Autism and Diabetes

We have been taking Aiden to an Endocrinologist for high calcium levels. As I was sitting in the waiting room for one of his appointments today a question popped into my mind: Is there a link between Autism and diabetes? Our family has a history of diabetes and this disease is not uncommon in our culture. That question has prompted this blog. 

Evidently I opened a door to a huge topic and large body of research. Studies into diabetes’s affects on Autism are broken into two parts: a prenatal or gestational impact or an individual development of diabetes while suffering from Autism. 

First let’s review exactly what diabetes is. Diabetes is a disease that affects the metabolism of sugars. That is why it is referred to as a metabolic disease in which the body does not properly process glucose (sugar). The development of diabetes is due to one of three cellular reasons: 1- not enough insulin is being produced by the body, 2- the body does not react properly to insulin, or 3- both of these reasons combined. There are three types of diabetes: 

Type 1: Often referred to as juvenile diabetes, these individuals are insulin dependent for their entire lives. The onset of this disease is before the age of 40. Only about 10% of diabetes cases are related to type 1 diabetes. 

Type 2: This type of diabetes is usually due to one of the first two reasons listed above. Approximately 90% of diabetes cases are due to this type of diabetes. Overweight individuals have a much higher risk of developing type 2 diabetes. This disease progressively gets worse over time, but it is controllable and individuals may become insulin dependent as a result. 

Gestational diabetes: This type of diabetes only affects pregnant women. It is caused when a woman's body is unable to process sugar, causing a progressive rise in sugars in the blood. Only about 10-20% of women with gestational diabetes will need medication to control it, most can control this condition with diet and exercise.

Following the natural path of life, let’s begin with gestational diabetes's impact on the development of Autism. In 2009 the British Journal of Psychology published an article titled: Prenatal risk factors for autism: comprehensive meta-analysis. The researchers participating in this article put together over 40 years of research on the topic of prenatal risks for Autism. Obviously one of the many, many risk factors covered in this article is gestational diabetes. The researchers basically said this risk factor may play a contributing role in the child's eventual development of Autism, but the research was inconclusive; which told me that up until 2009, no one had considered studying gestational diabetes in relation to Autism. For researchers to include this information in their final publication indicates there is a high number of gestational diabetes reported in the mother's of Autistic children, but it was not directly linked as a possible cause in previous studies. 

In July 2013 CBS published an article: Study: Autism risk tied to mom's obesity during pregnancy. This article cites a study conducted by researchers with UC Davis MIND Institute in California. This ground breaking study included approximately 1,000 children ages 2-5 and their mother's medical history. The study found that women who were obese during pregnancy were 67% more likely than woman of a normal weight to have Autistic children. Maternal obesity also doubled the risk of developmental delays in children. Researchers also looked into the effect of gestational diabetes in these participants. They discovered that pregnant mothers with diabetes had a 2 and 1/3rds chance of having a child with developmental delays, when compared to healthy mothers. 

Researchers admit more tests and studies need to be conducted in this area. They theorize that obesity is linked with inflammation and sometimes elevated levels of blood sugar, and this blood may reach the developing fetus and damage the brain. This research indicates that obese women have a 1 in 53 chance of having a child with Autism. This CBS article goes on to explain that over a third of American women, in childbearing years, are obese and almost one tenth have gestational diabetes or type 2 diabetes during pregnancy. These conditions may be linked to neurodevelopmental issues in a child. Interestingly Autism rates have increased along with obesity rates. 

In October 2013 SFARI published an article: Diabetic jeopardy. It cites an study published in the Journal of Autism and Developmental Disorders. This study is important because it found that the risk of developing Autism also extends to women who develop diabetes prior to pregnancy. Symptoms of gestational diabetes may start early in the pregnancy process. Research into fetal development shows that key brain development stages for growing babies is in the third trimester and shortly after birth. During the third trimester, gestational diabetes will be at its peak, and the high levels of blood sugar may inhibit the flow of oxygen to the fetal brain, impacting brain development. Researchers reviewed 12 reports of diabetes during pregnancy and Autism in the child. In 9 of 12 studies researchers compared birth history of children diagnosed with Autism and controls. The three other studies followed children over time, both with Autism and without. All the studies showed that children are more likely to have Autism if their mother has diabetes during the pregnancy. In the first set of studies (9 of 12) researchers found that women with gestational diabetes double their risk of having a child with Autism. Maternal diabetes either before or during pregnancy increased the risk of Autism in the child by approximately 50%. The three longevity studies showed that pregnant women with gestational diabetes increase the risk of Autism in their child by approximately 45% and those who developed diabetes before pregnancy increased the risk by approximately 75%, when compared to healthy controls. Researchers also theorize that women with diabetes have a higher amount of inflammatory molecules in their blood, which may impact fetal brain development. 

So does an Autistic individual have a higher chance of developing diabetes, even if they were not born to a mother with diabetes?

This was my next question. When Aiden was born I had gained 40 pounds of pregnancy weight, but I had absolutely no signs of diabetes in any form. In fact my blood pressure was outstanding for someone carrying a child and my blood work came back normal. 

In 2005 the American Diabetes Association published a study: Type 1 Diabetes and Autism. This research study included 984 children with diabetes seen at the Diabetes Clinic in 2002. Of those individuals 9 were identified as having ASD, 7 boys and 2 girls. Of all the data they collected and case studies conducted the researchers concluded that an individual with type 1 diabetes may have a greater risk than the general population of having Autism. The ADA admits their sample size is small and they strongly urge a larger study be conducted. 

In 2011 an article published by Science Daily linked autism and diabetes through hyperinsulinemia. This study, conducted by Rice University, linked Type 2 diabetes and Autism via an underlying impaired gluten intolerance and hyperinsulinemia. Hyperinsulinemia is a condition which there is high amounts of insulin in the blood, resulting in insulin resistance. Insulin resistance is associated with obesity and the development of Type 2 diabetes. Since gluten can increase insulin secretion researchers believe a low carb diet may help some individuals with Autism. Researchers also suggest gluten tolerance in pregnant women be tested as well. These researchers believe that insulin is a key element in Autism, due to its role in cognitive function and its affect on synaptic function. 

When I searched for an article explaining the insulin affect on synaptic function I found lots of research on the topic, but it was not easy to interpret. Rather than mislead or misinform you I think that it is best left to a medical professional to explain this impact, just know it could be playing a role in Autism. 

As you can see there is a lot of information to digest here. I find the correlation between diabetes and Autism very interesting. I hope more research in this area is released in the near future for parents to consider. This is just one more piece to a very big puzzle. 

Diabetes is a serious medical condition and it can be controlled. If you suspect diabetes in a loved one, please take them to see their general care practitioner or pediatrician. 

To read more about diabetes and pregnancy, please read this article from endocrineweb.

To read more about gluten and its impact on Autism, please read our blog: 
Autism and GI Issues: A Gluten Explanation

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