Dr. Ahmed
Just like Diabetes type 1, lupus erythematosus is also an autoimmune disease. Lupus has been associated with both Type 1 and Type 2 Diabetes.
Type 2 diabetes develops as a result of increased insulin resistance in patients with lupus especially when high doses of corticosteroids are initiated.
Type 1 Diabetes develops when autoantibodies react with the islet cells of the pancreas. The association has been termed APS-2 (Autoimmune Polyendocrine Syndrome Type 2).
APS-2 consists of the following conditions:
- Type 1 Diabetes
- Celiac Disease
- SLE (Lupus)
- Primary ovarian failure
- Rheumatoid Arthritis
- Vitiligo
- Alopecia
- Myasthenia Gravis
- Autoimmune Gastritis
Both Lupus and Type 1 Diabetes affect the kidneys. In fact, renal failure is one of the common complications of both these conditions.
Lupus is recognized throughout the world and 10 May is declared World Lupus Day. World Diabetes Day is celebrated on 14th November each year.
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Lupus or Systemic Lupus Erythematosis (SLE):
In the extremely rare autoimmune condition known as systemic lupus erythematosus (SLE) or commonly called lupus, antibodies made by the immune system wrongly attack the body’s tissues like tendons, skin, blood vessels, internal organs, brain, bones, and joints.
Sun-sensitive skin problems are the most typical, significant indication of lupus. Although the precise presentation of these problems varies from case to case.
A butterfly rash, which typically covers the nose and cheeks is one typical symptom. Lupus often coexists with other autoimmune diseases such as Type 1 diabetes.
It affects women 9 times more frequently than it does males [Ref]. Lupus and Type 1 diabetes patients are at risk for developing kidney complications.
Symptoms of lupus:
The following are the symptoms of lupus;
- Butterfly rash on face
- Photosensitivity
- Fatigue
- Headaches
- Shortness of breath and/or chest pain
- Anemia
- Fever
- Kidney issues especially when coexisting with Type 1 diabetes
Diagnosis of Lupus:
Due to the fact that each individual’s indications and symptoms of lupus vary so widely, there is no one test that can be used to conclusively identify the disease.
But if your doctor thinks you could have lupus, they might ask for blood and urine testing. As initial screening tests, these blood tests may comprise a blood count, a kidney and liver evaluation, a urinalysis, and/or an antinuclear antibody test.
A physical examination will also be done by your doctor. Your doctor might order a chest x-ray or echocardiography if you have heart or lung problems, and if they suspect kidney problems, they might advise a biopsy.
Autoantibodies are considered hallmarks of the disease. ANA (Antinuclear antibodies) is the usual screening test. If it comes out to be positive, specific tests are then carried out.
anti dsDNA is a specific test that confirms Lupus. It is also associated with disease severity. Another highly specific but less sensitive test is anti-sm antibodies (anti-smiths antibodies)
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Lupus and Diabetes Type 1:
Lupus affects the entire body when coexisting with diabetes type 1. It can have an impact on all aspects of a person’s life like organ damage, drugs, nutritional concerns, and an inability to exercise enough.
These consequences result in nearly doubling the chance of having diabetes type 1 in lupus patients.
Researchers have found that lupus patients generally have increased insulin resistance. Insulin resistance is the body’s inability to react to normal amounts of this hormone, which can cause problems with both too much and too little glucose in the bloodstream.
People with lupus have higher levels of other hormones, such as C-peptides, which are linked to diabetes.
It indicates that organ damage is the root cause of insulin resistance, which can exacerbate lupus symptoms. Diabetes type 1 may result from it as well.
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Effects of Diabetes on Lupus
Lupus is one of the disorders that diabetes is known to worsen. Lupus symptoms are made worse by diabetes, causing a loop of interaction between the two conditions.
Some of the hazards associated with lupus are further worsened by insulin resistance. It is very clear that these two illnesses have many links, and even share symptoms (including kidney disease).
They cannot be treated individually. The whole person with lupus and diabetes must be taken into account when managing treatment and medication.
Medications for both Lupus and Diabetes Type 1:
Controlling lupus involves a person’s entire way of life, not simply the use of medicines. This manner of living has numerous implications for diabetes.
According to research, several lupus treatments may lower the chance of developing diabetes. For instance, antimalarial drugs like hydroxychloroquine, which reduce inflammation and shield the body from lupus damage, appear to prevent type 1 diabetes in patients.
Anti-rheumatic drugs that treat lupus-related joint pain don’t seem to have an impact on diabetes. Glucocorticoids or corticosteroids, a typical immunomodulatory drug for lupus, however, appear to have a direct impact on insulin resistance.
On the other hand, lupus patients may benefit from using the anti-diabetic medication, metformin. It alters immune system metabolism, which could be beneficial for lupus.
However, it is well recognized to have unfavorable interactions with other medicines, such as insulin and ibuprofen.
However, Prednisone is another lupus drug that increases the risk of type 1 diabetes, thus the combination of glucocorticoids and prednisone may help reduce those risks.
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Diabetes Type 1, Lupus, and Diet:
The American Diabetes Association claims that nutrition and exercise are essential for controlling diabetes.
The exercise and food needs for both lupus and diabetes type 1 are highly similar. The most crucial factor in managing diabetes is timing and quantity.
People with diabetes should eat precisely calculated amounts of food at regular times, even though what one eats is also important. By doing this, blood sugar spikes are avoided and a healthy weight is preserved.
Nutrition is more crucial for lupus than regular mealtimes. Lupus sufferers should make every effort to follow regular meal schedules, but it’s also important to focus on eating a diet that’s nutritious.
Patients with coexisting lupus and diabetes type 1 should have a varied and balanced diet that includes whole grains, lean meats, fish, fruits, and nuts.
Keep it low in sugar, fat (particularly saturated and trans fats), and sodium, and keep it high in fiber and omega-3s.
Particularly, sugar has a significant impact on both diabetes and lupus. Both inflammation and significant spikes and swings in blood sugar are caused by it.
It’s also crucial to maintain a healthy intake of calories. It aids in preventing weight problems, which can aggravate the signs of lupus and diabetes type 1.
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Renal failure associated with autoimmune diseases
Lupus patients with type 1 diabetes have a greater overall prevalence of other disorders including end-stage renal disease (ESRD).
Diabetes type 1 does not, however, independently increase the incidence of ESRD in lupus patients.
It is suggested that a greater number of co-morbid disorders related to diabetes in lupus patients who also have subsequent Diabetes type 1 contribute to the acceleration of renal function deterioration.
To fully understand the relationship between DM and quickening renal failure in lupus patients, more research must be done.
In the therapy of patients with lupus, it is advised to modify the dosage of immunosuppressants and steroids meticulously, as well as to carefully monitor the patient’s blood glucose levels.
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Conclusion:
Lupus and diabetes have different causes and symptoms, although they can coexist and have a variety of interactions.
A person with lupus and diabetes needs to treat both disorders as effectively as possible to avoid renal damage, cardiovascular disease, and significant symptoms.
