Diabetes isn’t well established as being closely related to hereditary angioedema (HAE), but that doesn’t mean you can’t have both conditions at the same time. Living with HAE and diabetes simultaneously is a reality for some, and as with any combination of chronic (long-term) diseases, it is key to learn to manage both conditions.

Effective management of HAE and diabetes involves understanding how the two conditions can affect each other or their treatments. Here we provide a quick overview of what these conditions are and what to know if you’re diagnosed with both.

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Understanding Hereditary Angioedema

If you live with HAE, you probably have some understanding of common HAE symptoms and how they affect your quality of life. It’s a rare genetic condition that typically stems from a deficiency or malfunction of an immune system protein called C1 inhibitor (C1INH).

Hereditary angioedema causes episodes of swelling, called HAE attacks, that can affect multiple parts of your body. These attacks sometimes happen in response to triggers like stress, trauma, infections, or hormone changes (such as during pregnancy or menstruation).

Swelling from HAE is most common in these areas:

• Face
• Arms
• Legs
• Buttocks
• Gastrointestinal (GI) tract
• Upper airway

Swelling of the skin, which might appear on the face or extremities (arms, or legs), usually goes away on its own within a few days. It might be painful, but it isn’t a big threat to your health.

However, upper airway swelling, which occurs in just 1 percent to 3 percent of HAE attacks, can be a life-threatening medical emergency if it restricts your breathing.

Understanding Diabetes

Diabetes is a chronic disease that occurs when your body can’t properly regulate your glucose (blood sugar) levels. It occurs because of a hormone called insulin — either your pancreas doesn’t make enough insulin, or your cells don’t respond to insulin properly.

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease that involves your immune system destroying the cells in your pancreas that produce insulin. This type is more often diagnosed in children and young adults.

Type 2 diabetes is the most common type and is acquired — it isn’t an autoimmune disease or a genetic disorder (though you might be genetically predisposed to it).

Type 2 diabetes develops from insulin resistance, which means your cells don’t respond to insulin as they should. Lifestyle factors like a lack of exercise, certain eating patterns, or certain medications can contribute to type 2 diabetes.

Do HAE and Diabetes Overlap?

Health experts don’t consider diabetes to be a common comorbidity (condition that occurs alongside another) of HAE. However, they’ve found that around 6.5 percent of people with HAE also have diabetes.

Interestingly, the incidence of diabetes is lower in people with HAE than in the general population. According to the Centers for Disease Control and Prevention (CDC), around 12 percent of people in the United States have diabetes.

What To Know About Living With HAE and Diabetes Together

If you or your child lives with HAE and diabetes, work with your healthcare team to figure out the best ways to manage both conditions at the same time.

These two conditions can affect each other in ways you might not expect, and managing them can be a learning experience. Here are some possible ways hereditary angioedema and diabetes can affect each other.

Stress and Blood Sugar Control

Stress is one of the most common triggers for HAE attacks, and living with HAE can be a source of stress itself. In fact, over half of people with HAE have higher stress levels than the general population.

Unfortunately, stress isn’t great for blood sugar control in people living with diabetes. Stress hormones like cortisol and adrenaline can reduce insulin sensitivity, which contributes to insulin resistance and high blood sugar levels.

Chronic stress can keep your blood sugar levels high and may make diabetes treatments less effective in controlling your blood sugar.

Managing your stress can both prevent HAE attacks and improve blood sugar control in diabetes. Work with your doctor to find stress management techniques or mental health care to include in your treatment plan.

HAE Belly Attacks and Blood Sugar Control

Swelling in the GI tract during an HAE attack can cause nausea, vomiting, diarrhea, and stomach pain. Severe abdominal pain and other GI symptoms can make it difficult to eat or to keep food in your stomach.

If a person can’t eat due to GI symptoms from HAE, their blood sugar may spike too high or drop too low. Dangerous blood sugar fluctuations can result from skipped meals, which can be extra hard to control if a person can’t eat or keep food down.

Diarrhea during an HAE belly attack can lead to dehydration, which can also impact blood sugar control. People with diabetes are already at a higher risk of dehydration, and even mild dehydration can elevate their blood sugar to dangerous levels.

Talk to your doctor about how to stabilize your blood sugar during HAE attacks affecting your GI tract. Keeping your blood sugar as stable as possible can help you avoid dangerous diabetes complications.

Diabetes and Planning for HAE Attacks

It’s important to consider your diabetes while planning for possible HAE attacks. Your doctor may prescribe preventive medicines to reduce HAE attacks as well as on-demand medications to use during active HAE attacks. If you have diabetes, you may need to take additional steps to prepare.

For your safety while living with HAE and diabetes, you might need to check your glucose levels more often than you otherwise would. This goes beyond just checking when you have symptoms — your doctor might advise you to take multiple blood sugar readings throughout the day, especially when HAE attacks happen.

Your doctor might also advise you to keep fast-acting carbohydrates with you at all times if you take insulin to manage diabetes. Fast-acting carbs contain sugar (like fruit or cookies) and can increase your blood sugar if it drops after you take insulin. It’s also helpful to keep drinking water on hand in case of dehydration.

Talk With Your Doctor

If you’ve been diagnosed with HAE and diabetes, talk to your doctor about how to safely and effectively manage both conditions. Your healthcare provider can help you establish a plan to stabilize your blood sugar in case of an HAE attack, even if your HAE symptoms make it harder to do so.

When discussing HAE and diabetes with your doctor, be sure to cover:

• Your medications and how they might interact
• Potential medication side effects, particularly swelling or blood sugar changes
• When to seek emergency care for high or low blood glucose or upper airway swelling
• What to tell emergency medical services about your health in the event of an emergency
• How often to check your glucose levels
• How to handle your glucose medications if you have trouble eating or keeping food down

As always, continue taking your medications as prescribed unless your doctor tells you otherwise. Never start or stop a medication without talking to your doctor, as HAE therapies are specialized.

Join the Conversation

On myHAEteam, people share their experiences with hereditary angioedema, get advice, and find support from others who understand.

What steps do you take to manage your HAE and diabetes at the same time? Let others know in the comments below.