatment for gastroparesis in people with diabetes is to regain control of blood glucose levels. This may include prescribing insulin or oral medications, changing your meal plan and, in severe cases, feeding tubes and intravenous feeding. People with diabetes who are already on insulin may need to take insulin more often, take it after a meal instead of before and check blood glucose levels more frequently after eating and administer insulin whenever necessary.
Changes in eating habits may help control symptoms. For example, it may be easier to eat six small meals a day so that the stomach does not become overly full. Consuming several liquid meal replacements a day may help stabilize blood glucose levels. These provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.
Avoidance of fatty and high-fibre foods may aid digestion, as fat naturally slows digestion and fibre is difficult to digest. Some high-fibre foods, such as oranges and broccoli, contain material that cannot be digested easily and remain in the stomach too long, possibly causing blockages.
In very severe cases, surgical intervention may be needed to treat gastroparesis. Different drugs or combinations of drugs may be used to treat gastroparesis. These include metoclopramide, which stimulates stomach muscle contractions to help empty food and reduces nausea and vomiting, and erythromycin, an antibiotic that also improves stomach emptying.
If you experience any digestive problem for more than a few weeks, it is important to speak to your physician or diabetes educator, who can help to determine the steps you can take to control the problem.
Remember functional gastroparesis improves with diabetes correction.
Diabetes And Depression
Depression is twice as common in people with diabetes as in the general population, and major depression is present in at least 15% of people with diabetes. Depression is also associated with poorer blood glucose management, health complications and decreased quality of life, so people with diabetes should be screened regularly for this disorder.
The association between depression and diabetes is unclear. Depression may develop because of stress but also may result from the metabolic effects of diabetes on the brain. Studies suggest that people with diabetes who have a history of depression are more likely to develop diabetic complications than those without depression.
Despite the enormous advances in brain research in the past 20 years, depression often goes undiagnosed and untreated. It often takes a mental health professional to recognize these symptoms, inquire about their duration and severity, diagnose the disorder and suggest appropriate treatment.
Research shows that depression leads to poorer physical and mental functioning, so a person is less likely to follow a required meal or medication plan. Treating depression with psychotherapy (“talk” therapy), medication or a combination of these treatments can improve a patient's well-being and ability to manage diabetes.
In people who have diabetes and depression, scientists report that psychotherapy and antidepressant medications have positive effects on both mood and blood glucose management.
Prescription antidepressant medications are generally well tolerated and safe for people with diabetes. Specific types of psychotherapy can also relieve depression. However, recovery from depression takes time. Antidepressant medications can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosing may need to be adjusted.
Therefore, treatment for depression in the context of diabetes should be managed by a mental health professional, such as a psychiatrist, psychologist or clinical social worker who is in close communication with the physician providing diabetes care. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided.
People with diabetes who develop depression, as well as people in treatment for depression who subsequently develop diabetes, should make sure to tell any physician they visit about the full range of medications they are taking.
It is important to remember that depression is a disorder of the brain that can be treated in addition to whatever other illnesses a person might have, including diabetes. If you think you may be depressed or know someone who is, don't lose hope. Seek help for depression.