We're always hearing the scary warnings that the rate of diabetes is increasing dramatically. Here's another scary statistic: 1 in 88 children is diagnosed with autism each year. April is National Autism Awareness Month, so we wanted to take some time to highlight not just autism, but the relationship between autism and diabetes... if there is one.
If you're not familiar with autism (or "Autism Spectrum Disorder" known as ASD), it's actually a wide-spectrum disorder, meaning people diagnosed with it will have their condition manifest in different ways. From "high-functioning" autism, like Asperger's Syndrome, to "low-functioning" autism, which can leave people nonverbal, people with this disorder often have communication issues, behavioral issues, and sensory issues. Many with autism can have an unusual interest in repetitive behaviors, from schedules to activities to food. You all saw the movie Rain Man, right? About 40 percent of people on the spectrum have above average intelligence, yet about 25 percent are completely nonverbal.
There isn't a lot of published information about diabetes and autism, and much of what we found was from effected families themselves. But often, folks living "in the trenches" are the best sources of information about what life with two chronic conditions is really like.
Proof of a Type 1 / Autism Link?
The first thing we wondered was whether or not there is any proven link between autism and diabetes, especially since the diagnosis of both conditions is on the rise. Many parents also wonder, sometimes because the families are dealing with both diabetes and autism, but not necessarily in the same child.
The medical world does not seem consensus to offer. A 2006 study in Finland came to the conclusion that there is no link between autism and diabetes, but doctors at Toronto's Hospital for Sick Children argue that there could be a connection. A 2006 letter from an Italian physician to the journal Diabetes Care supports the theory that type 1 diabetes and autism are not linked, as Sardinia, an island near Italy with one of the highest incidences of type 1 diabetes, only had two patients diagnosed with autism out of 1,373 diabetics. Quite the minority!
Still, people out there are dealing with both. So what is the combination of autism and diabetes really like?
Double Diagnosis: Raising a Child with Autism and Type 1 Diabetes
In an interview on a special needs website, Ammey, mother of a 14-year-old son, Khy, describes the impact his autism has on his diabetes management: "He has never communicated pain, or feeling ill. We are always so concerned about whether he will communicate with people when he needs sugar or when he's feeling bad... He will always require daily support with living skills now because his difficulty communicating and deficits with daily living skills puts him in danger."
M (name withheld), a twentysomething who was diagnosed with autism in high school, explains that his communication issues and repetitive behavior can make it difficult to work with his doctor. One of M's symptoms of autism is stimming, which is a repetitive body movement that self-stimulates one of the senses, such as rocking back and forth, flapping hands, or scratching the skin.
"My mother has been concerned that the way I communicate might interfere with the medical care I get," M says. "One of the biggest issues is my inability to describe how my body feels, and in me wanting doctors to give me more space. I'm a little concerned that we can't really tell if I have neuropathy because I don't know what I'm feeling. I've had a few medical providers who were freaked out because I was jumping or flapping and they figured that meant something was wrong."
But this doesn't mean autism and diabetes are always at odds. Many people with autism resist change, and because diabetes management can be easier with a strict routine, the two can go hand-in-hand. Robert Plamondon, a father of Karl, 17, writes on his blog, "Because Karl's autism means that he likes his routine, he's settled into both a dietary and a daily medical routine very well. Because he doesn't pine for treats or change his mind about what he wants for dinner based on what's going on around him, it's very easy to stick with things that work."
However, rigidity is not always healthy, as Courtney Hurford, founder of the Facebook group Autism and Type 1 Diabetes, explains. She agrees with Robert that rigid eating habits can be great for diabetes, but that's not necessarily what her son's autism needs; anything new can be terribly upsetting to a child with autism, so smoothing the process of accepting new things is an important part of helping her son, Luke.
"As a parent of a child with autism, it is important to expand the diet and break the rigidity," Courtney explains. "So then as you fulfill your 'autism parent' responsibilities you have two issues: new carbs that you have to watch closely, figure out how they trend, and then respond with an appropriate insulin-to-carb ratio."
But the biggest issue is getting an autistic child to accept new food without the corresponding stress reaction. Courtney says, "For our children, the overwhelming sensory issues related to sampling new foods can cause (in our case) a blood sugar spike of 100-plus points within NO time. This is problematic because you cannot create proper insulin-to-carb ratios when the underlying cause of the spike is stress, not carbs." Frustrating!
In addition to Courtney's group, there's also a Yahoo! group, Autism Plus Diabetes, for parents raising children with both conditions. If you or your child has both diabetes and autism, we would love to have you share your story in the comments so we can help link families and individuals with the support they need!
Link Between Type 2 Diabetes & Autism
A second issue is a possible link between autism and type 2 diabetes. Dr. Michael Stern, a biochemist at Rice University, has been studying a possible connection and has found that there is a common underlying mechanism: hyperinsulinemia, which is a precursor for insulin resistance.
Dr. Stern's hypothesis was published as an opinion article in a recent issue of the journal Frontiers of Cellular Endocrinology. Although this theory has not been studied in-depth, Dr. Stern says, "It will be very easy for clinicians to test my hypothesis. They could do this by putting autistic children on low-carbohydrate diets that minimize insulin secretion and see if their symptoms improve."
You can also watch a short video where Dr. Stern discusses his theory.
Pregnancy + Type 2 Diabetes = Autism in Children?
Researchers at the University of California Davis have given mothers with type 2 diabetes or gestational diabetes something else to worry about. They recently found that 9.3% of children who had autism had a mother with one of these conditions, compared to 6.4% of children with autism who were born to a mother without diabetes. In addition, 11.6% of children who were born to a woman with diabetes had developmental disabilities.
Researchers determined that autistic children of diabetic mothers were more likely to learning issues and problems with language and communication, compared with children with autism born to non-diabetic mothers.
When I read this news, I groaned so loudly that my husband asked me what was wrong. Showing him the headline, I said, "As if we don't have enough to worry about!" (We're thinking of starting a family soon.)
Why such a high incidence of diabetes in diabetic moms? Researchers believe that in diabetics, high blood sugar levels during pregnancy causes fetal exposure to high blood sugar (what happens to mama happens to baby), and so the baby starts producing more insulin. However, elevated insulin production requires greater oxygen use, which may result in depleted oxygen supply. In addition, researchers say diabetes can cause fetal iron deficiency. Both low oxygen and low iron can cause problems in fetal brain development.
"The sequence of events related to poorly regulated maternal glucose levels is one potential biological mechanism that may play a role in adverse fetal development in the presence of maternal metabolic conditions," said Paula Krakowiak, one of the researchers. That's a fancy way of saying: PWD Moms, you need to have near-perfect glucose control! (At least that's what I hear)
And it's not just children of women with diagnosed diabetes who are at risk. In the study, obese women were 1-2/3 times more likely to have a child with autism and were more than twice as likely to have a child with another developmental disorder, compared to women without a metabolic condition.
While this particular study didn't include mothers with type 1, we know that all types of diabetes affect blood sugars, so I'm begrudgingly adding autism to the list of reasons why I hate diabetes.
Got any Autism + Diabetes insight to share? We'd love to hear from you.