What is LADA? (Latent Autoimmune Diabetes in Adults)


 

Latent autoimmune diabetes in adults (LADA) is a type of diabetes that is often misdiagnosed as type 2 diabetes. Also referred to as “type 1.5”, it’s actually a form of type 1 diabetes that develops very gradually.

Let’s take a closer look at this lesser known type of diabetes.

Read personal stories about LADA here:

What is LADA?

As a form of type 1 diabetes, LADA is the result of your immune system attacking the beta cells in your pancreas that produce insulin. The only difference is that this attack is slower which means your insulin production declines at a more slower rate compared to type 1—but a much faster rate compared to type 2.

LADA develops most commonly in people over 30 years old—which is also why it’s often misdiagnosed, because many healthcare providers still believe type 1 diabetes only develops during childhood.

On the other hand, when misdiagnosed as type 2 diabetes, it can eventually leave you feeling frustrated for years while taking non-insulin medications. (Although research has found that certain diabetes medications can help preserve insulin production in people with LADA.)

Medications and lifestyle changes used to treat type 2 diabetes can be effective for a handful of years in managing LADA—whether or not it’s been diagnosed properly. But as your insulin production declines, these treatment options will not work, leaving you with stubborn high blood sugars.

At this point, insulin becomes just as important to your daily health and management as it is for a person with traditional type 1 diabetes.

Fighting for the correct diagnosis can be frustrating, scary, and exhausting as you struggle with higher blood sugars.

As a person with LADA who hasn’t been properly diagnosed, you may be overwhelmed by feelings of failure, because you’re doing everything you can to manage your blood sugars but nothing seems to be working.

Signs & Symptoms of LADA

The signs and symptoms of LADA include symptoms similar to both type 1 and type 2 diabetes. While LADA is a form of type 1 diabetes, the earliest symptoms are different:

  • Brain fog, difficulty concentrating
  • Dry, itchy skin
  • Tired and lethargic, often after eating
  • Constant feelings of hunger, even after eating

The higher blood sugars rise while your insulin production declines, the more you’ll develop the classic symptoms of type 1 diabetes:

  • Feeling constantly thirsty
  • Needing to urinate frequently
  • Changes in your vision
  • Tingling in your hands, feet, legs
  • Feeling tired and exhausted
  • Unexpected weight-loss
  • Recurring yeast infections (women)

Getting Diagnosed Properly with LADA

Don’t be surprised if it takes a great deal of coercing your healthcare team to get further testing and a proper diagnosis. Many people with LADA report having to fire their existing healthcare team altogether in order to get a proper diagnosis from a new provider.

With the right testing—and the right healthcare team—getting a LADA diagnosis isn’t actually that difficult.

Research has determined several clear factors to make a LADA diagnosis:

  • The patient is over 30 years old.
  • The patient tests positive for at least one out of four types of diabetes-related autoantibodies.
  • The patient does not need insulin for at least six months after their initial diagnosis (assuming you’re diagnosed properly within the first year of elevated blood sugar levels).
  • The potential presence of other autoimmune diseases, including Grave’s disease, celiac, or Hashimoto’s.

Other factors that can help determine a LADA diagnosis but do not rule out the potential of type 2 diabetes, include:

  • The patient is not overweight or obese.
  • The patient does not have metabolic syndrome conditions including high blood pressure and high cholesterol.
  • The patient does not have a family history of type 2 diabetes. (Although, beware, your family members with type 2 could potentially be LADA and never diagnosed properly.)

Types of Testing to Diagnose LADA

There are a variety of blood tests that can rule out type 2 diabetes and confirm a LADA diagnosis. But the two tests that offer the clearest and most immediate diagnosis of LADA are:

  • Glutamic acid decarboxylase (GAD)
  • Islet cell antibodies (ICAs)

GAD and ICA testing is looking for autoantibodies—which are the result of your immune system attacking the cells in your pancreas that produce insulin. A person with type 2 diabetes would not test positive for these autoantibodies. (You can also order an at-home autoantibody test-kit from the JDRF for $55.)

While autoantibody testing should be adequate for a LADA diagnosis, other testing can include:

  • Hemoglobin A1c test (HbA1c)
  • Fasting plasma glucose test (FPB)
  • Oral glucose tolerance test (OGTT)
  • Random plasma glucose test (RPG)
  • Ketone test (performed through blood or urine)

While this list can feel overwhelming, the first two tests should lead your healthcare team to a clear diagnosis very quickly.

Treating LADA

As your insulin production declines, you’ll eventually manage your LADA just as a person manages traditional type 1 diabetes: with daily insulin therapy, blood sugar monitoring, and being thoughtful about choices around food, especially carbohydrates.

This also includes managing and preventing the complications of type 1 diabetes—which are often (but not always) the result of chronically high blood sugar levels.

Research has found that most LADA patients will need daily insulin via injections or a pump within 6 years of being diagnosed (including the date of an incorrect type 2 diagnosis). Within about 12 years, most LADA patients will produce as little insulin as a person with traditional type 1 diabetes.

Again, this means that the day-to-day management of LADA becomes identical to managing type 1 diabetes as your body depends on the 24/7 presence of insulin to survive and maintain healthy blood sugar levels.

The bottomline…

It’s overwhelming! In some ways, a LADA diagnosis is even more frustrating and overwhelming than a traditional type 1 diabetes diagnosis because you might’ve had to battle for the right diagnosis and then watch your insulin production decline over the course of about 12 years.

But the same tools, knowledge, and resources that help people manage and thrive with type 1 diabetes can help you as a person with LADA, too.

A few pages to get you started…

WRITTEN BY Ginger Vieira, POSTED 02/01/22, UPDATED 06/04/22

Ginger Vieira is the Senior Content Manager at Beyond Type 1. She is also an author and writer living with type 1 diabetes, Celiac disease, fibromyalgia, and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1, Ginger spent the last 15 years writing for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong, and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.