Understanding LADA: The “Other” Type of Diabetes

Latent Autoimmune Diabetes in Adults (LADA) is often called “type 1.5 diabetes” because it shares characteristics of both type 1 and type 2 diabetes. Despite affecting up to 10% of people diagnosed with diabetes, LADA remains largely misunderstood and frequently misdiagnosed.
What is LADA?
LADA is an autoimmune form of diabetes where the body’s immune system gradually destroys the insulin-producing beta cells in the pancreas. Unlike type 1 diabetes, which develops more rapidly, LADA progresses slowly over months or years, making it challenging to identify early on.

Key Differences from Type 1 and Type 2 Diabetes
While LADA shares features with both major types of diabetes, several characteristics set it apart:

Compared to Type 1 Diabetes:

– LADA develops much more slowly, typically in adulthood (usually after age 30)
– May not need insulin right away, this could last months or years
– Beta cell destruction(death of cells that make insulin) occurs gradually rather than rapidly

Compared to Type 2 Diabetes:

-LADA patients are typically not overweight (but could be)
-They show little or no insulin resistance
-Lifestyle changes and oral medications eventually become ineffective
-Autoantibodies are present, indicating an autoimmune condition

The Diagnosis Challenge
LADA’s gradual onset and mixed characteristics make it particularly difficult to diagnose correctly. Many patients are initially misdiagnosed with type 2 diabetes because they’re adults who don’t immediately need insulin. This misdiagnosis can lead to inappropriate treatment strategies and faster deterioration of beta cell function. If you have been diagnosed with Type 2 diabetes and you suspect LADA, immediately get a prescription from your provider for a Continuous Glucose Monitor (CGM).  Then request more lab tests.

Diagnostic Criteria and Testing
Proper diagnosis of LADA typically involves:
– Testing for autoantibodies, particularly GAD antibodies
– Measuring C-peptide levels to assess natural insulin production
– Considering age of onset (typically over 30)
– Evaluating initial response to oral medications
– Looking at body mass index and lifestyle factors

Healthcare providers should consider LADA when:
-A patient diagnosed with type 2 diabetes fails to respond well to oral medications
-The patient is not overweight or obese and has random high post meal spikes
-There’s a personal or family history of other autoimmune conditions
-Blood sugar control deteriorates rapidly despite adherence to treatment

Treatment Approaches
Managing LADA requires a different approach than either type 1 or type 2 diabetes:

Early Stage:
-Diet and lifestyle modifications
-Possible use of oral medications or GLP1 RA
-Close monitoring of blood sugar levels
-Regular antibody and C-peptide testing

Later Stage:
-Transition to insulin therapy as beta cell function declines
-Combination therapy (pills and insulin) may be necessary
-Individualized treatment plans based on progression rate

Living with LADA presents unique challenges. Patients often struggle with the psychological impact of a changing diagnosis and the need to adjust their treatment approach over time. Support groups and diabetes education programs specifically addressing LADA can be valuable resources. Joining groups that are Type 1 or Type 2 focused at initial diagnosis can leave the person feeling like they “don’t fit in”. People with LADA often deal with distress around diet, because they feel like they can’t eat anything without their blood sugar going really high and their pills are working less and less, even though they are trying harder.  They end up spending so much time and energy on food and restriction, it becomes exhausting.

Prevention and Future Research
While LADA cannot currently be prevented, research continues into:

-Early detection methods
-Understanding genetic factors
-Developing targeted treatments
-Preserving beta cell function

The medical community’s growing awareness of LADA is leading to better diagnostic protocols and treatment strategies. However, more research is needed to fully understand this distinct form of diabetes and develop optimal treatment approaches.

For anyone diagnosed with diabetes in adulthood, especially those who don’t fit the typical type 1 or type 2 profile, discussing the possibility of LADA with healthcare providers can lead to more appropriate treatment and better outcomes. Early recognition and proper management of LADA can help preserve beta cell function longer and improve long-term health outcomes.
Remember, proper diagnosis is crucial for effective treatment. If you suspect you might have LADA, discuss testing options with your healthcare provider, particularly if you’re not responding as expected to current diabetes treatments.

I partner with clients to help them navigate their diagnosis and make sense of diet and lifestyle I also offer a self paced course for people diagnosed with LADA.

Click here to chat with me about how to manage LADA in the most effective way!

Click here to find out the best way to treat LADA.

Lance Bass (former member of NSync) was misdiagnosed as Type 2 diabetes for a few years before discovering he had LADA – read his story here.