Type 1 Diabetes What Is Latent Autoimmune Diabetes in Adults (LADA)? Also known as type 1.5 diabetes By Debra Manzella, RN linkedin Debra Manzella, MS, RN, is a corporate clinical educator at Catholic Health System in New York with extensive experience in diabetes care. Learn about our editorial process Debra Manzella, RN Medically reviewed by Medically reviewed by Lindsey Waldman, MD, RD on November 13, 2019 linkedin Lindsey Waldman, MD, RD, is a board-certified pediatrician and pediatric endocrinologist. Learn about our Medical Review Board Lindsey Waldman, MD, RD Updated on August 18, 2020 Print Table of Contents View All Symptoms of LADA Causes Diagnosis Treatment Latent autoimmune diabetes in adults (LADA) is an irreversible autoimmune disease that affects insulin function. Although similar to type 1 diabetes, which typically is diagnosed during childhood, LADA develops in adulthood, usually after age 30. For this reason, and because the symptoms are similar, LADA sometimes is first misdiagnosed as type 2 diabetes. In fact, LADA may account for up to 10% of diabetes cases of all types. BSIP / UIG / Universal Images Group / Getty Images Although early on LADA may be manageable with lifestyle changes such as diet and exercise, the condition eventually requires insulin therapy and/or diabetes medication. A Controversial Classification Some experts regard LADA as a subtype of type 1 diabetes (it sometimes is called type 1.5 diabetes) while others don't see it as a separate condition. And yet other researchers see LADA as part of the diabetes continuum, ranging from type 1 to type 2. Symptoms of LADA When it first appears, latent autoimmune diabetes in adults often is misdiagnosed as type 2 diabetes. This is because the symptoms align closely with those of type 2 diabetes and tend to come on slowly over the course of several months. Whereas type 1 diabetes develops rapidly, the progression of LADA is much slower, and may appear to be a slowly progressing form of type 1. (When type 1 diabetes afflicts a child, it tends to come on suddenly and dramatically.) LADA also may bring on sudden weight loss, which is not typically associated with type 2 diabetes, and so for practitioners familiar with the disease, this may be a strong indicator of latent autoimmune diabetes. Otherwise, the symptoms of LADA and type 2 diabetes are similar: Increased thirst (even with adequate fluids)Xerostomia (dry mouth)Frequent urinationExtreme fatigueExtreme hungerBlurry visionNerve tingling Symptom Comparison of Diabetes Types 1, 2, and 1.5 diabetes Symptom Type 1 Diabetes Type 2 Diabetes Type 1.5 Diabetes (LADA) Increased thirst X X X Frequent urination X X X Unexplained weight loss X X Blurry vision X X X Nerve tingling X X Extreme hunger X X X Fatigue/weakness X X X Dark skin patches X One thing to note about LADA is that unlike type 2 diabetes, it is not associated with excess body weight or obesity. Most people with LADA are unlikely to be overweight and have a body mass index (BMI) below 25 and a low waist-to-hip ratio. Complications Without proper diagnosis and prompt treatment, LADA can result in a dangerous complication called diabetic ketoacidosis in which the body starts to break down fat for fuel because no glucose can get into cells. This occurs when the function of beta cells in the pancreas, which are responsible for the production of insulin, begins to decline. Ketoacidosis can require immediate insulin injection. Other complications of LADA are the same as those of all type of diabetes, including: Diabetic retinopathyDiabetic neuropathyDiabetic nephropathyCardiovascular complications, such as stroke and acute coronary events Understanding the Complications of Type 1 Diabetes Causes Like type 1 diabetes, LADA is an autoimmune disease in which the body views beta cells as foreign and attacks them, resulting in a shutdown of insulin production. That said, people with LADA also may develop insulin resistance—the cause of type 2 diabetes. What may cause someone to develop autoimmune diabetes later in life is not fully understood, but researchers have been able to pinpoint certain risk factors for LADA: A family history of autoimmune conditionsA genetic predisposition to type 1 or type 2 diabetes Thyroid disease is a common comorbidity with LADA, meaning that the two conditions often coexist, though it is not known if one causes the other. How Comorbid Conditions Can Affect Your Diabetes Care Diagnosis Diagnosing LADA can be tricky. Not all practitioners recognize it as a distinct type of diabetes and may mistake it for type 2 diabetes—at least initially. Once the disease is suspected, bloodwork may be done to test for certain factors associated with LADA: Fasting plasma glucose test: A blood test to measure levels of glucose in the blood after a period of not eatingOral glucose tolerance test: A blood test to measure glucose levels after an eight-hour fast followed by consumption of special sugary beverageRandom glucose tolerance test: A blood test that looks at glucose levels without fastingHemoglobin A1C test: A blood test that looks at the percentage of glucose attached to hemoglobin (a primary component of red blood cells), which indicates blood glucose control over the past two to three months, and may be used to monitor and assess treatment, such as oral diabetes medications. A review study found that some patients with LADA had worse blood sugar control and higher A1C levels than patients with type 2 diabetes.C-peptide test: A measurement of C-peptides, substances made along with insulin in the pancreas that can show how much insulin your body makes. Low-to-normal C-peptides are associated with LADA.Antibody testing: Tests to determine the presence of antibodies, such as autoantibodies to glutamic acid decarboxylase 65 (GAD), islet cell autoantibodies (ICA), tyrosine phosphatase-related islet antigen 2 (IA-2), and insulin autoantibodies (IAA), the presence of at least one of these antibodies may signify an underlying autoimmune process taking place. Antibody testing may be a key way to identify LADA and distinguish it from type 2 diabetes. The Immunology of Diabetes Society recommends specific criteria to help standardize the diagnosis of LADA:Age is greater than 30 yearsPositive for at least one of the four possible antibodiesNo treatment with insulin in the first six months post-diagnosis Treatment Like type 1 diabetes, LADA is an irreversible condition that requires treatment for the remainder of a person's lifespan after they are diagnosed. Some people with the disease may be able to control their blood sugar early on by making lifestyle changes similar to those necessary for managing type 2 diabetes. These include following a carbohydrate-conscious diet and increasing physical activity. Treatment also may include oral diabetes medications to help control blood sugar and to support insulin output. However, oral medications and lifestyle changes likely won't be enough to preserve insulin function and control blood sugar levels in the long term. After that point, insulin support will be needed—typically within five years of diagnosis. Specific oral medications that may be helpful in treating LADA include: Dipeptidyl peptidase-4 inhibitors, such as Januvia (sitagliptin)Glucagon-like peptide 1 receptor agonists (Ozempic, Trulicity, Byetta, and others)Thiazolidinediones Metformin, a biguanide, which is typically used as a first-line treatment in type 2 diabetes, should be used with caution in LADA, as there is a potential risk for a condition called lactic acidosis, a dangerous buildup of lactic acid in the body that may be fatal. Sulfonylureas, another class of anti-diabetes drugs, should be avoided, as they may exhaust beta cells (the cells in the pancreas responsible for producing insulin) and further deplete insulin levels. How Type 1 Diabetes Is Treated A Word From Verywell A diagnosis of LADA can be unexpected to say the least, given autoimmune type diabetes typically is associated with children. But even though you will need to manage your condition for the rest of your life, be reassured that once you've incorporated lifestyle changes and/or insulin therapy into your daily routine, they will become as second nature as brushing your teeth. If you find yourself worried about or struggling with living with LADA, ask your endocrinologist or a certified diabetes educator about how you might get additional support—for example, through a local or online support group. With time, you'll get to know your disease and how to care for yourself. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hals IK. Treatment of latent autoimmune diabetes in adults: What is best?. Current diabetes reviews. 2019 Jun 1;15(3):188-93. doi:10.2174/1573399814666180716144429 Poudel RR. Latent autoimmune diabetes of adults: From oral hypoglycemic agents to early insulin. Indian J Endocrinol Metab. 2012;16 Suppl 1:S41-6. doi:10.4103/2230-8210.94257 Laugesen E, Østergaard JA, Leslie RD. Latent autoimmune diabetes of the adult: Current knowledge and uncertainty. Diabet Med. 2015;32(7):843-52. doi:10.1111/dme.12700 Unger J. Latent autoimmune diabetes in adults. Am Fam Physician. 2010 Apr 1;81(7):843-847. Pozzilli P, Pieralice S. Latent autoimmune diabetes in adults: Current status and new horizons. Endocrinol Metab (Seoul). 2018;33(2):147‐159. doi:10.3803/EnM.2018.33.2.147 O’Neal KS, Johnson JL, Panak RL. Recognizing and appropriately treating latent autoimmune diabetes in adults. Diabetes Spectrum. 2016 Nov 1;29(4):249-52. doi:10.2337/ds15-0047 Laugesen E, Ostergaard JA, Leslie RDG, et al. Latent autoimmune diabetes of the adult: current knowledge and uncertainty. Diabet Med 2015;32:843–852 doi:10.1111/dme.12700 O’Neal KS, Johnson JL, Panak RL. Recognizing and appropriately treating latent autoimmune diabetes in adults. Diabetes Spectrum. 2016 Nov 1;29(4):249-52. doi:10.2337/ds15-0047 Poudel RR. Latent autoimmune diabetes of adults: From oral hypoglycemic agents to early insulin. Indian J Endocrinol Metab. 2012;16 Suppl 1(Suppl1):S41-S46. doi:10.4103/2230-8210.94257