LADA – Latent Autoimmune Diabetes of Adulthood or Diabetes Type 1.5 or Late Onset Diabetes of Adulthood
All these names for the same thing? So far, yes!
LADA is diagnosed with a positive GAD (glutamic acid decarboxylase) Antibody test, and progression of the disease can be seen with a c-peptide test, the results of which continue to fall over time. Not enough testing is being done, not only for people who don’t fit a typical Type 2 profile, but for people who do fit, but are really not Type 2.
The average time to needing full replacement insulin is 6 years – but that’s just a number. No publication that I have seen, states any definite numbers for the outer limits – the shortest progression to insulin and the longest what they call “honeymoon”.
While at the time of writing, there’s no official diabetes classification of LADA – it’s just classed as Type 1, LADA and Type 1 are not the same thing.
I believe my progression was way longer than the average 6 years – maybe 15-20 years or maybe more. I’ve seen a reported case of one man who had a honeymoon of 20 years, so I’m not alone.
While it should have been, going to insulin really was no clue for my endo because it had been some 30 years since I was first diagnosed. A Type 2 can progress to insulin (with a background of overproduction of insulin because of resistance progressing to ‘beta-cell burnout’) way before that, so no real alarm flags were raised with him.
I was in the overweight category (BMI between 25-29.9) and believe me, whereas once the weight would fall off me when I uttered the word ‘diet’, by by 50s almost nothing I do other than major calorie restriction and fasting will shift the weight. Of course, taking insulin is weight-promoting, so that doesn’t help!
Apparently you get more insulin resistant as you get older, so even a few pounds overweight and an initial diagnosis of diabetes would look like Type 2.
So everything looked like I was Type 2, having been diagnosed years before. That was their first mistake – assuming. I already had another autoimmune disease (Lupus), and that’s another reason to get tested for LADA – autoimmune diseases often go hand-in-hand or run in families.
There’s a lot of information out there about LADA – not all of it correct. Literature pushes for testing of normal weight Type 2s and although that’s right, limiting the testing to healthy-eating, exercising, normal BMI Type 2s, makes the rest of us miss out!
The LADA testing criteria should be broadened, and the medical community should stop assuming only normal weight Type 2s could have LADA.
There are plenty of overweight and even obese people misdiagnosed with Type 2. In some trials with mass testing of Type 2s, they found that around 20% of Type 2s are misdiagnosed. And although for some, LADA takes on some features of Type 2 and some genetic markers of both Type 1 and Type 2, (which is why LADA is sometimes called Type 1.5 ), it may not for all.
The problem with LADA is the slow onset to when the body produces little to no insulin. In Type 1, can be weeks or days usually with obvious DKA. In LADA it can be years, often making the disease look like Type 2. Type 2s can also have a progressive failure of pancreatic beta-cell function against a background of insulin resistance.
Why is diagnosis important? Because it’s thought that early intervention with insulin may preserve precious beta-cells and therefore the body’s own insulin production. Taking drugs that promote insulin production in your beta-cells is surely counter-productive! There’s only one study I know of that came to this conclusion. Another study concluded it didn’t matter. Which one to believe? I’d rather err on the side of caution until they know for sure.
Beta-cell preservation is important on many levels, not the least of which is that when the body produces its own insulin, it produces other assisting chemicals including c-peptide – it’s so much better for so many reasons.
There’s another, equally important, reason in my opinion – a psychological one.
At one time, I was accused of not following diet and medication advice. I was! They weren’t working for a reason! I’m pretty bold and figuratively stuck my middle finger up at the person who accused me, but how many others slink away, guilt ridden, and have no idea why a dutifully followed regime isn’t working for them? Must always be their fault, right? Wrong!
More importantly, the longer your body is exposed to higher blood glucose, the more possibility for long-term damage. I got to the point where I didn’t care because whatever I was doing, wasn’t working as well as it should have. That’s not a good place to be. It’s like diabetes burnout – something that happens to many for other reasons!
I have to tell you that an enormous weight was lifted from my shoulders once I had the right diagnosis!
At what appears to be an early stage of LADA being known (it was discovered in the 1970s), I’m hearing that many medical people still don’t know what it is!
If you have been diagnosed as Type 2 and have progressed quickly to needing insulin or if the oral medication you take doesn’t work the way it is supposed to, then it’s a good enough reason to push for testing, WHATEVER weight you are.
But you need to be brutally honest with yourself. Is the medication not working because you’re not following a healthy lifestyle – eg lower carbs and exercise? Is it not working because you’re really not following the plan all the time? Have you not educated yourself enough to understand the relationship between what you eat and your blood glucose? Or do you have a genuine reason to suspect you may have LADA and increases in medication isn’t having expected effects?
You still may not have LADA, but if you suspect you do, I encourage you to push for GAD antibody and c-peptide testing (along with testing of other diabetes antibodies, often done at the same time). If your doctor won’t order the test, find one who will, and give them convincing arguments! Do the research and go armed!