Thyroid Disease & Type 1 Diabetes – Insights from Juicebox Podcast Episode 413
Undiagnosed hypothyroidism in people with type 1 diabetes can quietly wreak havoc — slowing growth, dropping blood sugars, and draining energy.
💊 Levothyroxine tips
💡 When “normal labs” aren’t enough
🧬 Why type 1 and Hashimoto’s often come as a pair
Executive Summary
Thyroid health is closely intertwined with type 1 diabetes management. In this Juicebox Podcast episode with Dr. Adi Benito (an endocrinologist with an integrative approach) and follow-up “Defining Thyroid” segments with CDE Jennifer Smith, the discussion breaks down thyroid disorders—especially hypothyroidism/Hashimoto’s—in people with type 1. Key takeaways include the importance of comprehensive care, such as monitoring thyroid function, screening for related autoimmune conditions, and checking nutrient levels. Treatment is individualized, typically beginning with standard levothyroxine therapy. In select cases, this may include adding T3 or using natural thyroid preparations if symptoms persist. The conversation emphasizes patient advocacy, proper medication use, and staying attuned to symptoms for optimal thyroid and overall health.
Key Topics & Definitions
Hypothyroidism – An underactive thyroid gland that doesn’t produce enough thyroid hormone, causing a slowed metabolism (fatigue, weight gain, feeling cold, etc.).
Hyperthyroidism – An overactive thyroid producing excess hormone, leading to a sped-up metabolism (rapid heartbeat, weight loss, anxiety, heat intolerance).
Hashimoto’s Thyroiditis – An autoimmune disease where the immune system attacks the thyroid, typically resulting in hypothyroidism.
Graves’ Disease – An autoimmune disease that causes the thyroid to overproduce hormones, leading to hyperthyroidism (often with symptoms like eye bulging).
Autoimmune Thyroid Disease – A broad term for thyroid dysfunction caused by autoimmunity (encompassing Hashimoto’s and Graves’); often identified by the presence of thyroid antibodies.
TSH (Thyroid Stimulating Hormone) – A pituitary hormone that regulates the thyroid; high TSH suggests low thyroid activity (hypothyroid), while low TSH suggests high thyroid activity (hyperthyroid).
T4 (Thyroxine) – The primary hormone made by the thyroid gland (mostly inactive form); it converts in the body to T3. Available as medication levothyroxine for hypothyroid treatment.
T3 (Triiodothyronine) – The active thyroid hormone influencing metabolic processes. While the thyroid produces some T3, the majority is generated by peripheral conversion of T4. In certain cases, synthetic T3 (liothyronine) may be prescribed.
Levothyroxine – Synthetic T4 thyroid hormone replacement (e.g. brand name Synthroid, or Tirosint in gel-capsule form). It is the standard treatment for hypothyroidism to normalize T4/T3 levels.
Liothyronine – A synthetic form of the active thyroid hormone T3 (brand name Cytomel), occasionally added to levothyroxine therapy in patients who continue to experience symptoms despite normalized TSH levels.
Desiccated Thyroid Extract – A thyroid hormone replacement derived from porcine thyroid glands, containing both T4 and T3 hormones. While some patients prefer it, its hormone ratios differ from human physiology, and its use should be individualized.
Hashitoxicosis – A transient hyperthyroid phase in Hashimoto’s thyroiditis caused by inflammation-induced release of stored thyroid hormones. This phase precedes the typical progression to hypothyroidism.
Addison’s Disease – An autoimmune disorder where the adrenal glands are damaged, leading to cortisol deficiency. It’s another condition that can co-occur with type 1 diabetes and thyroid disease.
Celiac Disease – An autoimmune condition in which ingestion of gluten damages the small intestine. It commonly coexists with type 1 diabetes and autoimmune thyroid disease, affecting nutrient absorption.
Autoimmune Gastritis – An autoimmune condition where the immune system targets gastric parietal cells, leading to decreased intrinsic factor production and subsequent vitamin B₁₂ and iron malabsorption. Commonly coexists with autoimmune thyroid diseases and type 1 diabetes, contributing to fatigue and anemia.
Thyroid Antibodies – Immune-system proteins (like anti-TPO or anti-thyroglobulin antibodies) that target the thyroid gland. Their presence indicates autoimmune thyroid disease (though absence doesn’t fully rule it out).
Integrative Endocrinology – An approach to endocrine disorders that combines conventional medical treatments with evidence-based complementary therapies, including nutrition, supplements, and lifestyle modifications, aiming to address the whole person.
Ferritin – A protein that reflects iron storage levels in the body. Low ferritin indicates iron deficiency, which can cause fatigue and may worsen symptoms in individuals with thyroid disorders.
Vitamin B₁₂ – A vital vitamin for neurological function and red blood cell formation. Deficiency, often due to pernicious anemia or autoimmune gastritis, can lead to fatigue, cognitive disturbances, and neuropathy, symptoms that may overlap with hypothyroidism.
Selenium – A trace mineral vital for thyroid hormone metabolism and antioxidant defense. Some studies suggest that selenium supplementation may reduce thyroid antibody levels in Hashimoto’s thyroiditis; however, evidence on its impact on disease progression and quality of life remains inconclusive. Supplementation should be approached cautiously to avoid toxicity.
Findings & Insights
Thyroid Disease Overview & Prevalence
Hypothyroidism is more common than hyperthyroidism, and in the United States the vast majority of hypothyroid cases are caused by autoimmune attack on the thyroid (Hashimoto’s). Worldwide, iodine deficiency remains a leading cause of hypothyroid, but in iodine-sufficient regions like the US, Hashimoto’s thyroiditis is the number one cause.
Other causes of thyroid failure exist but are less common – for example, thyroid destruction by medical treatment (such as surgical removal or radioactive iodine therapy for hyperthyroidism) or external radiation to the neck can lead to hypothyroidism. These were noted as the “second most likely cause” in a U.S. context after autoimmunity.
Graves’ disease is the main cause of hyperthyroidism. It results in high thyroid hormone levels (hyperthyroid symptoms) and is autoimmune in nature. Graves’ can eventually lead to hypothyroidism in later stages or after treatment (since treatments often reduce thyroid function).
Autoimmune thyroid diseases have both genetic and environmental components. Many of the genes that predispose to Hashimoto’s or Graves’ overlap with genes for type 1 diabetes. This explains why these conditions often cluster in individuals and families. Environmental triggers (infections, stress, etc.) are believed to contribute, although specific triggers remain under study.
Autoimmune Connections & Risk in Type 1 Diabetes
People with type 1 diabetes have a much higher risk of developing autoimmune thyroid disease. Dr. Benito noted that about 10 - 25% of individuals with type 1 will develop thyroid autoimmunity (positive thyroid antibodies), and roughly 12–24% in females and ∼6% in males with T1D (one in four) will progress to actual thyroid dysfunction requiring treatment. There is a 4.6% risk in the general population.
Autoimmune thyroid issues also tend to cluster with other autoimmune conditions. For instance, families might see one person with type 1 diabetes and another with Hashimoto’s, or the same individual may eventually have multiple autoimmune diagnoses. Conditions like celiac disease and vitiligo were mentioned as commonly co-occurring in those prone to autoimmunity.
Routine screening is essential: Because of the strong association, those with type 1 diabetes are often monitored periodically via TSH tests to catch thyroid disease early. Similarly, if someone is diagnosed with Hashimoto’s, a good practice is to screen for related autoimmune conditions (Dr. Benito routinely checks her thyroid patients for celiac disease and pernicious anemia/autoimmune gastritis via labs). This comprehensive screening can identify issues like iron or B₁₂ deficiencies that might be causing symptoms beyond the thyroid’s contribution.
Unexplained changes in diabetes control can be a red flag. The speakers highlighted that when a person with type 1 develops an additional autoimmune condition like hypothyroidism, their insulin needs often drop, leading to more frequent hypoglycemia episodes. In children, poor growth or delayed puberty can be another sign of undiagnosed hypothyroidism. Dr. Benito pointed out that if a type 1 diabetic child “just isn’t growing” and is having more lows, it’s a clue to check thyroid function (or other autoimmune issues like celiac or Addison’s disease). In her words, “hypoglycemia is a big one” that can signal something like thyroid or adrenal insufficiency in the background.
Symptoms & Patient Experience
Hypothyroidism’s symptoms can be widespread and often develop gradually. Common signs mentioned include fatigue, low energy, feeling cold, unexplained weight gain, dry skin, hair thinning, constipation, and in women, irregular or heavy menstrual periods. Severe or prolonged hypothyroid can cause a visible goiter (enlarged thyroid in the neck) or puffiness. The podcast provided a comprehensive list sourced from Mayo Clinic, even noting that infants can present differently (jaundice, large tongue, poor feeding) and that teens might have delayed growth and puberty.
Hyperthyroidism’s symptoms are essentially the opposite: palpitations or rapid heart rate, nervousness, tremors, increased appetite with weight loss, frequent bowel movements or diarrhea, heat intolerance (excessive sweating), and possible eye changes (like eye bulging in Graves’ disease). A swollen thyroid (goiter) can occur in hyperthyroid as well. These lists (sourced from Cleveland Clinic in the discussion) help listeners recognize thyroid imbalance signs.
Hashimoto’s disease may cause a mix of symptoms over time. As explained, early in Hashimoto’s, there can be a short phase of gland inflammation causing excess hormone leakage – during that phase a person might oddly experience temporary hyperthyroid symptoms (anxiety, rapid heart rate) despite ultimately having an underactive thyroid. Over time, as the thyroid tissue is damaged, the person becomes definitively hypothyroid and needs lifelong hormone replacement. This transition (sometimes called Hashitoxicosis) can be confusing for patients if they feel symptoms swing from high to low.
Impact on daily life: The podcast underscored how profoundly thyroid levels affect well-being. The host, Scott, described his daughter’s undiagnosed hypothyroidism as “she was on a dimmer… someone was turning her down slowly” – her energy faded and she wasn’t herself. Proper treatment “brought her right back” to normal energy. He also observed a significant growth spurt once treatment began – his daughter went from the shortest in her class to one of the tallest after thyroid hormone normalized. This illustrates that timely intervention in a hypothyroid child can restore normal development.
Thyroid vs Diabetes management: Jennifer Smith pointed out that managing thyroid conditions doesn’t usually involve the intense day-to-day micromanagement that diabetes does – you’re not making constant dose decisions each day. Instead, it’s about consistent routine and periodic adjustments. However, she stressed it’s “always something in the background” – patients must pay attention to their bodies and labs over time. You can’t just ignore it; for example, fatigue or weight changes should prompt a thyroid check rather than being written off, especially in someone with existing autoimmune conditions.
Thyroid Hormone Treatment & Medication Management
Levothyroxine (T4) is the standard therapy for hypothyroidism. The goal is to supply the body with the hormone it lacks and bring the TSH into a normal range (often around 1–2 mIU/L is considered an optimal TSH target for treated patients). When the dose is right, symptoms usually improve and TSH stabilizes in target range. Scott noted that once his daughter started on Synthroid (levothyroxine), her symptoms resolved and labs normalized fairly quickly.
Proper dosing is crucial, but so is proper timing and consistency. A key insight was that thyroid medication must be taken under specific conditions for full absorption. Take levothyroxine on an empty stomach, first thing in the morning (or at least 3-4 hours after your last meal if taken later). Avoid taking iron or calcium supplements at the same time – these minerals bind with thyroid medication in the gut and block its absorption. (For example, an iron-heavy multivitamin or a calcium pill will make the thyroid dose ineffective if taken together.) Even common meds like antacids, reflux medications, certain cholesterol drugs, and soy or high-fiber foods can interfere with thyroid pill absorption. The experts advised spacing thyroid pills at least 4 hours apart from such supplements/medications.
Many medications can affect thyroid levels or absorption. Jennifer rattled off a list: some antidepressants, blood thinners, statin cholesterol drugs, birth control pills, and diabetes medications can all interact with thyroid function or the efficacy of thyroid meds. This means if a thyroid patient starts or stops another medication, their thyroid dose might need re-evaluation. Keeping your doctor informed of all meds and supplements is important so they can adjust thyroid treatment appropriately.
Consistency in brand/formulation matters: Not all levothyroxine is identical – there are different brands (Synthroid, Levoxyl, etc.) and also generic versions, as well as unique formulations like Tirosint (a liquid gel cap form of T4 that is free of dyes, gluten, or fillers). Some patients are sensitive to the fillers or minor potency variations in different brands. The host shared that his wife felt unwell after a pharmacy switched her to a generic levothyroxine; the subtle change in formulation caused a return of symptoms. The advice here is if you feel stable on a particular brand or type of thyroid medication, stay with it consistently. If you must switch (due to insurance or pharmacy changes), be extra vigilant for any changes in how you feel, and do follow-up labs – you may need dose adjustments.
If symptoms persist despite “normal” labs, dig deeper: A recurring theme was patients who are on levothyroxine and have a TSH in the supposedly normal range, yet still feel unwell (fatigued, brain fog, etc.). Dr. Benito acknowledged this common scenario and outlined a stepwise approach. First, ensure the thyroid levels truly are optimized: sometimes “normal” isn’t optimal (for instance, a TSH of 3.5 might be technically in range, but a patient might feel better at 1.0). She ensures a patient’s TSH is around the low end of normal and free T3 is adequately in range. Next, check for other causes of symptoms – this is where testing for iron deficiency, B₁₂ deficiency, vitamin D status, and other autoimmune conditions (like celiac) comes in. Often, she finds a coexisting issue that, when corrected, alleviates the fatigue or other complaints.
Combination T4 + T3 therapy is an option for some. For the subset of patients who still don’t feel “right” after those steps, adding a small dose of T3 (liothyronine) can make a difference. The podcast discussed how guidelines generally discourage T3 use, because not everyone needs it and too much T3 can cause palpitations or bone loss. However, major endocrine societies do acknowledge that on a case-by-case basis, adding T3 may be considered. Dr. Benito explained that some people’s bodies might not efficiently convert T4 to T3 in the tissues, leaving them with normal blood levels but low cellular T3 effect. These patients – often identified by persistent symptoms – may feel markedly better with a combination therapy. She has seen a subset of hypothyroid individuals experience improved energy and well-being by adding a low dose of liothyronine to their regimen (or by using a desiccated thyroid medication which naturally contains T3).
Caution with T3: Because T3 is the active hormone and acts quickly, it can cause symptoms of hyperthyroid if the dose is even a bit too high for a given patient. Scott mentioned his wife had “a ton of success with Cytomel (T3) until it started giving her palpitations.” This suggests they found an effective T3 dose that improved her symptoms, but over time it might have led to a slight excess, causing heart-racing. They likely had to tweak or reduce it. The lesson is to work closely with a knowledgeable doctor, start T3 low, and monitor symptoms and heart rate when adjusting therapy.
Natural desiccated thyroid (NDT) as an alternative: The conversation also introduced Armour Thyroid and similar natural products. These are made from pig thyroid glands and provide a mix of T4 and T3 in one pill. One of the hosts’ children takes a combination of Tirosint (T4) plus a small amount of Armour (to get some T3 naturally). This regimen “is working really well for him.” NDT can be a viable option, especially for those who want a more holistic medication or need that T3 boost; however, because the T3:T4 ratio in desiccated products is fixed and not exactly the same as human thyroid output, some patients may feel it’s too much T3 or too variable. The key insight is that treatment can be individualized – some do best on T4-only, others on T4+T3 (synthetic or natural), and finding the right balance can greatly improve quality of life.
Pregnancy considerations: One important caveat raised was that T3-containing therapies are not recommended during pregnancy or when trying to conceive. The fetus’ developing brain depends on the mother having adequate T4 (which crosses the placenta; T3 does not as well). So, women who are pregnant or may become pregnant are kept on T4-only (levothyroxine) and maintained at appropriate levels for pregnancy. If a woman on combination therapy plans to get pregnant, her doctor will typically transition her to T4-only and ensure TSH is well-controlled for the baby’s sake.
Integrative & Holistic Management Approaches
Treat the whole person, not just the lab number. Dr. Benito’s approach to thyroid care is more integrative than what patients may have experienced elsewhere. She emphasized looking at the patient “in their entirety” – that means if someone with thyroid disease is still unwell, consider other body systems, nutrition, and lifestyle, not solely the thyroid labs. This holistic mindset is a core principle of integrative endocrinology. It explains why she routinely tests for other autoimmune conditions and nutrient deficiencies in her thyroid patients; fatigue might not always be from low thyroid hormone, even if they carry that diagnosis. It could be iron deficiency from heavy periods or celiac disease causing malabsorption, for example. By addressing those issues (iron supplements, B₁₂ injections, a gluten-free diet in celiac, etc.), patients often feel better.
Role of supplements and vitamins: While many patients ask about supplements to prevent or manage thyroid problems, Dr. Benito made it clear that no supplement has been proven to prevent autoimmune thyroid diseasefrom developing. For instance, if someone has positive thyroid antibodies but normal thyroid function, there isn’t a confirmed way to stop progression to hypothyroidism – iodine, selenium, vitamin D, etc., have all been studied without definitive preventative success. However, certain supplements can be useful adjuncts once the disease is present.
Selenium is the standout supplement for Hashimoto’s. Multiple studies (including some mentioned in the episode) have shown that selenium supplementation can lower thyroid antibody levels, improve the ultrasound appearance of the thyroid gland (less inflammation), and even enhance a patient’s overall sense of well-being. Most trials used a dose of around 200 micrograms daily. Dr. Benito does often recommend selenium early in the course of Hashimoto’s disease because of these positive effects – she views it as a helpful, low-risk intervention to aid the autoimmune process and symptom improvement.
Selenium caution: The region’s baseline selenium sufficiency matters. In the U.S., most people are not deficient in selenium, so adding high doses on top can potentially overshoot. The podcast noted concerns that excessive selenium supplementation might be linked to an increased risk of type 2 diabetes or other issues. Thus, Dr. Benito might use a more moderate dose (or periodically measure levels) to avoid toxicity. The bottom line is selenium in moderation can be beneficial for autoimmune thyroid patients, but more is not always better.
Vitamin D is another factor mentioned. Many patients with autoimmune disorders have low vitamin D levels, and vitamin D plays a role in immune regulation. Ensuring a Hashimoto’s or Graves’ patient has sufficient vitamin D (through safe sun exposure or supplements) is thought to support immune balance. Dr. Benito indicated she “also uses vitamin D to help with... immunity” in these patients, especially if there’s any sign of deficiency.
Other supplements: While not discussed at length, integrative practitioners sometimes check zinc, magnesium, and iodine status. In general, iodine is a double-edged sword – it’s essential for thyroid hormone production, but too much iodine can actually trigger or worsen autoimmune thyroiditis. Because most Americans get enough iodine in salt and diet, supplementing iodine is usually not advised in Hashimoto’s (unless there’s a documented deficiency). Dr. Benito noted that the U.S. is considered “iodine sufficient” as a population, suggesting that routine iodine supplements aren’t needed for thyroid patients here and could even be harmful in excess.
Dietary approaches: The discussion didn’t dive deeply into diet changes beyond identifying celiac disease. However, an integrative view often is to eat a balanced, anti-inflammatory diet. Some patients choose to go gluten-free even without celiac, in hopes of reducing Hashimoto’s antibodies (there is anecdotal support for this, though not definitively proven). The speakers did highlight that if someone does have celiac, a strict gluten-free diet is medically necessary and often improves how they feel. There was also mention of ensuring any thyroid medication used does not contain allergens; for example, certain thyroid pill formulations are gluten-free and lactose-free (Tirosint was implicitly referenced as a hypoallergenic option). This can be relevant for patients who are very sensitive or who have celiac and want to avoid even trace gluten in medications.
Patient-centered care and access: An interesting insight was the contrast between Dr. Benito’s private integrative practice and typical insurance-based practices. Scott described her practice as “uncommon” – she doesn’t take insurance, working directly for the patient. In their family’s experience, this meant they could spend more time with her, communicate by email between appointments, and make rapid adjustments to the treatment plan as new results came in or symptoms changed. This intensive, responsive care is something he felt made a huge difference (as opposed to the standard model of brief visits every 3–6 months). The downside is cost and availability: not everyone can pay out of pocket or find such a specialist. It highlights a healthcare gap where many patients struggle to find a doctor who will dig as deep or be as accessible for a common issue like thyroid disease.
“Listen to the patient” approach: Both experts echoed that patients know their bodies best. If you feel on-going symptoms, a good clinician will investigate further rather than dismiss you just because your TSH is “fine.” Similarly, keep communicating things like fatigue level, weight changes, mood, etc., to your provider. Thyroid treatment is a partnership – the medication dose might need tweaking or another condition might need addressing. Dr. Benito’s routine inclusion of antibody tests and related autoimmune screenings is an example of thorough care, whereas she noted that in her past conventional practice, they often wouldn’t even test for thyroid antibodies or related diseases in straightforward hypothyroid cases. Her current integrative philosophy is to always ask “Why is this person still unwell? Is there more to the story?” and that leads to better outcomes.
Patient Tips & Advocacy
Keep detailed personal health records. Jennifer strongly advised thyroid patients (especially those with complex cases or multiple changes over time) to maintain a written log of medications, doses, and how they felt on each. Note any side effects or issues (e.g., “Generic levothyroxine caused heart palpitations” or “switched to Armour in 2019, energy improved”). This history becomes invaluable if you change doctors or see a new specialist – it prevents retrial of something that didn’t work and quickly informs the doctor what approaches have been tried. It also helps ensure continuity if something like an insurance change forces a switch in providers.
Be your own advocate with providers. Thyroid patients often have to speak up to get optimal care. That might mean asking for specific tests (“Could we check my B12/iron/vitamin D since I’m still so tired?”) or ensuring the doctor doesn’t overlook something like thyroid antibodies or a small nodule on exam. If you have a child with type 1, for example, and they are not growing or having unusual low blood sugars, it’s appropriate to advocate for a thyroid test or other autoimmune screening without delay. The podcast conversation encourages patients to push for comprehensive evaluation rather than settling for “your TSH is in range, you’re fine” if you clearly don’t feel fine.
Medication diligence: Taking thyroid hormone correctly every single day is the patient’s responsibility, and it makes a huge difference. One should treat it as a ritual – same time each day, following the rules about food and other meds. If life circumstances make a morning empty-stomach dose hard, discuss alternatives (some take it at night, or split dose morning and night for T3-containing regimens). What you don’t want is to unknowingly sabotage your treatment by washing your pill down with a calcium-fortified orange juice or taking it with your iron-rich breakfast – that could render it much less effective. As Scott put it, “you’re going through the effort of taking this pill… if you take it with something that blocks it, you’re not going to know why you feel bad, because in your mind you take that every day, you think you’re doing it right.” Pay attention to the fine print instructions your doctor or pharmacist gives; these details matter for thyroid meds.
Monitor changes and follow up: Thyroid levels can fluctuate over time – stress, weight changes, pregnancy, and other medications can shift your dosage needs. It’s recommended to have thyroid labs checked at least annually (or a couple of times a year if adjusting doses). Don’t just refill the same dose indefinitely without re-checking if it’s still appropriate. If you experience a return of symptoms, schedule a lab test sooner. Also, if you have Hashimoto’s and become pregnant, alert your endocrinologist promptly – dosage needs often increase in pregnancy, and tight control is needed to support the baby’s development.
Support your overall health: While no special diet or supplement can single-handedly “cure” thyroid disease, maintaining a healthy lifestyle will help your body cope better. Eat a balanced diet with adequate protein, fruits and vegetables (for micronutrients), and sufficient selenium and iodine from foods (Brazil nuts for selenium, iodized salt or seafood for iodine) – but avoid mega-doses. Manage stress and get good sleep, as stress hormones can affect thyroid function and how you feel. Essentially, good general health practices support thyroid management, whereas neglecting nutrition, sleep, or stress can exacerbate the strain on your thyroid/immune system.
Practical Recommendations (How-To & Tips)
Schedule Regular Thyroid Screenings – If you have type 1 diabetes (or a family history of thyroid issues), get your thyroid levels checked periodically. A simple TSH blood test (with free T4, and antibodies if appropriate) can catch developing thyroid problems early, before symptoms become severe.
Ask for a Comprehensive Workup – Upon a thyroid disorder diagnosis, request testing for related conditions and nutrients. For hypothyroid patients, that means checking thyroid antibody levels (to confirm if it’s Hashimoto’s) and screening for celiac disease and vitamin deficiencies (iron/ferritin, Vitamin B₁₂, Vitamin D). Identifying and treating these issues can significantly improve how you feel.
Take Thyroid Medication Properly – Consistency is key: take your levothyroxine (T4) every day at the same time. Swallow it with water on an empty stomach, then wait 30–60 minutes before eating or drinking anything else. Do NOT take it alongside supplements or medications like multivitamins, calcium, iron, antacids, or cholesterol drugs – these must be separated by at least 4 hours so they don’t block absorption. If morning doesn’t work, talk to your doctor about a bedtime routine (at least 2–3 hours after your last meal of the day).
Stick to the Same Formulation – Once you find a thyroid medication brand or type that works for you, try to stay on it. If you are prescribed Synthroid and feel good on it, ensure your pharmacy keeps giving you that brand (you can request “dispense as written” if needed). If a switch is unavoidable (to a generic or different brand), mark your calendar for a follow-up blood test in 6–8 weeks and be alert to any symptom changes. Communicate any differences you feel to your doctor so your dose can be adjusted if necessary.
Keep a Medication/Symptom Journal – Maintain a record of your thyroid treatment history. Note the dose and brand, how your labs looked, and how you felt on each regimen. For example: “75 mcg levothyroxine – TSH 1.8 – still fatigued mid-day” or “added 5 mcg liothyronine – more energetic, but had some palpitations at 10 mcg.” This log empowers you (and any new healthcare provider you see) to fine-tune your treatment.
Follow Up on Symptoms – Don’t accept feeling lousy as “normal.” If you’re on thyroid meds but still symptomatic, revisit your doctor. Ask, “Can we investigate why I still feel this way?” Work together to check if your levels need tweaking or if something else is contributing (stress, anemia, etc.). You deserve to feel well, not just “okay.”
Consider Combination Therapy Wisely – If you have persistent hypothyroid symptoms despite a good TSH level, discuss with your endocrinologist whether a trial of adding T3 (liothyronine) or using a natural desiccated thyroid medication could help. Do not add T3 on your own – it requires medical supervision. But an open-minded doctor might prescribe a small dose to see if you improve. Monitor how you feel and report any jitters or heart racing (they may adjust the dose). Important: If you are pregnant or trying to conceive, stick to T4-only therapy and consult your doctor for any dose changes needed.
Supplement Smartly (with Doctor’s OK) – Talk to your provider about supplements that might support your condition. Selenium (100–200 mcg daily) is often recommended in Hashimoto’s to reduce antibody levels and inflammation – consider taking it if your doctor agrees. Ensure your Vitamin D level is in a healthy range (supplement if it’s low, as this can bolster your immune regulation). However, avoid high-dose iodine unless directed by a doctor, as too much iodine can be harmful in autoimmune thyroid disease.
Watch for Changes Over Time – Life events and other health changes can alter your thyroid needs. For example, if you start a new medication (like birth control pills or an antidepressant) or if you go through pregnancy/menopause, your thyroid dosage might need re-evaluation. Similarly, significant weight loss or gain can shift thyroid hormone requirements. Schedule a thyroid function test if anything major changes with your health or how you feel.
Stay Educated and Connected – Thyroid issues can be complex, so continue learning about your condition. Reliable sources and patient communities (online forums or local support groups) can provide tips and emotional support. At the same time, be cautious of fads – always run new ideas by your healthcare provider. If your current doctor isn’t addressing your concerns, consider getting a second opinion or consulting an integrative thyroid specialist. You are your best advocate – don’t give up until you feel heard and on a path to feeling your best.
Quotes for Context
On Autoimmune Risk and Clustering:
“If you think of the risk of autoimmune thyroid disease in the general population it’s close to 10%. If you have a relative with type 1 diabetes, that risk is 40–50%. And if you yourself have type 1 diabetes, the risk of having autoimmune thyroid disease is 50%.” – Dr. Adi Benito highlighting the strong linkage between type 1 diabetes and thyroid autoimmune disorders.
“Autoimmune thyroid disease, like any other autoimmune condition, is purely genetic and probably environmental… That’s why those two conditions (type 1 and Hashimoto’s) happen in clusters in families.” – Dr. Adi Benito explaining why one family member’s autoimmune illness often foreshadows another’s.
“Hypoglycemia is a big one. And that’s a pretty big clue for almost any other autoimmune condition – whether it’s celiac, whether it’s Addison’s disease… If your type 1 diabetic child suddenly has more lows and isn’t growing, always think to check the thyroid or other autoimmune issues.” – Dr. Adi Benito on the importance of noticing low blood sugars or growth changes as warning signs of thyroid or adrenal problems in diabetics.
On Patient Experience with Hypothyroid:
“It was just like she was on a dimmer and someone was turning her down slowly. She just didn’t have the energy… The Synthroid brought her right back.” – Scott Benner (host, describing his daughter’s fatigue before and after hypothyroid treatment).
“Arden was at one time the smallest child in her school. And she is now probably one of the tallest.” – Scott Benner, noting his daughter’s remarkable catch-up growth once her thyroid was treated, illustrating how much hypothyroidism can affect development.
“Thyroid disease doesn’t involve the micromanagement day-to-day that diabetes does. But it is always something in the background… You should be paying attention to your body awareness.” – Jennifer Smith, CDE, comparing the management styles of diabetes vs. thyroid conditions – fewer daily tasks for thyroid, but still requiring long-term vigilance.
On Treatment and Medical Approach:
“We assume that it’s autoimmune… We don’t tend to test for antibodies. I don’t even remember testing people for other autoimmune conditions, which now is part of my routine practice. If I find somebody with autoimmune thyroid disease… I will be screening those patients for celiac, as well as for autoimmune gastritis… many times, it’s actually the cause of their symptoms, not the thyroid itself.” – Dr. Adi Benito contrasting conventional thyroid care (limited testing) with her integrative approach (comprehensive testing), and finding that issues like B₁₂ or iron deficiencies can be the real culprits behind persistent symptoms.
“Not having antibodies doesn’t mean you don’t have autoimmune thyroid disease. But if you have the antibodies, it’s a marker… Finding them is helpful; not finding them is not that helpful.” – Dr. Adi Benito clarifying that a negative antibody test doesn’t 100% rule out Hashimoto’s (a significant minority of patients are “seronegative”), so doctors may need to use clinical judgment or ultrasound in suspicious cases.
“What do you do when somebody has a perfectly normal TSH on paper, but you don’t feel well? First thing, make sure that you’re really within the optimal range… In spite of that, we do know some people with hypothyroidism – in spite of having normal levels – do not feel well. A subset of those people feel better when they take T3 along with T4.” – Dr. Adi Benito acknowledging the limitations of a T4-only approach for some patients and the rationale for considering combination therapy.
“My son actually takes a mix of Tirosint and Armour Thyroid… a more natural version – Armour is made from dried thyroid glands of a pig. He takes a blend of T4 and a very small amount of Armour, and it seems to be working really well for him.” – Scott Benner sharing a personalized treatment example where using both synthetic and natural thyroid hormone achieved good results.
“If you took an iron supplement or a multivitamin with iron at the same time as your Synthroid or Tirosint, it would just block the uptake of it… you’re going to start having problems and you’re not going to know why.” – Scott Benner explaining how common supplements can interfere with thyroid medication, and warning patients to separate them to avoid undermining their treatment.
“Many other meds can change the way your thyroid med gets absorbed… The list is extensive – antidepressants, blood thinners, some statins, even some birth control pills, oral diabetes medications, reflux antacids… you need to pay attention.” – Jennifer Smith, CDE emphasizing that thyroid patients must be mindful of drug interactions and inform their doctors about all therapies they use.
“Selenium has a lot of studies in autoimmune thyroid disease… Most of the studies on selenium are positive – meaning they have a beneficial effect. They help with the antibodies, they help with how the thyroid looks on ultrasound, and they also help with well-being.” – Dr. Adi Benito highlighting selenium supplementation as a helpful adjunct in Hashimoto’s management.
“Why is what you know so difficult to find? …You have an uncommon practice. We paid you in cash, you don’t take insurance, but with that comes the ability to send you an email, which is lovely… no big gaps, and you can move along quickly.” – Scott Benner questioning why more endocrinologists don’t practice the kind of comprehensive, responsive care that Dr. Benito provides, and noting the advantages of her model (direct access and faster iterations in care).
“It’s a good question. I don’t really know the answer, to be honest.” – Dr. Adi Benito responding humbly to why such care isn’t widespread, implying that systemic factors in healthcare make it challenging to offer the level of detail and availability that patients like Scott’s family benefited from.
Unanswered Questions & Research Gaps
What environmental triggers are driving the rise in autoimmune thyroid disease? The discussion acknowledged a growing prevalence of thyroid disorders not explained by genetics alone. It remains unclear which environmental factors (dietary components, infections, chemicals, stressors) might be contributing to more cases of Hashimoto’s and Graves’ in recent decades. This is an area for further research.
Why do some patients remain symptomatic despite “normal” thyroid levels? Medicine still doesn’t fully understand why a subset of hypothyroid patients experience fatigue, brain fog, or other complaints even after TSH is normalized on levothyroxine. Is it due to differences in T4-to-T3 conversion, thyroid hormone receptor sensitivity, or unrelated conditions? Research is ongoing, but for now it’s managed by trial of therapy adjustments (like adding T3) rather than a clear diagnostic test.
Can we prevent Hashimoto’s thyroiditis from progressing? For individuals who test positive for thyroid antibodies but have normal thyroid function, there is no proven intervention to stop the eventual development of hypothyroidism. Various supplements (selenium, vitamin D, myo-inositol) are being studied as potential preventative therapies, but evidence is inconclusive. The podcast made it clear that currently “none of these have been shown to help prevent thyroid disease” – a notable gap in care.
What is the optimal way to treat patients who need more than T4? The medical community is divided on the use of combination T4/T3 therapy. Guidelines are cautious, yet patient anecdotes and some studies suggest a benefit for certain individuals. More research is needed to identify who exactly benefits from added T3 (genetic differences in deiodinase enzymes, etc.), and to develop personalized protocols. This would help standardize care so patients don’t suffer or have to shop around for a doctor willing to try options.
Holistic care vs. standard care outcomes: It’s evident that an integrative approach (thorough testing, frequent follow-ups, lifestyle focus) can lead to better patient satisfaction and possibly better outcomes, but it’s not widely accessible. It raises the question: could elements of this comprehensive approach be integrated into mainstream practice? Studying the outcomes of patients under intensive management versus typical 15-minute visits might provide data to advocate for changes in guidelines or insurance coverage (for example, routine screening for B₁₂/iron in Hashimoto’s, or allowing email consultations for quicker dose titrations).
Long-term effects of supplements like selenium: While selenium looks promising for autoimmune thyroid support, the long-term safety of supplementing it (especially in selenium-replete populations) needs further clarity. The mention of a possible link between high selenium and type 2 diabetes risk is a reminder that more research is needed to determine safe upper limits and verify any unintended consequences of chronic use of such supplements.
Appendix: Definitions & Abbreviations
T1D (Type 1 Diabetes) – An autoimmune form of diabetes in which the pancreas produces little or no insulin. Often diagnosed in childhood or young adulthood, it requires lifelong insulin therapy. It is associated with other autoimmune diseases like thyroiditis.
T2D (Type 2 Diabetes) – Type 2 Diabetes, a metabolic disease characterized by insulin resistance and high blood sugar. (Mentioned in context of selenium studies and diabetes risk).
TSH (Thyroid Stimulating Hormone) – A hormone produced by the pituitary gland that tells the thyroid how much hormone to make. High TSH = underactive thyroid, Low TSH = overactive thyroid (in most cases). It’s the primary lab test for thyroid function.
T4 (Thyroxine) – The main hormone produced by the thyroid gland. T4 is relatively inactive by itself and gets converted to T3 in the body’s tissues. Measured as Free T4 in blood tests. Available as levothyroxine medication.
T3 (Triiodothyronine) – The active thyroid hormone that regulates metabolism. Only a small amount is secreted directly by the thyroid; most is made from converted T4. Measured as Free T3 in labs. Available as liothyronine medication.
Anti-Thyroid Antibodies – Immune proteins (such as TPO-Ab – thyroid peroxidase antibody, and TgAb – thyroglobulin antibody) that mistakenly target thyroid tissue. Used to diagnose autoimmune thyroid disease. High levels are seen in Hashimoto’s and sometimes in Graves’.
Hashimoto’s Thyroiditis – An autoimmune disease where the immune system attacks the thyroid, leading to chronic inflammation and a decline in thyroid hormone production (hypothyroidism). It is the most common cause of hypothyroidism in the U.S.
Graves’ Disease – An autoimmune disease causing the thyroid to become overactive (hyperthyroidism). The immune system produces antibodies (TSH receptor antibodies) that stimulate the thyroid to produce too much hormone. Key signs can include goiter and eye bulging (Graves’ ophthalmopathy).
Hashitoxicosis – A temporary hyperthyroid phase in Hashimoto’s disease. As the thyroid is inflamed and damaged, it can leak excess hormone into the bloodstream causing short-term hyperthyroid symptoms before transitioning to hypothyroid.
Addison’s Disease – Primary adrenal insufficiency, often autoimmune. The adrenal glands fail to produce sufficient cortisol (and often aldosterone). Symptoms include fatigue, weight loss, low blood pressure, and can cause unexplained hypoglycemia in a person with diabetes.
Celiac Disease – An autoimmune disorder triggered by gluten (a protein in wheat, barley, rye). In celiac, eating gluten causes immune damage to the small intestine lining, leading to malabsorption. Symptoms range from digestive issues to anemia or no symptoms at all. Commonly associated with type 1 diabetes and thyroid autoimmunity.
Autoimmune Gastritis (Pernicious Anemia) – An autoimmune condition where the stomach’s parietal cells are attacked, reducing intrinsic factor and leading to vitamin B₁₂ deficiency. Causes pernicious anemia. Can co-occur with Hashimoto’s; symptoms include fatigue, numbness, memory issues due to low B₁₂.
CGM (Continuous Glucose Monitor) – (Mentioned tangentially in podcast ads) A device for diabetes that provides real-time blood sugar readings. Relevant in context if thyroid issues cause blood sugar swings, a CGM can help catch those.
Omnipod – (Mentioned in intro) A brand of tubeless insulin pump for diabetes management. Not directly related to thyroid, but referenced as a sponsor of the podcast.
Endocrinologist – A doctor specializing in hormone-related diseases (like diabetes and thyroid disorders). Dr. Adi Benito is an endocrinologist with additional training in integrative medicine.
CDE (Certified Diabetes Educator) – A health professional certified in providing coaching and education to people with diabetes. Jennifer Smith, who co-hosted the defining thyroid segment, is a CDE.
Levothyroxine – Synthetic T4 hormone used as a replacement in hypothyroidism. Common brands: Synthroid, Levoxyl, Euthyrox, and Tirosint. Restores T4 levels and should normalize TSH over weeks.
Synthroid – A brand name for levothyroxine. Often used colloquially to refer to any levothyroxine therapy. Known for consistent potency and various pill colors indicating dose strength.
Tirosint – A brand of levothyroxine that comes in a gel capsule. It contains minimal fillers (no dyes, gluten, or lactose), designed for people with absorption issues or allergies to ingredients in regular tablets.
Liothyronine – Synthetic T3 hormone used in hypothyroid treatment when T3 supplementation is needed. Brand name Cytomel. It has a shorter half-life, often taken twice daily if prescribed.
Cytomel – Brand name for liothyronine (T3). Used for combination therapy or in certain cases of thyroid cancer follow-up. Can cause more immediate effects (energy, heart rate changes) due to being the active hormone.
Desiccated Thyroid Extract (NDT) – Dried thyroid gland powder from animals (usually pigs) used as a thyroid medication. Standardized to provide a certain amount of T4 and T3 per grain. Brands include Armour Thyroid, NP Thyroid, Nature-Throid. Some patients prefer “natural thyroid” for the T3 component or perceived holistic nature.
Armour Thyroid – A popular NDT brand (porcine thyroid). Each tablet’s strength (in “grains”) contains a fixed ratio of T4:T3 (approximately 4.2:1 by weight). Because it includes T3, dosing needs careful titration to avoid hyperthyroid symptoms.
Nature-Throid – Another brand of natural desiccated thyroid (similar to Armour). Mentioned as an alternative name in the podcast discussion.
Selenium – A trace mineral essential for thyroid enzyme function (especially the deiodinase that converts T4 to T3). In supplement form (typically selenium yeast or selenomethionine), it’s used at 200 mcg/day in studies to treat Hashimoto’s.
Vitamin D – A fat-soluble vitamin that doubles as an immune-modulating hormone. Adequate vitamin D is associated with lower incidence of autoimmune diseases. Many thyroid patients take supplements if levels are low.
Ferritin – The storage form of iron, measured via blood test. Low ferritin can indicate iron deficiency before anemia develops. Iron is a co-factor for thyroid hormone production (and needed for overall energy), so it’s checked when fatigue is persistent.
From Diagnosis to Regrowth: Tackling Hair Loss in Type 1 Diabetes
When you’re newly diagnosed with type 1 diabetes, you may be bracing for insulin shots and carb counting—but you might not expect a sudden bout of hair loss. In fact, many people experience a temporary shedding called telogen effluvium in the months following diagnosis. Here’s the up‑to‑the‑minute, fully referenced explanation of why it happens, when to expect it, and how to support regrowth.
1. What Is Telogen Effluvium?
Telogen effluvium (TE) is a reversible form of hair loss in which an unusually large number of hair follicles enter the resting (telogen) phase at once, then shed a few months later. Under normal conditions, about 85–90% of scalp hairs are in growth (anagen) and 10–15% in telogen; in TE, that telogen percentage jumps dramatically my.clevelandclinicmedicalnewstoday.
2. Three Triggers After a Type 1 Diabetes Diagnosis
Metabolic Stress
Blood‑sugar swings: Hyper‑ and hypoglycemia elevate stress hormones (cortisol, adrenaline), which shift follicles from anagen to telogen prematurely ccjmmedicalnewstoday.
Emotional Shock
Psychological burden: Grief, anxiety, or depression following a chronic‑illness diagnosis alone can trigger TE. Emotional stress is a well‑documented precipitant of hair‑cycle disruption dermnetnzmedicalnewstoday.
Autoimmune “Overspill”
3. Timing: When You’ll Notice the Shedding
Latency: Hairs pushed into telogen in January typically fall out around March–April—about 8–12 weeks later ccjmmedicalnewstoday.
Duration: Acute TE lasts under six months; once the trigger resolves, follicles gradually return to normal and regrowth begins my.clevelandclinicverywellhealth.
4. Contributing Factors
Dietary Shifts: New meal plans may inadvertently reduce protein or micronutrient intake (iron, zinc, biotin), exacerbating shedding medicalnewstodaypatient.
Medication Fluctuations: As you and your care team “dial in” insulin doses, intermittent highs and lows can prolong metabolic stress. Rarely, treatments for complications (e.g., steroids for DKA) can also provoke TE medicalnewstodaypatient.
5. How to Support Your Scalp and Speed Recovery
Stabilize Glucose
Work closely with your endocrinologist to minimize swings. Every day of steady blood sugar helps follicles stay in anagen.Optimize Nutrition
Emphasize lean proteins and foods rich in iron, zinc, and B‑vitamins. If you struggle to eat enough, discuss a multivitamin or targeted supplement with your provider medicalnewstodaypatient.Manage Stress
Techniques like meditation, gentle yoga, or counseling lower cortisol and support hair‑cycle balance dermnetnzmedicalnewstoday.Be Gentle
Avoid tight hairstyles, harsh chemicals, and excessive heat. Use sulfate‑free shampoos and wide‑tooth combs to reduce breakage my.clevelandclinicmassgeneral.
6. When to Seek Professional Help
If shedding persists beyond 6 months or you notice patchy loss, consult a dermatologist or your endocrinologist. They’ll rule out other causes (thyroid disease, alopecia areata) and can discuss treatments such as topical minoxidil or short‑course corticosteroids medicalnewstodayverywellhealth.
Conclusion
Hair loss after a type 1 diabetes diagnosis is almost always a temporary telogen effluvium. With balanced blood sugars, stress management, and proper nutrition, your hair‑growth cycle will reset—typically within 6–12 months. Stay patient, be kind to yourself, and remember: this too shall pass.
Disclaimer: This article was researched and written with the assistance of AI, using current, evidence-based medical sources including peer-reviewed journals and expert guidance from reputable health organizations. It is intended for informational purposes only and should not be considered a substitute for professional medical advice. Always consult your healthcare provider with any questions or concerns.
The “Rule of 10”
The “Rule of 10” is a simple guideline that some people use to estimate how many minutes before a meal you should pre‑bolus based on your current blood glucose (BG) level. Here’s a detailed explanation:
What the Rule Is
Basic Concept: You take your current BG reading (in mg/dL) and divide it by 10. The result gives you an approximate number of minutes to pre‑bolus before starting your meal.
Example: If your BG is 180 mg/dL, you would divide 180 by 10, resulting in an 18‑minute pre‑bolus window. If your BG is 90 mg/dL, then 90 divided by 10 equals 9 minutes.
Before You Bolus: When you check your BG prior to a meal, note the number. Using the rule, calculate your pre‑bolus timing.
High BG (e.g., 180 mg/dL): Indicates you might need a longer lead time because your body requires more time to start lowering a higher BG level.
Low BG (e.g., 90 mg/dL): Suggests a shorter lead time, since the risk of dropping too low increases if you wait too long.
Adjusting the Timing:
If your BG is high, the rule suggests that a longer pre‑bolus may help the insulin catch up with the rapid rise from carbohydrates.
If your BG is already low or normal, a shorter interval prevents your insulin from starting to lower your BG before food is on board.
Personalizing the Approach:
The Rule of 10 is not a one-size-fits-all prescription—it’s a starting point. You might find that your personal insulin action, meal composition, or even time of day means you need to adjust this rule by a couple of minutes. For instance, some people might need to add or subtract 2–3 minutes based on their past experiences.
Why It Might Work
Simplicity: It offers an easy calculation that can be quickly done in your head or on a smartphone before meals.
Intuitive Matching: Higher BG levels signal a need for more “lead time” so the insulin has a chance to start lowering the blood sugar before the carbohydrates hit; lower BG levels mean there’s less of a “buffer” needed.
Limitations to Consider
Individual Variability: Everyone’s insulin sensitivity and absorption rates differ. The Rule of 10 might need modifications depending on whether your insulin acts faster or slower than average.
Meal Composition: This rule primarily addresses timing based on BG and does not account for differences in the glycemic index of foods. For instance, very high glycemic meals might require a longer pre‑bolus than the rule suggests, while meals with a mix of fat and protein might need additional adjustments.
Not a Substitute for Monitoring: Use this as an initial guideline—not a strict formula. Regular monitoring using a continuous glucose monitor (CGM) or frequent fingerstick tests is essential to determine what works best for you.
In Practice
Many people find that the Rule of 10 provides a helpful starting point to experiment with pre‑bolusing. Over time, as you gather more data on how your BG responds before and after meals, you can fine‑tune your timing for optimal results. By combining this rule with your own observations and the feedback from your CGM, you create a personalized strategy that helps balance insulin action with carbohydrate absorption—minimizing spikes and keeping your BG within range.
Important Disclaimer:
This guideline is for informational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before making any changes to your insulin regimen. This post was researched and written by a language model (LLM) based on community insights and should be tailored to your individual needs.
Vertex Pharmaceuticals is stopping development of VX-264
Hey everyone, I wanted to share an update on Vertex’s research that many of us were following with hope. Vertex recently announced they are stopping the development of VX-264, an experimental cell therapy designed to help people with type 1 diabetes. In a Phase 1/2 trial with 17 patients, VX-264—which used donor stem cells packaged in a protective implantable device to boost insulin production without needing long-term immune suppression—was found to be safe but didn’t show the expected increase in C-peptide levels (a key marker for insulin production). In simple terms, while the treatment didn’t cause harm, it wasn’t effective enough to offer the benefits we hoped for.
Trial Discontinued:
Vertex is halting development of VX-264, an experimental cell therapy for type 1 diabetes, after early Phase 1/2 results did not meet efficacy goals.Therapy Concept:
VX-264 aimed to restore insulin production by transplanting islet cells derived from donor stem cells, using an implantable device to shield the cells from the immune system—potentially avoiding the need for chronic immunosuppression.Study Findings:
In a trial with 17 patients, the therapy was found to be safe and well tolerated. However, the key measure—an increase in C-peptide levels (a marker for insulin production)—did not reach levels necessary to provide clinical benefit.Background:
VX-264 emerged from Vertex’s 2019 $950 million acquisition of Semma Therapeutics, marking their foray into type 1 diabetes research.Next Steps for Vertex:
While VX-264 is discontinued, Vertex is advancing another therapy, zimislecel, which involves a “naked” cell approach (without encapsulation) and requires immunosuppression. This alternative, now in Phase 3 trials, targets patients with more severe type 1 diabetes and could potentially help around 60,000 individuals.Additional Research:
Vertex plans to conduct further analyses on the VX-264 data—including a closer look at the removed devices—and is exploring gene-editing techniques to further protect transplanted cells.Financial Note:
The company anticipates a $400 million asset impairment charge related to VX-264, with detailed results to be shared in their upcoming financial report.
For more details and to read the full article, check it out here:
https://medcitynews.com/2025/03/vertex-cell-therapy-type-1-diabetes-t1d-immunosuppression-vrtx/
This post was researched and written by a LLM using the link above.
Dentistry & Type 1 Diabetes: Tips for Strong Smiles
🦷 Dentistry & Type 1 Diabetes: Sweet Tooth Tips for Strong Smiles
The longer I practice dentistry—and live with Type 1 Diabetes—the more I’m struck by how beautifully connected everything is. What started as a personal diagnosis during dental school has turned into a lifelong journey of learning how deeply oral health and whole-body health intertwine. It’s been humbling, eye-opening, and honestly, kind of awe-inspiring.
As a pediatric dentist and someone managing T1D myself, I think often about how even small daily habits can shape our health in big ways. The mouth truly is the gateway to the rest of the body, influencing everything from digestion and inflammation to heart health and blood sugar control.
With over 41 known factors affecting cavity risk—including diet, genetics, saliva pH, and hygiene—it’s clear there’s no one-size-fits-all approach. T1D is just one important piece of the puzzle when it comes to understanding a person’s full health picture.
In this post, I’m sharing some of my favorite oral health tips—especially for families navigating Type 1 Diabetes. I hope they’re helpful, doable, and maybe even a little fun!
Dr. Niekia Franklin is a pediatric dentist living with T1D. You can listen to her recent episode of the Juicebox Podcast here.
🪥 Daily Habits for a Healthy Smile
1. Floss Daily
Flossing removes plaque from 40% of tooth surfaces that brushing can’t reach. Hug each tooth like a squeegee!
Kids need help until age 10.
✅ Why it matters for T1D: Diabetes significantly increases the risk of gum disease. Kids with T1D experience 35–57% more bleeding around teeth. Gum inflammation increases systemic inflammation, worsens insulin resistance, and raises the risk of heart disease and stroke.
2. Brush Twice a Day for 2 Minutes
Focus on gum lines, chewing surfaces, and molars. Use an electric toothbrush when tolerated, and choose a toothpaste with fluoride or hydroxyapatite.
Kids usually need help until at least age 7.
✅ Why it matters for T1D: Sticky plaque combined with dry mouth makes the mouth more acidic and cavity-prone. Plaque will start to harden after 24 hours and can turn into tartar which cannot be cleaned off at home and contributes to gum inflammation.
3. Tongue Scraping
Gently scraping your tongue each morning helps remove bacteria, freshen breath, and support a healthy oral microbiome.
✅ Why it matters for T1D: Fungal overgrowth is more common—scraping helps reduce the risk.
🫁 Breathing & Development
4. Encourage Nasal Breathing
Nasal breathing supports proper jaw growth, reduces dry mouth, and promotes better sleep and focus.
✅ Why it matters for T1D: Nasal breathing helps reduce mouth dryness and supports cardiovascular and sleep health.
5. Watch for Signs of Sleep-Disordered Breathing
Signs include snoring, mouth breathing, teeth grinding, restless sleep, enlarged tonsils, and symptoms like ADHD. Use tools like the Fairest 6 and Pediatric Sleep Questionnaire as at-home screening resources.
✅ Why it matters for T1D: Poor sleep impacts hormones, attention, school performance, and blood sugar regulation.
6. Stop Non-Nutritive Sucking Early
Pacifiers and thumb-sucking should ideally stop by age 1–1.5 to avoid lasting jaw changes.
✅ Why it matters: Prolonged habits can increase the need for braces—braces can make hygiene harder and raise cavity risk.
🥕 Nutrition & Snacking Smarts
7. Eat Nutrient-Dense, Microbiome-Loving Foods
Prioritize fish, meat, veggies, and fermented foods like kefir, unsweetened yogurt, and sauerkraut.
✅ Why it matters: Nutrients like vitamins A, D, E, K2, and calcium support tooth and bone health, balance the microbiome, and won’t spike blood sugar.
8. Limit Sticky, Processed Snacks
Avoid crackers, gummy vitamins, dried fruit, and other sticky carbs that cling to teeth. If eating stickier carbs, pairing with cheese, crunchy veggies, water, or following with xylitol gum to neutralize acids.
✅ Why it matters for T1D: Frequent snacking on carbs contributes to both cavity formation and blood sugar challenges.
9. Hydrate, Hydrate, Hydrate
Water all day, milk with meals, and ideally no more than one sweet drink daily. *if not for blood sugar management.
✅ Why it matters for T1D: T1D kids often produce less saliva and have higher salivary glucose—both increase cavity risk. Milk has natural sugars that can contribute to cavities. Juice is missing the fruit fiber and tends to cause a rapid rise in blood sugar in addition to being a lot of sugar and acid.
🦷 Prevention & Dental Visits
10. Start Dental Visits Early & Stay Consistent
The first visit should be by age 1 or when the first tooth erupts.
Preventive options like sealants, silver diamine fluoride, and Curodont can stop cavities in their tracks.
✅ Why it matters for T1D: Regular visits catch small problems early, avoiding larger treatments that carry higher risks for kids with T1D.
💬 Final Thoughts
A few small habits can go a long way in protecting your child’s smile—and their overall wellness. There are unique oral health connections that come with Type 1 Diabetes, and I hope all families feel confident asking questions and finding the support they need.
Everything shared here is based on my experience and current research. Please talk with your healthcare providers about what’s best for your child’s specific needs.
💌 Have a tip that’s helped your family? I’d love to hear it!
📧 doc@redwoodpediatricdentist.com
📚 Sources & Further Reading
Oral Health Implications and Dental Management of Diabetic Children – Davidopoulou et al., PMC9973101
International Journal of Clinical Pediatric Dentistry, 2022 – DOI: 10.5005/jp-journals-10005-2426
Flossing May Reduce Risk for Stroke and Irregular Heart Rhythm – American Heart Association
🔗 Helpful Resources
🦷 Dentist Dad Snack Guide – Tooth-friendly snack ideas for busy families
😴 Pediatric Sleep Questionnaire (UC Davis) – A helpful screening tool for sleep-disordered breathing
🛏️ Fairest 6 Tool – At-home checklist for airway and sleep health