Latent Autoimmune Diabetes in Adults (LADA)
Also known as Type 1.5 diabetes,is a sub category form of autoimmune diabetes,which unlike ‘classic’ type 1 diabetes which tends to affect younger people,it tends to develop much slower and can affect adults of any age,due to this factor many people may be mis-diagnosed as having type 2 diabetes initially purely based on the patients age at diagnosis.
Patients with this condition tend to be slimmer on presentation, possibly without the other symptoms of metabolic syndrome although this is not always the case.
Patients with LADA however,may initially have a reasonably low HbA1c and fairly low fasted BG levels and may also appear to respond well to oral medications whilst the phase 2 insulin response is still reasonable enough to level out the huge post meal spikes that tend to occur with this condition and this can delay things in terms of correct diagnosis and treatment.
Possible diagnostic tests that may be carried out
If your physician or Endocrinologist suspects that you may have an autoimmune type of diabetes such as LADA then one or more blood tests may be ordered for analysis,these may include testing for C-Peptide levels which is a by-product of the bodies own naturally produced insulin,a low level may suggest LADA as opposed to type 2 where typically there is insulin resistance and a higher level than normal,another test is for GAD antibodies which if positive would most likely differentiate between type 2 and LADA as these antibodies are one of the many possible antibodies that can attack and destroy the pancreases insulin producing cells.
Is LADA progressive ?
As LADA is an autoimmune condition the general consensus is that BETA cells will continue to be destroyed by the antibodies,however diabetes expert Dr Richard Bernstein believes this is not always the case,to quote Dr Bernstein ” Based upon my experience with a fair number of type 1 diabetics I’ve treated from the time of diagnosis, I’m convinced that the honeymoon period can be prolonged indefinitely. The trick is to assist the pancreas and keep it as quiescent as possible. With the meticulous use of small doses of injected insulin and with the essential use of a very low carb diet, the remaining capacity of the pancreas, I believe, can be preserved.”
With differing opinions on this subject it’s prudent to regularly self monitor your blood glucose at home and at the surgery or clinic via HbA1c blood tests to keep a close eye on any potential deterioration in diabetic control.
What are the treatment options ?
It depends on how early your LADA was diagnosed,some patients who are in the very early stages may gain control through diet or diet and oral meds in the early days or some will go straight onto an insulin regime which may be Basal (background) only or a Basal and Bolus(Rapid acting) multiple daily injection regime or sometimes a mixed insulin may be used,it depends on the patient and their diabetes teams view for what is the best way forward in treatment but there is a school of thought,as previously quoted above from Dr Bernstein that a patient should start insulin therapy straight away.
Mature Onset Diabetes of the Young (MODY)
A snippet from the Wikipedia page states…
“Maturity onset diabetes of the young (MODY) refers to any of several hereditary forms of diabetescaused by mutations in an autosomal dominant gene (sex independent, i.e. inherited from any of the parents) disrupting insulin production. MODY is often referred to as “monogenic diabetes“ to distinguish it from the more common types of diabetes (especially type 1 and type 2), which involve more complex combinations of causes involving multiple genes (i.e., “polygenic”) and environmental factors. MODY 2 and MODY 3 are the most common forms. “Maturity onset diabetes of the young (MODY) is a rare autosomal dominant form of type 2 DM affecting young people with a positive family history.” MODY should not be confused with latent autoimmune diabetes of adults (LADA) — a form of type 1 DM, with slower progression to insulin dependence in later life.”
More from the Wikipedia page here