What Is LADA (Latent Autoimmune Diabetes in Adults)?
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LADA: Latent Autoimmune Diabetes in Adults
Latent autoimmune diabetes in adults (LADA) is a relatively new term for a type of diabetes. Although LADA more closely resembles type 1 diabetes, it can often be misdiagnosed as type 2 diabetes by health care providers who don't specialize in diabetes care. Providers have been taught that most people who develop type 1 are typically younger than age 30. "In the past, type 1 was always associated with kids, which is why it was called juvenile diabetes," says endocrinologist James McCallum, M.D., of the Scripps Clinic in La Jolla, California. Many endocrinologists are diabetes specialists.
Today's reality is that many people older than 30 are being diagnosed with type 1 diabetes. Another factor leading to the growing population of adults living with type 1 diabetes as well as LADA is people are living healthier and longer. It's estimated that about 85 percent of people currently living with type 1 diabetes are adults.
"Now we recognize that there is a small but growing subset of adults diagnosed with LADA," McCallum says. Some experts believe LADA is a more slowly progressing type 1 diabetes than the type more typically diagnosed in people under 30 years of age. Unfortunately, many people with LADA are often misdiagnosed and incorrectly treated for type 2 diabetes.
LADA Is a Form of Type 1 Diabetes
LADA is a considered a form of type 1 diabetes because people who have it test positive for the glutamic acid decarboxylase (GAD) autoantibodies in their blood. The autoantibodies serve as markers for immune changes in the beta cells of the pancreas. However, some people with LADA are often not tested for GAD antibodies. Instead, they are commonly misdiagnosed as having type 2 diabetes until it is observed that they their blood glucose is uncontrolled even after trying a number of the medications typically used in early treatment of type 2.
"LADA is on a spectrum of insulin deficiency between type 1 and type 2," says Sally Pinkstaff M.D., Ph.D., FACP, FACE, an endocrinologist at Sinai Hospital in Baltimore. "And people with LADA are a heterogeneous group. This means they can have a range of antibody levels, are lean or carry some excess weight; but their diabetes will likely require insulin to control glucose levels quickly, which is unlike typical type 2."
People with LADA don't fit the typical type 2 profile. "We're clinically suspicious of LADA in individuals who are younger than 50, who are lean, and who often don't have a family history of type 2 diabetes," says endocrinologist James McCallum.
How Many People Have LADA?
The Centers for Disease Control and Prevention (CDC) estimates that 90-95 percent of people with diabetes in the United States have type 2 and that about 5-10 percent have type 1. The CDC doesn't track LADA as a separate category but considers people with LADA a segment within the count of people with type 1. Endocrinologists Sally Pinkstaff and James McCallum estimate the percentage of people with LADA in the whole population of people with diabetes is less than 10 percent.
Reasons Why LADA Resembles Type 1
Similar to type 1 diabetes, LADA is an autoimmune disease, which means the body attacks and slowly destroys the insulin-producing beta cells in the pancreas. But unlike people who are diagnosed in their younger years with type 1 -- who have a relatively rapid and absolute insulin deficiency -- people with LADA more slowly progress to an absolute insulin deficiency and a need to take insulin.
"People with LADA may have some insulin resistance, which is a key problem in type 2 diabetes, but [could] still be making some insulin in their beta cells," says endocrinologist Sally Pinkstaff. This immune process and other features (weight or age) are often what lead health care providers to make a diagnosis of type 2.
Do You Fit the LADA Profile?
Do you wonder whether you might have latent autoimmune diabetes in adults (LADA) and not type 2 diabetes? Here are some signs:
• You're younger than 50.
• You don't have high blood pressure.
• You don't have high triglycerides and low HDL cholesterol.
• You're at a healthy weight.
• You're physically active.
• You have a family history of autoimmune disease (thyroid problems, rheumatoid arthritis, etc.).
• You have no family history of type 2 diabetes.
• You require insulin because other blood glucose-lowering medications aren't working.
Seek Tests with a Diabetes Specialist
If you suspect you have latent autoimmune diabetes in adults (LADA), here are some steps to take:
1. Request a C-peptide test from your diabetes health care provider. This test provides an estimate of how much insulin your pancreas is producing. It measures the C (connecting) peptide (protein) that is present in the insulin made in your pancreas, but is not present in the insulin that people take as a medication.
2. Request a glutamic acid decarboxylase (GAD) antibody test. A positive test means your body has cells that are attacking your immune system.
3. Look for a primary care provider or endocrinologist who specializes in managing diabetes.
4. If you can't find a health care provider knowledgeable about LADA, talk to your provider closely monitoring your blood glucose levels and A1C measures. If you aren't hitting target levels with increasing amounts of blood glucose-lowering medications, then ask your provider about starting insulin. You can take as much insulin as you need to get your glucose levels under control. Achieving target glucose goals is the best
Set Goals for Your Health
The right diagnosis can ease confusion and frustration. "It's better to know what type of diabetes you have from the beginning so you and your health care providers know what to expect over time," endocrinologist Sally Pinkstaff says.
As with all types of diabetes, you've got three goals:
• Control blood glucose.
• Control cholesterol and blood pressure.
• Prevent acute and long-term diabetes complications.
"Whether the person has type 2 or LADA, health care providers should intervene sooner with insulin if it is needed," endocrinologist James McCallum says.
Some People with LADA Can Produce Insulin
Unlike people with type 1 diabetes, people diagnosed with LADA might not need to start taking insulin right away. The period during which a person's blood glucose levels can be controlled without insulin therapy varies.
Some people with LADA can produce enough insulin for up to six years after being diagnosed, while others need to start insulin therapy to control their blood glucose a few months after diagnosis. “I have patients I've followed for many years who are still producing enough insulin, even though I know from testing that they have LADA,” endocrinologist Sally Pinkstaff says.
People with LADA usually need to start taking insulin when they can no longer control their glucose levels, despite their efforts to control them with healthy eating, physical activity, and glucose-lowering medications other than insulin. Spikes in blood glucose levels indicate that the pancreas is no longer making sufficient insulin.
LADA and the Diabetes Community
People with LADA might experience a range of emotions: confusion if they get the wrong diagnosis; frustration and anger when they need to start taking insulin; relief when they learn what they really have; uncertainty about just where they fit in the diabetes community.
Some people are turning to online forums to share emotions, information, and advice about LADA.
"You should always have someone you can relate to -- you don't need to go it alone," says Cherise Shockley. Cherise was diagnosed with LADA at age 23, and according to her blog, she turned to the Internet in search of answers and understanding about her diagnosis. She became involved in an online forum about LADA at tudiabetes.org. Since then she went on to create another voice in the diabetes online community, the Diabetes Social Media Advocacy (DSMA), a very active forum for people with all types of diabetes, not just LADA.
According to the DSMA website, Cherise created DSMA to bring the diabetes community together for a once-a-week chat about all things diabetes, including support, awareness, and education, and to show how powerful peer support and social media can be for people with diabetes, their family members, and other advocates.
Connect with other people with diabetes through DSMA at diabetescaf.org.