Moving on with this series about diseases that are sometimes associated with vitiligo, I’d like to turn the spotlight on diabetes. Both diabetes and vitiligo share a common theory of autoimmunity and, whilst the two conditions certainly don't always occur together, diabetes can bring about the onset of vitiligo.
For some reason, diabetes is probably one of the most widely publicised 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 it is treated.
For starters, what is it?
Diabetes is a condition in which your body cannot make proper use of glucose. Glucose comes from digesting carbohydrate and it is also produced by the liver. If you have diabetes, the glucose builds up in the blood instead of being used as fuel. This happens either because the pancreas does not produce enough insulin – the hormone that unlocks the cells of the body allowing glucose to be used for energy - or because the insulin produced does not work properly (known as insulin resistance).
Next up, who gets it?
According to Diabetes UK, there are 3.2 million people diagnosed with diabetes in the UK and an estimated 630,000 people who have the condition, but don’t know it.
Most people are aware that there are two sorts of diabetes, Type 1 and Type 2, but may not be clear about the difference. Type 1 is when no insulin at all is produced and Type 2 is when too little is produced or it is not working properly. Type 1 usually develops during childhood (and is sometimes referred to as juvenile diabetes) whereas Type 2 (adult-onset diabetes) 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. If this situation is not addressed the pancreas can stop making insulin altogether, resulting in a very similar condition to type 1 diabetes. This then becomes a life-long condition and is one that is becoming increasingly common in the developed world as the number of obese people is consistently on the rise.
So, how is diabetes treated? 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, if it is diagnosed soon enough, can be reversed by making the appropriate changes to diet and lifestyle, above all by losing excess weight. Alcohol consumption is one lifestyle issue that can impact diabetics: ADT Healthcare's article “The Ultimate Guide to Alcohol and Diabetes", written by Paul Clarke is a very useful source of guidance on the subject.
It appears, from the information that I have read on the subject, that vitiligo is more often associated with Type 1 diabetes. Evidently, patients with type 2 diabetes more often develop skin infections, whereas those with type 1 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 it has been suggested 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 30’s or 40’s and is characterised by 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.
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 tested for diabetes without delay. Before you get too anxious, the chances are that you do not have it, but 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.
My name is Caroline.