Type 1 Diabetes and Addison’s Disease: What’s the Connection? (2022)

Type 1 diabetes is considered to be an autoimmune disorder, which means that the body’s immune system attacks and destroys healthy cells and tissues by mistake. People who have type 1 diabetes are more likely to have another autoimmune disorder, as well, such as celiac disease, Graves’ disease or rheumatoid arthritis.

Another type of autoimmune disorder is Addison’s disease. You may not be that familiar with this condition, but the risk of getting Addison’s is significantly higher in those with type 1 diabetes compared to the general population.

What is Addison’s disease?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Addison’s disease “is a disorder that occurs when the adrenal glands don’t make enough of certain hormones.”

The adrenal glands are small glands that sit on top of each of your kidneys. They make two essential hormones: cortisol and aldosterone. With Addison’s disease, the adrenals don’t make enough of these two hormones. Here’s a bit more about cortisol and aldosterone:

∙ Cortisol: Also called the “stress hormone,” cortisol helps the body respond to stress, helps control blood pressure, blood sugar and metabolism, and reduces inflammation.

∙ Aldosterone: This hormone keeps a balance of sodium and potassium in the blood, which, in turn, helps to maintain blood pressure. Sodium and potassium also help nerves and muscles function properly.

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Addison’s disease, which is also called primary adrenal insufficiency, can occur due to a number of factors:

· An autoimmune response

· Injury to the adrenal glands

· Infection, such as tuberculosis and HIV/AIDS

· Cancer

· Surgical removal of the adrenal glands

· Amyloidosis

· Genetic defects

(Video) Type 1 diabetes (autoimmune diabetes) | cause and consequences

How common is Addison’s disease?

Addison’s disease is pretty rare. In the United States, it’s estimated that 1 in 100,000 people have this condition. Women are more likely than men to develop Addison’s disease, and it occurs most often in people between the ages of 30 and 50.

According to research published in 2018 in The Journal of Clinical Endocrinology & Metabolism, while the incidence of Addison’s disease in those with type 1 diabetes is pretty low, the risk of developing Addison’s disease is more than 10 times higher in people with type 1 diabetes compared to the general population.

What are the risk factors for Addison’s disease?

There are several risk factors for the “autoimmune type” of Addison’s disease. These include:

· Type 1 diabetes

· Graves’ disease (also called overactive thyroid)

· Chronic thyroiditis (inflammation of the thyroid gland)

· Dermatitis herpetiformis (an itchy rash with bumps and blisters)

· Pernicious anemia (not enough healthy red blood cells)

· Myasthenia gravis (a condition that affects nerves and muscles)

· Vitiligo (loss of color, or pigment, from areas of the skin)

What are the symptoms of Addison’s disease?

For the most part, symptoms of Addison’s disease develop gradually over the course of several months. That’s because damage to the adrenal glands usually develops slowly. For this reason, you and/or your healthcare provider may attribute your symptoms to other causes or issues.

The most common symptoms of Addison’s include any of the following:

· Abdominal pain

· Nausea and/or diarrhea

(Video) Diabetes 11, Autoimmune Diseases associated with DM

· Loss of appetite and weight loss

· A craving for salt or salty foods

· Feeling very thirsty

· Lightheadedness or dizziness when standing up

· Irritability

· Feeling extremely tired

· Muscle or joint pain

· Depression

· Low blood pressure

· Low blood sugar

· Darkening of the skin, or darkened lips or gums

· Loss of body hair

· Sexual dysfunction in women

Because there may be other reasons for the above symptoms, such as uncontrolled high blood sugars, for example, you may not seek medical help for them. However, an injury, illness or a time of intense stress can cause symptoms of Addison’s to appear suddenly. This is called acute adrenal failure, or Addisonian crisis, and if not treated immediately, can lead to life-threatening shock. Get medical help immediately if any of the following symptoms occur:

· Severe weakness

(Video) What's it like living with Addison's Disease? Answering your questions!

· Confusion or fear

· Sudden pain in your lower back, stomach or legs

· Fever

· Feeling faint or losing consciousness

How is Addison’s disease diagnosed?

Having any of the symptoms above should prompt you to see your healthcare provider. Be sure to let him or her know about all of your symptoms. Your provider should do a physical exam and order blood work. If Addison’s disease is suspected, you will have labs that measure the amount of sodium, potassium, cortisol and ACTH (adrenocorticotropic hormone). ACTH stimulates the adrenal glands to produce cortisol. You might also have antibodies measured, as well.

The presence of Addison’s disease will likely show high potassium, low sodium, low cortisol, low pH, and a high eosinophil count, which is a type of white blood cell. Blood pressure may be low, especially when going from a sitting to a standing position.

Other tests may be ordered, too, such as:

· Imaging tests: An X-ray or CT scan of your abdomen to check your adrenal glands, and an MRI of your pituitary gland may be ordered to determine if you have another type of adrenal insufficiency.

· ACTH stimulation test: You may be given an injection of synthetic ACTH to see how much cortisol is made by your adrenal glands.

You have Addison’s disease – now what?

Addison’s disease, like type 1 diabetes, is treated with hormone medication. Remember that Addison’s disease means that the body isn’t producing enough of steroid hormones, so you will need to take hormones that are similar to what the adrenal glands make.

Specifically, treatment of Addison’s consists of taking oral forms of these steroids:

· Hydrocortisone, prednisone or methylprednisolone to replace cortisol

· Fludrocortisone acetate to replace aldosterone (if you’re lacking in aldosterone)

You will need to take medication for life, and it’s important that you don’t miss any doses of your medication; missed doses can lead to Addisonian crisis.

In addition, you will need to be prepared to:

· Carry a medical alert card or wear a bracelet to alert medical personnel that you have Addison’s disease.

(Video) Primary adrenal insufficiency (Addison's disease) - pathology, symptoms, diagnosis, treatment

· Have a glucocorticoid injection kit available, which contains an injectable form of corticosteroids in case of emergency. Make sure someone close to you knows when and how to give you an injection.

· See your provider regularly. An endocrinologist who helps you manage your diabetes can also help you manage Addison’s.

When the weather is hot and humid, and/or if you exercise heavily or have diarrhea, you will likely need to make sure you get plenty of sodium (salt) in your diet.

Stress management is important for everyone, but it’s especially important if you have Addison’s. Life events, such as the death of a loved one or losing your job raise your stress level and can affect how your medications work. Make time in your schedule to “de-stress.” Exercise, practicing yoga or meditation, or using deep breathing are all ways to lower stress levels.

Speaking of stress – if you experience any type of stress in your life, such as an injury, illness or a death, let your healthcare provider know right away. You may need a dose adjustment to your medication.

Possible predictors of Addison’s disease

Because of the higher risk of Addison’s disease among people with type 1 diabetes, Swedish researchers wondered if there might be telltale signs and symptoms to alert healthcare providers. In a study of 36,515 adults with type 1 diabetes, 66 patients also had been diagnosed with Addison’s disease. The researchers observed that, compared to the control group (the people without Addison’s):

· There was no difference in hemoglobin A1C levels (HbA1c; a measure of glucose control over the previous 2–3 months).

· The patients with both conditions had a greater frequency of infections requiring hospitalization.

· The patients with both conditions had more prescriptions for thyroid medication and glucagon.

· They also had a higher frequency of diabetic retinopathy.

The researchers published their findings in The Journal of Clinical Endocrinology & Metabolism in 2018. Their conclusions? Healthcare providers should suspect possible Addison’s disease in a person with type 1 diabetes who has had more infections requiring hospitalization, has more prescriptions for thyroid medication and glucagon, and/or who has diabetic retinopathy.

Keep in mind that the presence of these factors does not definitively predict the presence of Addison’s disease; more research is needed to explore these findings further.

More information about Addison’s disease

To learn more about Addison’s disease, get support, or learn about clinical trials, visit the following websites:

· National Adrenal Diseases Foundation (NADF)

· National Organization for Rare Disorders (NORD)

Want to learn more about type 1 diabetes? Read “Type 1 Diabetes Questions and Answers,” “Six Type 1 Diabetes Symptoms You Need to Know” and see our type 1 diabetes videos.

(Video) Endocrinology: (wk5)(Mon and Tues)(Win 21): Primary and Secondary Adrenal Insufficiency


Is there a connection between Addison's disease and diabetes? ›

Addison's disease occurs more frequently in patients with type 1 diabetes mellitus as part of the autoimmune polyendocrine syndromes. The diagnosis of Addison's disease is, however, often delayed because the onset of diabetes mellitus usually precedes the diagnosis of Addison's disease.

Can Addison's disease cause type 1 diabetes? ›

The combination of Addison's disease and Type 1 diabetes is known as Schmidt syndrome, which is sometimes used interchangeably with autoimmune polyglandular syndrome type II (APS II), is common.

Can diabetes cause adrenal insufficiency? ›

Abstract. Primary adrenal insufficiency (Addison's disease) often develops insidiously. Although a rare disorder, it is more common in type 1 diabetes mellitus.

Is diabetes an adrenal disease? ›

Disorders of the adrenal cortex and medulla can result in glucose intolerance or overt diabetes mellitus. Cushing's syndrome, characterized by excessive secretion of glucocorticoids, impairs glucose tolerance primarily by causing insulin resistance at the post-receptor level.

Why does Addison's disease cause low blood sugar? ›

With adrenal insufficiency, the inability to increase cortisol production with stress can lead to an addisonian crisis. An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium.

Is glucose high or low in Addison's disease? ›

Symptoms of Addison's disease include: frequent low blood glucose (sugar) levels. low insulin needs.

What triggers Addison's disease? ›

Addison's disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands will not be able to produce enough of the steroid hormones cortisol and aldosterone.

What is the most common cause of Addison disease? ›

Tuberculosis link (TB) can damage the adrenal glands and used to be the most common cause of Addison's disease.

How are cortisol and insulin related? ›

Cortisol is a potent insulin-antagonistic hormone inhibiting insulin secretion, stimulating glucagon secretion and disrupting insulin signaling. Cortisol inhibits insulin release and reduces GLP-1 production and thereby also insulin secretion (Figure 1).

How does cortisol affect diabetes? ›

Blood Sugar Imbalance and Diabetes

However, elevated cortisol over the long term consistently produces glucose, leading to increased blood sugar levels. Theoretically, this mechanism can increase the risk for type 2 diabetes, although a causative factor is unknown.

How is the adrenal gland related to glucose levels? ›

When cortisol is unavailable, glucose levels get too low. The adrenal glands release epinephrine (aka adrenaline) as their back-up plan. This causes the lightheadedness, shakiness and irritability that people with low blood sugar experience, and is why people with low blood sugar commonly wake up during the night.

Does the adrenal gland control sugar? ›

The most important hormone produced by the adrenal glands, cortisol helps you to burn protein and fat, control your blood sugar, manage stress and regulate your blood pressure.

Is diabetes an autoimmune disease? ›

Type 1 diabetes is an autoimmune disease. It's often diagnosed in children and teens, but it can appear at any age. In people with type 1 diabetes, the immune system mistakenly attacks the healthy tissues of the body and destroys the insulin-producing cells of the pancreas.

Which of the following hormonal imbalances causes Addison's disease? ›

Addison's disease is a rare but serious adrenal gland disorder in which the body can't produce enough of two critical hormones, cortisol and aldosterone.

Which patient is most likely to have Addison's? ›

Women are more likely than men to develop Addison's disease. This condition occurs most often in people between the ages of 30 and 50, 2 although it can occur at any age, even in children. Secondary adrenal insufficiency occurs in people with certain conditions that affect the pituitary.

Does Addison's disease affect the brain? ›

Regardless of the specific terminology used, it is clear that some patients with Addison's disease have a disturbance in brain function and may develop a range of neuropsychiatric symptoms as a result.

What mimics Addison's disease? ›

Multiple conditions can mimic one or more symptoms of adrenal insufficiency (chronic fatigue syndrome, depression, hypothyroidism, fibromyalgia, chronic dyspepsia, etc.).

Is there a special diet for Addison's disease? ›

Some people with Addison's disease who have low aldosterone can benefit from a high-sodium diet. A health care professional or a dietitian can recommend the best sodium sources and how much sodium you should have each day.

Can you gain weight with Addison's disease? ›

One of the most common signs of this disorder is the feeling of fatigue and sluggishness. However, it is common that people with this disorder experience weight gain, while patients with Addison's disease will lose weight due to the vomiting and anorexia.

What organs are affected by Addison's disease? ›

Description. Autoimmune Addison disease affects the function of the adrenal glands, which are small hormone-producing glands located on top of each kidney. It is classified as an autoimmune disorder because it results from a malfunctioning immune system that attacks the adrenal glands.

Can Covid cause Addison's disease? ›

He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.

Is Addison's disease a disability? ›

Addison's disease is considered under the disability listing for endocrine disorders because it is a type of adrenal gland disorder. The listing for endocrine disorders is a bit different than other disability listings that include specific impairment requirements to qualify for disability.

What is the life expectancy of someone with Addison's disease? ›

The mean death ages for female and male patients were 75.7 and 64.8 years respectively, which is 3.2 and 11.2 years less than the estimated life expectancy at the time of diagnosis.

What medication is taken for Addison's disease? ›

Medicine for Addison's disease

A medicine called hydrocortisone is usually used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, although these are less commonly used. Aldosterone is replaced with a medicine called fludrocortisone.

How do you balance insulin and cortisol? ›

While cortisol is an important hormone, chronically high levels may lead to conditions such as obesity, heart disease, and diabetes.
Tips for lowering cortisol levels
  1. Optimize sleep. ...
  2. Exercise regularly. ...
  3. Practice mindfulness. ...
  4. Maintain a moderate body weight. ...
  5. Eat a balanced diet.

Does low cortisol cause high insulin? ›

Hypoglycemia may develop from low cortisol and high insulin levels. The stress response is to increase glucose through elevated cortisol. In stage 1 and 2 adrenal fatigue, cortisol is elevated and results in elevated glucose.

Does low cortisol affect insulin? ›

Cortisol is a steroid hormone also secreted from the adrenal gland. It makes fat and muscle cells resistant to the action of insulin, and enhances the production of glucose by the liver. Under normal circumstances, cortisol counterbalances the action of insulin.

Does stress affect type 1 diabetes? ›

When you have type 1 diabetes, stress may make your blood sugar go up and become more difficult to control – and you may need to take higher doses of insulin. During times of stress, individuals with diabetes, may have more difficulty controlling their blood sugars.

What are the symptoms of low cortisol? ›

Too Little Cortisol
  • Changes in your skin, like darkening on scars and in skin folds.
  • Being tired all the time.
  • Muscle weakness that grows worse.
  • Diarrhea, nausea, and vomiting.
  • Loss of appetite and weight.
  • Low blood pressure.

How does cortisol affect blood sugar? ›

Under stressful conditions, cortisol provides the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can help an individual fight or flee a stressor. However, elevated cortisol over the long term consistently produces glucose, leading to increased blood sugar levels.

How are cortisol and insulin related? ›

Cortisol is a potent insulin-antagonistic hormone inhibiting insulin secretion, stimulating glucagon secretion and disrupting insulin signaling. Cortisol inhibits insulin release and reduces GLP-1 production and thereby also insulin secretion (Figure 1).

Does cortisol cause low blood sugar? ›

As adrenal dysfuntion continues and the cortisol levels are dropping off, the blood glucose levels fall. Dysregulation occurs as cortisol levels are dropping and insulin levels are increased, leading to hypoglycemia. This hypoglycemia then leads to proteins and fats of the body being used as energy sources.


1. Addisons vs Cushing's Disease for NCLEX RN
(Simple Nursing)
2. Evaluation and Management of Adrenal Insufficiency
(MedStar Georgetown Department of Medicine)
3. Addison Disease
(Dewan Raja)
4. Diabetes Insipidus, SIADH, Addison's, Cushing's
(Caroline Tyler)
5. Possible correlation between childhood diabetes and pandemic being studied
(KMTV 3 News Now)
6. The Adrenal Gland and Potassium Connection – Dr.Berg
(Dr. Eric Berg DC)

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