An Overview of Latent Autoimmune Diabetes in Adults (LADA)

Latent autoimmune diabetes in adults (LADA) is an autoimmune condition similar to type 1 diabetes that sets in during adulthood, usually after age 30. Also called type 1.5 diabetes, LADA is often initially diagnosed as type 2. It may account for up to 10 percent of cases of diabetes, regardless of type.

Diabetes of any type affects how the body uses energy. Glucose, or sugar, is broken down from the food we eat. Glucose circulates in the bloodstream until a hormone, insulin, carries the glucose out of the bloodstream and into the body's cells. Every cell in the body uses glucose for fuel. Diabetes is marked by too much glucose in the bloodstream and not enough in the cells.

In autoimmune conditions, on the other hand, the body mistakenly views its own cells as foreign and starts to attack them. In the case of type 1 diabetes, the body begins to attack the beta cells of the pancreas, which are responsible for producing insulin. As a result, insulin production shuts down and you must rely on an external source of insulin to remove glucose from the bloodstream, usually in the form of insulin injections.

LADA can strike later in life than typical type 1 diabetes. Symptoms may be quite vague, but usually, mimic those of type 1 and include the following:

• Increased thirst and dry mouth, even with regular fluid intake
• Frequent urination
• Extreme fatigue
• Unexplained weight loss
• Extreme hunger
• Blurry vision
• Tingling nerves

Symptoms may come on rather slowly, throughout the course of several months. However, if left untreated, blood glucose levels may soar too high in the absence of adequate insulin. As a result, the body will start to break down fat for fuel as no glucose can get into the cells—a condition called diabetic ketoacidosis.

The autoimmune origins of LADA are still unknown, although diabetes itself is caused by autoimmune damage caused by antibodies that destroy the pancreas' beta cells. However, researchers have correlated the following factors in most cases of LADA:

• A family history of autoimmune conditions
• A genetic predisposition to type 1 or type 2 diabetes

Thyroid disease is also common comorbidity with LADA, meaning that the two conditions often coexist, though it is not known if one causes the other.

Diagnosing patients with LADA can still be fairly difficult and may take time, which is why it is often initially diagnosed as type 2 diabetes. Type 1.5 diabetes is still not officially recognized by all practitioners. Patients diagnosed with LADA tend to exhibit the following conditions:

• Over the age of 30
• Less likely to be overweight, with a BMI below 25 and a low waist-to-hip ratio
• The presence of antibodies such as glutamic acid decarboxylase 65 (GADA) antibody and/or others
• The presence of a low-to-normal C-peptide count (a substance made along with insulin in the pancreas that can show how much insulin your body makes)

The following lab tests may be useful for diagnosis of LADA:

• Fasting plasma glucose test: a blood test occurring after you've fasted for eight hours
• Oral glucose tolerance test: a blood test occurring after you've fasted for eight hours and two hours after you've consumed a glucose drink
• Random glucose tolerance test: a blood test that looks at glucose levels without fasting
• C-peptide test
• GADA antibody and other LADA-specific antibody testing

Type 1.5 diabetes is usually a lifelong condition. The goal of treatment is to support the body's natural insulin production for as long as possible.

At first, LADA may be best managed by lifestyle changes such as diet and exercise to help control your body's glucose levels, but as your insulin production declines, you may need to take insulin shots. The timeline for insulin support varies with each individual but usually occurs within five years of diagnosis.

Treatment methods also include taking oral diabetes medications to help control blood sugar and using medication to support your current insulin output. Work with an endocrinologist to create a customized plan that works for you.

You may feel isolated, confused, frustrated, and/or in shock or denial about your LADA diagnosis, but know that you're not alone. Seek out a support group in your area or online for others diagnosed with LADA. While there is no current cure, there are numerous advances in insulin therapies and monitoring devices that can fit into your everyday lifestyle and make the disease more manageable.

While it can be overwhelming, a LADA diagnosis is not a death sentence. Surround yourself with supportive care providers, such as an endocrinologist and certified diabetes educator, who can both help create a management plan that works for you. Aim to keep stress to a minimum and practice good self-care. With time, you'll get to know your disease and how to care for yourself.