LADA, the Other Diabetes, Can Be Hard to Spot
I recently saw a 69-year-old woman for diabetes education. She was diagnosed with type 2 diabetes about seven years ago and has been well controlled on oral medications until now. She is lean and exercises regularly. The more we talked, I could see that she has a very high energy level and enjoys being active.
Yet a red flag went up when the woman told me she had lost 10 pounds in the past year without trying. In fact, she said she had lost about 30 pounds since her type 2 diagnosis, even though she has been very careful with her diet. She also has a history of Graves' disease, an autoimmune thyroid disorder. Her current A1C is up to 7.1 percent, after having typically been in the 6 percent range. She is concerned that she can't eat "normally" anymore without her blood glucose going up.
So what's the bottom line with this patient? She was diagnosed with type 2 diabetes in her 60s, and she has lost the ability to control her blood glucose with oral medications and a healthy lifestyle. Because she is lean and continues to lose weight, and has had another autoimmune disease, she needs to be tested for LADA, latent autoimmune diabetes in adults. It's sometimes called type 1.5.
What is LADA? LADA is "a slowly developing kind of type 1 diabetes," according to the National Institute of Diabetes and Digestive and Kidney Diseases. It is a genetically linked hereditary autoimmune disorder that results in the destruction of the insulin-producing beta cells of the pancreas. At diagnosis, people with LADA usually do not require insulin right away because they are still producing some insulin. Because of their older age, they are often misdiagnosed as type 2 and started on oral medications. They may be normal weight or slightly overweight (not typical in type 2). LADA has characteristics of type 1 and may include insulin resistance, like type 2 diabetes. The main difference between LADA and type 2 is the autoimmune response, which is similar to type 1. The loss of beta cells is much more gradual in LADA than in type 1, though. It can take several years before blood glucose control starts to worsen.
How is LADA diagnosed? LADA can be seen at any age. Tests for LADA are the same as for type 1. A blood test is done to see if any antibodies are present, and a measure of C-peptide levels is taken to determine how much insulin is being produced. If levels of GAD and islet cell antibodies are high, along with a low C-peptide level, LADA is diagnosed.
How should LADA be treated? Most experts agree that early treatment with insulin may preserve the functioning beta cells. Although many people with LADA will initially respond to changes in diet and exercise, along with oral medications, these will not halt or slow the progression of beta cell destruction. So, people with LADA will eventually require insulin to maintain blood glucose control.
The label for your diabetes matters less than your seeking and receiving treatment that helps you maintain your best health.