Autoimmunity

I'm still having trouble with food digesting slowly. If I inject before eating, I go low (and my lows are taking at least forty minutes to come up), sometimes followed by a high. If I wait until the CGMS shows a rise, it's too late to stop the spike, but it's not showing any rise until more than an hour after I eat. So I think I need to inject about half an hour after I start eating in order to both prevent the spike and the low.

Yesterday on the bus I couldn't help noticing a young African American woman with large irregular white patches of skin, and patches of white strands in among her mostly black braids. It took a little effort to keep from blurting the diagnosis: VITILIGO! (so I signed it to myself instead)

Vitiligo is a group of diseases, like diabetes is, only vitiligo is about a dysfunction of the pigmentation. It turns patch(es) of skin and hair white. Some people with vitiligo just have a small patch that can be covered up; others have patches covering most of the body. It's more obvious in people with darker skin.
Vitiligo usually can't be treated, although sometimes people bleach the neighboring skin or hair to make the patches less obvious. It confers a slightly higher risk of skin cancer.

One form of vitiligo is autoimmune, and estimates of the prevalence of vitiligo among type 1 diabetics range from about 2% to 10%.

People with type 1 diabetes and their immediate families are at increased risk of various autoimmune disease, even the ones they don't have high risk genes for (such as multiple sclerosis).
But the additional autoimmune diseases that are most common in type 1 diabetics are Hashimoto's Thyroiditis, celiac sprue, and vitiligo.
Women and girls with type 1 diabetes are especially at risk for celiac and thyroiditis.

Red flags for for thyroiditis include: lethargy, loss of appetite, weight gain despite stable or decreased food intake, goiter (swelling at the location of the thyroid at the base of the neck). Asymptomatic thyroiditis does not really have bad side effects. Treatment is thyroid hormone pills.
Untreated celiac can have negative impacts long term even without symptoms, so it is important to get screened and not depend on being able to tell if there are symptoms. Treatment is a gluten free diet.

I came across this interesting case report recently. The title is Vitiligo Associated With Subcutaneous Insulin Lispro Infusion In Type 1 Diabetes but don't be fooled- it is only one patient, and she gets vitiligo in response to both insulin lispro and insulin aspart, plus she had it before she started pumping.