Podcast Summary: Autoimmune Conditions Associated with Diabetes

Podcast: Taking Control Of Your Diabetes® – The Podcast!

Hosts: Dr. Jeremy Pettus (A) & Dr. Steve Edelman (B)
Episode Date: November 11, 2025

Episode Overview

In this engaging and informative episode, Drs. Jeremy Pettus and Steve Edelman, both veteran endocrinologists and type 1 diabetics themselves, dive deep into the world of autoimmune conditions that commonly co-occur with type 1 diabetes. With characteristic humor and empathy, they break down the most prevalent conditions—thyroid disorders and celiac disease—plus discuss the importance of regular screening, symptoms to watch out for, and practical treatment approaches. The episode also touches on Addison’s disease, highlights the interconnectedness of autoimmune disorders, and leaves listeners with actionable insights, especially for those newly diagnosed or managing long-term diabetes.

Key Discussion Points & Insights

1. Why Do Autoimmune Conditions Cluster with Type 1 Diabetes?

• Autoimmune Raindrop Analogy (00:23)
  Dr. Pettus recalls Dr. Edelman's old analogy: life rains on everyone, but type 1 diabetes often brings extra “raindrops” in the form of additional autoimmune conditions.
  • Quote: “It doesn’t seem fair that if you get hit with a type 1 diabetes raindrop that you can get these other things, and not only can you, but you’re at higher risk.” — Dr. Jeremy Pettus (00:53)
• Both hosts remark on the injustice and randomness of autoimmunity, emphasizing the underlying unknowns while maintaining a lighthearted tone about their personal experiences.

2. Thyroid Disease in Type 1 Diabetes

• Prevalence & Types (03:00)

  • Up to 30% of type 1 diabetics may develop thyroid issues.
  • Two main types:
    • Hypothyroidism (formerly “Hashimoto’s thyroiditis”): thyroid underactivity.
    • Hyperthyroidism (“Graves disease”): thyroid overactivity.
    • Memorable moment: “Graves was actually a guy’s name... it’s not a graveyard!” — Dr. Jeremy Pettus (03:44)

• Screening and Diagnosis (04:09)

  • Check thyroid stimulating hormone (TSH) annually.
  • TSH is an affordable, accessible blood test; abnormalities tend to be flagged clearly.
    • Quote: “Everybody with type 1 diabetes should be doing this probably every year and just add it to your usual things...” — Dr. Jeremy Pettus (04:41)

• Symptoms (06:58)

  • Hypothyroidism: Fatigue, weight gain, mental fog, cold intolerance, constipation.
  • Hyperthyroidism: Jitteriness, weight loss, heat intolerance, palpitations, anxiety, distinct eye changes (thyroid eye disease).
  • Quote: “Check my thyroid!” — Drs. Pettus & Edelman (08:59), as a recurring patient refrain.

• Treatment (09:18, 13:03)

  • Hypothyroidism: Easy to treat with oral medication; dosage may need adjusting with significant weight change.
    • Quote: “It’s probably one of the easiest things to treat.” — Dr. Steve Edelman (09:55)
  • Hyperthyroidism: Antithyroid medications, sometimes beta blockers. For persistent cases, radioactive iodine is commonly used.
    • Quote: “[Radioactive iodine]... slowly kind of burns the thyroid, but it’s very, very local, very, very safe.” — Dr. Jeremy Pettus (14:09)

• Thyroid Eye Disease (16:25)

  • Can occur independent of thyroid hormone levels; may require ophthalmology referral.

3. Celiac Disease: Hidden & Serious

• Prevalence & Distinction (17:16, 18:29)

  • Much higher rates in type 1 diabetes (6-10%) compared to general population (1%).
  • True celiac is a severe, physiological autoimmunity to gluten, unlike gluten sensitivity.
    • Quote: “This is a confirmed medical diagnosis... you get an actual physiologic kind of inflammation that can be very, very severe.” — Dr. Jeremy Pettus (18:18)

• Screening & Symptoms (22:04)

  • Universal screening recommended at type 1 diagnosis and annually in children.
  • Symptoms: GI distress, weight loss, fatigue, anemia, growth issues, sometimes asymptomatic (“silent celiac”).
    • Quote: “Not everyone gets all these symptoms. They don’t get them at the same intensity... And I’ve been or completely asymptomatic.” — Dr. Steve Edelman & Dr. Jeremy Pettus (23:29)

• Diagnosis (24:38)

  • Blood antibody tests, confirmed by small intestine biopsy via upper endoscopy.
  • Tip: Testing must be done while consuming gluten.

• Treatment (25:18)

  • Strict gluten-free diet; practical challenges acknowledged.
    • Quote: “What’s the treatment for celiac, Steve?” “Gluten free diet.” — Drs. Pettus & Edelman (25:18)
  • Importance of working with a dietician due to dietary complexity with type 1 diabetes.

• Evolutionary Insight (18:56, 20:16)

  • Discussion of “thrifty gene hypothesis” and T cell evolution behind autoimmunity.

4. Other Autoimmune Conditions

• Addison’s Disease (Polyglandular Autoimmunity) (29:03)

  • Destruction of the adrenal glands leads to lack of cortisol.
  • Subtle symptoms: fatigue, low blood pressure, weakness, hyperpigmentation.
  • Diagnosed with ACTH and cortisol testing.
    • Quote: “She was weak, lost weight, her blood pressure was low. She had nausea, vomiting, abdominal pain. And I ordered a test called the ACTH... and it was sky high.” — Dr. Steve Edelman (29:27)
  • Treatment: corticosteroid replacement, usually very effective.

• Other Noted Conditions (28:32)

  • Lupus, rheumatoid arthritis, vitiligo, pituitary dysfunction, psoriasis—all occur at higher rates in type 1 diabetics.

5. Takeaways and Practical Advice

• Vigilance & Screening Is Key (15:56, 33:54)

  • Annual thyroid and celiac screening is recommended.
  • Addison’s disease and other autoimmune diseases: maintain awareness, ask your doctor if symptoms are suspicious.
    • Quote: “Knowing what these conditions can do, and just a little red light goes off in your head, ‘Hey, I listen to that great podcast...’” — Dr. Steve Edelman (34:13)

• Balanced Perspective (32:55, 34:13)

  • Don’t let other providers blame every ailment on diabetes: “There are things that are associated with type one... but it isn’t always type 1 diabetes.”
  • Quote: “Doctors love to blame things on type 1 diabetes... Don’t let them get away with that either.” — Dr. Jeremy Pettus (32:55)

Memorable Quotes & Moments

• “Less wrinkles. We have less wrinkles. If you look at Steve and I, especially Steve, he looks amazing.” — Dr. Jeremy Pettus (02:25)
• “If I had Graves, I would like to get the whole thing destroyed by radioactive iodine and then just take a thyroid medication that keeps me in the normal range.” — Dr. Steve Edelman (15:09)
• “It is pretty wild how easy it is compared to type 1 diabetes.” — Dr. Jeremy Pettus (09:55)
• “You know, you have a lot of gas. So I thought you had celiac for a while.” — Dr. Steve Edelman (23:44), illustrating their clinical and personal camaraderie.

Timestamps for Important Segments

| Time | Segment | |---------|------------------------------------------------| | 00:23 | Episode introduction, the “raindrop” analogy | | 03:00 | Introduction to thyroid disease | | 04:09 | Annual thyroid screening explained | | 06:58 | Symptoms of hypothyroidism/hyperthyroidism | | 09:18 | Treating hypothyroidism | | 13:03 | Treating hyperthyroidism/Graves’ | | 17:16 | Celiac disease overview | | 22:04 | Who should be screened for celiac | | 24:38 | Diagnosing celiac: biopsy & antibodies | | 25:18 | Gluten-free diet challenges | | 28:32 | Brief on other autoimmune diseases | | 29:03 | Detailed Addison’s disease case | | 32:55 | Don’t blame everything on diabetes | | 34:13 | Final takeaways, value of awareness |

Final Thoughts

This episode delivers a wealth of practical, empathetic advice for people living with type 1 diabetes, or for those supporting someone who does. The hosts’ firsthand knowledge and approachable style make even complex autoimmunity topics understandable and relevant. Regular screening, a solid care team, and staying informed are the best defenses—plus, a little humor and camaraderie go a long way in managing life’s unpredictable “raindrops.”