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Family Health Magazine
DIABETES

Type 1.5 Diabetes
Could you have LADA (Latent Autoimmune Disease in Adults)?

Much to your surprise, you were recently diagnosed with diabetes. When you research the disease, you see that there are two basic kinds. Type 1 affects about 10 per cent of people with diabetes. Since you are 40 years old, you do not meet the age and symptom criteria for type 1. Most people with diabetes have type 2. However, since you have always been very active and weight is not an issue, you don’t really match those criteria either.

On the Internet, you see occasional reference to a type of diabetes called LADA, or latent autoimmune diabetes in adults. Could this be the type of diabetes affecting you? To understand LADA, you must first know about the two basic types of diabetes and how autoimmune diseases work.

In autoimmune disease, the body’s immune (defence) system is overactive. The body attacks its own cells and destroys them. In type 1 diabetes, the immune system has destroyed the insulin-producing beta cells of the pancreas. Insulin permits cells of the body to use glucose, the sugar from food, for energy. Without beta cells, the body lacks insulin. The amount of glucose in blood and urine increases. Those with type 1 diabetes produce no insulin. This kind of diabetes is usually diagnosed in children and young adults.

Contrary to type 1 diabetes, those with type 2 still produce some insulin. However, the insulin does not work as well as it should. The cells of the body resist insulin, resulting in high blood glucose. This type occurs most often in adults. Type 2 diabetes is linked with obesity, high blood pressure, high cholesterol and metabolic syndrome rather than an autoimmune cause.

LADA, an autoimmune disorder, is a form of type 1 diabetes. In LADA, the body attacks and destroys insulin-producing beta cells of the pancreas, much as with type 1 diabetes.

At first, some cells still produce insulin, but eventually they are destroyed as the disease progresses.

LADA is diagnosed in people over the age when type 1 diabetes typically starts. It affects adults over age 30, and is often confused with type 2 diabetes. LADA has been referred to as type 1. 5 diabetes. It can be passed down through the genes.

What does LADA look like?

Although both type 2 diabetes and LADA start later in life, the two are quite different. Those with LADA often share certain characteristics. They:

• are diagnosed with diabetes as adults
• at first appear to be a person of healthy weight with type 2 diabetes
• have a slender build with normal body weight, though not always
• do not have a family history of type 2 diabetes
• do have a personal or family history of autoimmune disease
• test positive for antibodies that attack beta cells
• gradually become dependent on insulin
• have minimal insulin resistance.

How common is LADA?

LADA is thought to affect 15 to 20 per cent of all people diagnosed with type 2 diabetes. This suggests that about five to 10 per cent of those with diabetes have LADA, although this number may be significantly higher.

How is LADA diagnosed?

LADA is often initally diagnosed as type 2 diabetes, usually because it occurs later in life. Oral medications may work well to begin with, but their effect can be short lived (months to a few years) or they may not work well at all. Those over the age of 30 with newly diagnosed diabetes, having a slender build and no family history of type 2 might be tested for LADA.

Your doctor may order the following tests to help tell whether you have LADA.

• insulin secretion level measurements (by measuring C-peptide).
• testing for autoantibodies
• glutamic acid decarboxylase antibody test
• insulin antibody test
• islet cell antibody test.

How is LADA treated?

At first, the body still makes some insulin after the onset of LADA. Lifestyle factors, such as eating a healthy, balanced diet, may be enough to manage the disease for a while. Medications that treat insulin resistance are not effective, since insulin resistance is minimal at most. Oral anti-diabetes medications can be effective early on. Sulfonylureas and metformin have proved effective in controlling blood glucose levels as long as some beta cells still produce insulin.

There is some debate over whether insulin should be taken immediately or be delayed until necessary. Since insulin-producing beta cells are continually and gradually destroyed, insulin will eventually be required. Some believe that early insulin use allows the remaining beta cells to survive longer. However, this has yet to be determined. On average, half of those with LADA will require insulin within four years of diagnosis, compared to over 10 years for people with true type 2 diabetes.

A future with LADA

Long term complications of LADA are the same as for people with type 1 and type 2 diabetes, as is the need for blood glucose control. Blood glucose targets are also the same, though targets are often set individually for each person. Special care must be made to avoid hypoglycemia and hyperglycemia, since these can result in very serious complications. Checkups with the doctor and an eye care specialist must be done regularly.

One major benefit is that once people with LADA have their blood glucose under control, they usually do not have the high risk for heart problems found with type 2 diabetes.

Although LADA is becoming better known, your doctor may still be unaware of it. Adults with LADA are often misdiagnosed at first as having type 2 diabetes. They are often put on medications for insulin resistance, which are not effective.

If you are not benefiting from traditional diabetes medications and suspect you have LADA, ask your doctor to test you for it. If it is the type of diabetes affecting you, you can get on the right track with your diabetes management.