Last Updated on 14th November 2023 by Caroline Haye
Moving on with my series of blogs about diseases that are sometimes associated with vitiligo, I’d like to turn the spotlight on diabetes. Both diabetes and vitiligo share an association with autoimmunity. And, whilst the two conditions certainly don’t always occur together, having one increases your likelihood of developing the other. So it makes sense for anyone receiving a vitiligo diagnosis to get a test for diabetes too.
Nowadays, diabetes is one of the most common diseases around. And yet most of us have only a sketchy knowledge (unless we have first-hand experience of course) of what it is, what causes it and how to treat it.
What is diabetes?
Diabetes is a condition in which your body cannot make proper use of glucose. Glucose comes from digesting carbohydrate and it is also a producet of the liver. If you have diabetes, glucose builds up in the blood instead of converting into fuel. This happens either because the pancreas does not produce enough insulin – the hormone that unlocks the cells of the body allowing glucose to convert into energy – or because the insulin produced does not work properly (known as insulin resistance).
According to Diabetes UK, there are 3.2 million people with a diabetes diagnosis in the UK. Plus an estimated 630,000 people who have the condition, but don’t know it.
What is the difference between Type 1 and Type 2 diabetes?
Most people are aware that there are two sorts of diabetes, Type 1 and Type 2. But they may not be clear about the difference. Type 1 is when your body produces no insulin at all. Whereas Type 2 is when there is too little insulin production or it is not working properly. Type 1 usually develops during childhood (hence the term juvenile diabetes). Type 2 (adult-onset diabetes), on the other hand, is generally related to obesity. As a person becomes more and more overweight they generally become increasingly resistant to insulin. And consequently their blood sugar levels rise.
Eventually, they can become so resistant to insulin that their sugars remain at high enough levels for them to develop diabetes. Without corrective action at this stage the pancreas can stop making insulin altogether… Which results in a very similar condition to type 1 diabetes. This then becomes a life-long condition. And it is one that is becoming increasingly common in the developed world as the number of obese people rises.
Type 1 – and also Type 2, if it goes untreated for long enough – requires life-long management… Usually by means of insulin injections. But Type 2, with an early enough diagnosis, can be reversed by making the appropriate changes to diet and lifestyle. And the biggest factor in this is losing excess weight.
So, how is vitiligo linked to diabetes?
It appears, from the information that I have read on the subject, that vitiligo more often occurs with Type 1 diabetes. Evidently, patients with type 2 diabetes more often develop skin infections. Those with type 1, on the other hand, more often have autoimmune-related lesions, vitiligo being one example of this. Between 1% and 7% of all diabetic patients have vitiligo vs 0.2% to 1% of the general population.
The mechanism behind this association is not at all clear. But some think that it might be due to Polyglandular Autoimmune Syndrome (PAS), a rare immune condition in which at least two endocrine gland insufficiencies based on autoimmune mechanisms exist side by side. This syndrome develops mainly in the patient’s 30s or 40s. And often in association with adrenal failure, autoimmune thyroid disease, or type 1 diabetes. If, like me, you suffer from digestive problems, it is worth noting that Immunogastritis (or Autoimmune Metaplastic Atrophic Gastritis) is another of the conditions that sometimes features in this syndrome.
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All this information is very interesting but what does it mean for someone with vitiligo? Well, hopefully, if you have diabetes and manage it properly, you may be able to lessen the chances of developing vitiligo. (There is no guarantee of this but it does seem to make sense that if you can keep your diabetes well under control, all related conditions will also improve). But, more crucially, for anyone who develops vitiligo later in life (as opposed to people like myself who have it from childhood) the advice is to get a test for diabetes without delay.
Before you get too anxious though, the chances are that you do not have it. However, if it turns out that you do, you will at least be able to start getting the diabetes treatment you need so you can minimise, or completely avoid, some of the other health problems that are the inevitable result of ignoring the condition long-term.
