Related Conditions - Diabetes

1. Celiac Disease
2. Hemochromatosis
3. Frozen Shoulder

1. Celiac Disease

Celiac disease, sometimes called sprue or celiac sprue, is an inherited intestinal disorder in which the body cannot tolerate gluten. Gluten is a protein found in wheat, rye, barley, farina, and bulgar. When people with celiac disease eat foods containing gluten, their immune systems respond by attacking and damaging the lining of the small intestine. The small intestine is responsible for absorbing nutrients from food into the bloodstream for the body to use. When the lining is damaged, so is its ability to absorb these nutrients.

Celiac disease affects people differently. Some people develop symptoms as children and others as adults. Symptoms vary and may or may not occur in the digestive system. They may include diarrhea, abdominal pain, weight loss, irritability, and depression, among others. Irritability is one of the most common symptoms among children. In some cases, a diagnosis of celiac disease is missed because the symptoms are so varied and may only flare up occasionally.


Diagnosing Celiac Disease

Recognizing celiac disease can be difficult because some of its symptoms are similar to those of other diseases. In fact, sometimes celiac disease is confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, Crohn's disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease is commonly under diagnosed or misdiagnosed.

Recently, researchers discovered that people with celiac disease have higher than normal levels of certain autoantibodies in their blood. Antibodies are protective proteins produced by the immune system in response to substances that the body perceives to be threatening. Autoantibodies are proteins that react against the body's own molecules or tissues. To diagnose celiac disease, physicians will usually test blood to measure levels of

• Immunoglobulin A (IgA)
• anti-tissue transglutaminase (tTGA)
• IgA anti-endomysium antibodies (AEA)

Before being tested, one should continue to eat a regular diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if celiac disease is actually present.

If the tests and symptoms suggest celiac disease, the doctor will perform a small bowel biopsy. During the biopsy, the doctor removes a tiny piece of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, the doctor eases a long, thin tube called an endoscope through the mouth and stomach into the small intestine. Using instruments passed through the endoscope, the doctor then takes the sample.

2. Hemochromatosis

(he-mo-kro-ma-toe-sis)

Hemochromatosis is the disease that occurs as a result of significant iron overload. It can have genetic or nongenetic causes. Diabetes is a primary complication if hemochromatosis goes untreated. Hemochromatosis is sometimes referred to as "bronze diabetes." Once it is diagnosed, it is managed extremely effectively via frequent phlebotomy [fle-bot-o-me] (blood letting).


What is phlebotomy [fle-bot-o-me] (blood letting)
It’s the same procedure that is used when you donate blood. A nurse takes about a pint of blood from a vein in your arm. The procedure takes about an hour.


Hemochromatosis runs in families. So, your blood relatives — your parents, grandparents, sisters, brothers, or children—may also have it. Without phlebotomies, hemochromatosis can cause death. Treatment is worth the effort.


Early symptoms of Hemochromatosis

Hemochromatosis affects everyone differently. Early symptoms may include fatigue, weakness, weight loss, joint pain, or abdominal pain. There is no definite set of symptoms to indicate that a person has too much iron. Diagnosing hemochromatosis is difficult because the symptoms are like the symptoms of many other diseases.


Complications if Hemochromatosis is untreated

• Diabetes
• Liver cancer
• Heart disease
• Impotence for men
• Infertility and premature menopause for women
• Arthritis
• Cirrhosis of the liver
• Bronze skin

3. Frozen Shoulder

(Adhesive Capsulitis)

As the name implies, movement of the shoulder is severely restricted in people with a “frozen shoulder.” This condition, which doctors call adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain. Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Intermittent periods of use may cause inflammation. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder.

People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or those who have been in an accident, are at a higher risk for frozen shoulder. Frozen shoulder is more common among women than men. People between the ages of 40 and 70 are most likely to experience it.


Signs and symptoms

With a frozen shoulder, the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. Stiffness and discomfort may worsen at night.


Diagnosis

A doctor may suspect a frozen shoulder if a physical examination reveals limited shoulder movement. X rays usually appear normal.


Causes of frozen shoulder are

• Lack of use due to chronic pain
• Rheumatic disease that is getting worse
• Bands of tissue that grow in the joint and restrict motion
• Lack of the fluid that helps the shoulder joint move.

Treatment

Treatment of this disorder focuses on restoring joint movement and reducing shoulder pain. Usually, treatment begins with nonsteroidal anti-inflammatory drugs and the application of heat, followed by gentle stretching exercises.

These stretching exercises, which may be performed in the home with the help of a therapist, are the treatment of choice. In some cases, transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses.

If these measures are unsuccessful, an intra-articular injection of steroids into the glenoid humeral joint can result in marked improvement of the frozen shoulder in a large percentage of cases. In those rare people who do not improve from nonoperative measures, manipulation of the shoulder under general anesthesia and an arthroscopic procedure to cut the remaining adhesions can be highly effective in most cases.