TED and Diabetes

Reviewed by: HU Medical Review Board

Thyroid eye disease (TED) is an autoimmune disease that largely affects the tissues behind and around the eyes. Autoimmune means the body’s immune system can no longer tell the difference between healthy cells and harmful invaders like viruses, fungi, or bacteria.1,2

In TED, the immune system begins to attack healthy tissue, fat, and muscle behind and near the eyes. This causes inflammation, swelling, and pain in and around the eyes.1

About 5 out of every 100 people have an autoimmune disorder. About 19 out of every 100,000 people have TED. Research shows that people who develop TED may have inherited genes that make them more likely to develop other autoimmune conditions.1,3,4

Autoimmune conditions are not the only type of condition that can coexist with TED. Other chronic (long-term) conditions have been shown to occur more frequently with TED. Diabetes is a chronic condition that can be either autoimmune or non-autoimmune, depending on its type. Both types can occur more often in TED.5,6

What is diabetes?

Diabetes is a chronic condition that affects how the body uses food for energy. More than 34 million American adults have diabetes, with 1 in 5 of them not knowing they have the condition.7

Diabetes can occur exclusively in pregnancy, known as gestational diabetes. However, in TED, types 1 and 2 are most common.5

Diabetes presents a serious health concern and is linked to many long-term and life-threatening health conditions, including:6

  • Heart and blood vessel disease
  • Nerve damage
  • Kidney, eye, and foot damage
  • Skin problems
  • Hearing problems
  • Depression
  • Alzheimer’s disease

Type 1 diabetes

Type 1 diabetes is an autoimmune condition where the body destroys insulin-producing cells in the pancreas. Insulin is needed to allow glucose (sugar) into the body’s cells for energy. In type 1 diabetes, the pancreas cannot make insulin. This leads to a buildup of sugar in the blood, which can be life-threatening. Type 1 diabetes was previously known as juvenile diabetes or insulin-dependent diabetes. However, type 1 diabetes can occur at any age.8

Type 2 diabetes

Like type 1 diabetes, type 2 diabetes is a condition characterized by high blood sugar. Unlike type 1, type 2 diabetes is not an autoimmune disease. In type 2 diabetes, the body works hard to release enough insulin to keep blood sugar levels down. However, over time, the body cannot make enough insulin to keep up. This leads to a buildup of sugar in the blood.9

Symptoms of diabetes

Symptoms of diabetes depend on how high your blood sugar is elevated. Symptoms may include:6

  • Increased thirst
  • Increased hunger
  • Increased urination
  • Unexplained weight loss
  • Fatigue and irritability
  • Wounds that do not heal
  • Frequent infections, like urinary tract infections (UTIs)
  • Blurred vision

Diabetes and thyroid eye disease

Both type 1 and type 2 diabetes occur more often in those with TED. Additional facts about diabetes and TED include:5

  • Sight-threatening TED is more common among those with both type 1 and type 2 diabetes.
  • People who have both type 2 diabetes and TED tend to have a more severe form of TED.
  • Symptoms of TED often present differently in those with diabetes. People with diabetes often have more muscle involvement in TED than those without diabetes.


If you have both diabetes and TED, your doctor will first make sure your blood sugar levels are within an acceptable range. People with type 1 diabetes require insulin. This is because the pancreas is unable to make it, and your body needs it to convert blood sugar to energy.8,10

People with type 2 diabetes may or may not require insulin depending on the severity. Oftentimes, diet and lifestyle changes may be recommended first. This is because with type 2 diabetes, the body is still making insulin but the tissues and cells are not using it properly. Changes, such as diet and exercise, might help to increase the body’s sensitivity to insulin, improving diabetes.9,10

If diet and exercise alone are not adequate, your doctor may give you medicine to:10

  • Tell your pancreas to make and release more insulin
  • Increase the sensitivity of the cells to insulin
  • Decrease blood sugar levels

You may need a combination of several medicines to properly treat your symptoms. An endocrinologist (doctor who treats hormone problems including diabetes) or your primary care doctor will help manage your condition. These doctors will work closely with your TED specialist to make sure you get the right care and treatment to manage both diabetes and TED.

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